Living a healthy and active life can help in controlling diabetes and helps in preventing its complications.
Type 2 Diabetes mellitus can lead to various complications like retinopathy, nephropathy, macrovascular complications like stroke and myocardial infarction. Goals in diabetes treatment are achieving appropriate glycemic control with normal blood pressure. These goals can be achieved with physical activity, maintaining an appropriate weight.
An active lifestyle does not mean running or vigorous exercise but it means we should not have a sedentary lifestyle we should be mobile most of the day doing routine activities. These activities can be a normal walk, gardening etc. maintaining optimum weight is also important. We should set realistic goals and then we should try to achieve those goals.
For this continuous motivation is required. If you have never done exercise before it is important to start slowly. Physical activity increases insulin sensitivity and helps in controlling sugars. But close watch should be kept for hypoglycemia. Don’t skip meals; don’t do strenuous and long exercise because these can cause hypoglycemia (low sugar level). If someone has already developed complications of diabetes mild to moderate amount of activity is recommended. While doing exercise take extra precaution to avoid injury to feet. In case there is dizziness immediately stop exercise. Always keep an immediate source of carbohydrate with you. You should wear bracelet indicating that you have diabetes so that in an emergency it will be helpful. Always talk to your doctor.
Trials have proved that 150 minutes walk per week and diet-induced weight loss to prevent progression of impaired glucose tolerance to overt diabetes mellitus. American diabetic association recommends that person who is having a sedentary lifestyle they should not be sedentary for more than 30minutes. Every 30 minutes they should do walking for few minutes, can do stretching of legs, arms overhead stretching can be done. These movements should be in addition to the routine exercise.
There are two types of physical activities which are recommended one is moderate aerobic exercise and resistance exercise. Combination of both is more effective. But prolonged activity should be avoided. Individuals with type 2 diabetes mellitus who are doing physical activity under supervision have been found to have a better glycemic control.
Exercise also has psychological benefits in persons with type 2 diabetes mellitus. Physical activity can prevent gestational diabetes also. The dose of insulin and oral diabetic medications has to be reduced before exercise. Persons who are having diabetes and its complications physical activity advice are different. Patients who are diabetic and have cardiovascular disease physical activity should be started under close cardiac supervision. Patients with diabetes and peripheral vascular disease can do physical activity like other diabetic patients without complications. Patients with diabetes and peripheral neuropathy can also do a moderate amount of physical activity. But foot care should be done carefully in these patients to prevent ulcers. Patients with diabetic autonomic neuropathy should be advised physical activity after stress testing.
Patients with diabetic retinopathy should avoid aerobic exercise because this can increase the risk of haemorrhage in proliferative retinopathy. Efforts to promote physical activity should focus on developing self-efficacy and fostering social support from family, friends, and healthcare providers.
By Dr. Ashish Kumar Arora, Consultant Internal Medicine and Critical Care Medicine