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Chapter 9
Exercise for Those with Diabetes
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Diagnosis of diabetes
• Fasting plasma glucose test
– Measures blood glucose after 8-hour fast
– Meaning of values
• ≤99 mg/dL is normal
• 100–125 mg/dL suggests prediabetes
• ≥126 mg/dL indicates diabetes
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Diagnosis of diabetes (cont'd)
• Oral glucose tolerance test
– Measures blood glucose after 8-hour fast
– Give patient a liquid with 75 g of glucose
– Measure blood glucose 2 hours after intake
– Meaning of values
• ≤139 mg/dL is normal
• 140–199 mg/dL suggests prediabetes
• ≥200 mg/dL indicates diabetes
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Diagnosis of diabetes (cont'd)
• Random plasma glucose test
– Measures blood glucose without requiring a fast
– A reading of ≥200 mg/dL suggests diabetes if the
patient also complains of frequent urination,
excessive thirst, and unexplained weight loss
– Follow with FPG or OGT test to confirm
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Anatomic and physiologic changes
associated with diabetes
• Role of the pancreas
– Exocrine role
• Produces digestive enzymes for digestion
• 99% of its cells devoted to this role
– Endocrine role
• Releases hormones involved with blood glucose
homeostasis
• 1% of its cells devoted to this role
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Anatomic and physiologic changes
associated with diabetes (cont'd)
• Endocrine tissue of the pancreas
– 4 types of cells produce 4 different hormones
– Most important cells are the alpha and beta cells
• Beta cells produce insulin
• Alpha cells produce glucagon
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Anatomic and physiologic changes
associated with diabetes (cont'd)
• Insulin
– Facilitates the movement of glucose into cells when
blood levels are high
– Binds to receptors on target cells to open glucose
gates
– Promotes glycogenesis with low energy demands
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Effects of insulin on muscle, liver, and fat
cells
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Anatomic and physiologic changes
associated with diabetes (cont'd)
• Glucagon
– Stimulates
• Glycogenolysis
• Gluconeogenesis
• Lipolysis
• Amino acid uptake
• Ketone body formation
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Negative feedback loop for insulin and
glucagon
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Hyperglycemia
• Occurs when blood glucose levels remain elevated
• Symptoms include
– Sweating
– Trembling
– Rapid heart rate
– Hunger
– Frequent urination
– Increased thirst
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Major types of diabetes
• Type 1 diabetes mellitus
– Autoimmune disorder in which immune cells attack
beta cells in pancreas
– Results in inability to produce insulin
– Causes elevated blood glucose levels
– Symptoms include hunger, severe systemic
weakness, and weight loss
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Major types of diabetes (cont’d)
• Type 2 diabetes mellitus
– More common than type 1
– Pancreas continues to produce insulin, but insulin
receptors on target cells are unresponsive
– Blood glucose levels remain elevated, which
promotes increased insulin production and release
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Risk factors for diabetes
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Diabetes-related complications
• High blood pressure
• Heart disease
• Stroke
• Liver damage
• Retinopathy
• Neuropathy
• Nephropathy
• Poor circulation
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Precautions during exercise
• Increased risk for cardiovascular disease
• Increased risk of hypoglycemia
• Increased risk of dehydration
• Increased risks associated with high-intensity resistance
training
• Increased risk of injury to the extremities
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Benefits of exercise
• Improved insulin sensitivity and glucose tolerance
• Reduced risk for cardiovascular disease and improved
work capacity
• Reduced need for medication
• Improved mood and well-being
• Better weight management
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Exercise testing
• Diabetics should receive medical clearance owing to their
increased risk for cardiovascular, renal, neurologic, and
visual problems
• If at low risk of a cardiac event, diabetics may begin a
low-to-moderate exercise program without testing
• If at high risk, obtain a medically supervised graded
exercise test
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Exercise guidelines
• Begin with 5–10 minutes of limbering movements
followed by 5–10 minutes of stretching; end with a 5- to
10-minute cool down
• Cardiovascular training
– Perform for 20–60 minutes on 3–7 days per week at
a moderate intensity of 50–80% VO2R (RPE of 12–
16)
– Encourage low-impact activities like walking, floor
aerobics, water aerobics, or the elliptical trainer
– If neuropathy of the feet is present, encourage
nonimpact activities like swimming or cycling
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Exercise guidelines (cont'd)
• Resistance training
– Safe in the absence of retinopathy, recent laser
treatment, or any other contraindications
– Perform on 2–3 days per week at an intensity of 60–
80% of 1 RM
– Complete 2–3 sets, each consisting of 8–12
repetitions for 8–10 multijoint exercises
– Rest at least 48 hours in between workouts
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Other special considerations
• Hypoglycemia can occur during and after exercise
• Hyperglycemia can occur in type 1 diabetics with poor
blood glucose control
• Those with neuropathy of legs and feet might have gait
or balance problems; avoid quick changes
• Participate in activity at the same time each day
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Other special considerations (cont'd)
• Check blood glucose levels before exercising
– If <100 mg/dL, consume small amount of
carbohydrates
– If 100–250 mg/dL, begin exercise
– If >250 mg/dL, be careful; test for urine ketones and
avoid exercise if ketone level is high
• Have a source of carbohydrates available
• Do not inject insulin into exercising limbs
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Other special considerations (cont'd)
• Consume water before, during, and after exercise
• Always exercise with a partner
• Use perceived exertion to monitor intensity
• Wear well-fitting, breathable shoes
• Wear a medical ID bracelet
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Tips for the diabetic exerciser
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When diabetics should avoid exercise
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Sample exercises
• Upper body
– Chest press
– Lateral pull-down
– Seated row
– Shoulder press
– Biceps curl
– Triceps dip
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Sample exercises (cont’d)
• Lower body
– Leg press
– Squats
– Lunges
– Leg extension
– Leg curl
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Nutritional considerations
• Carbohydrates
– Consume at least 130 grams/day
– Include about 14 grams of fiber per 1000 kcal
– Strive to consume a similar amount each day, at the
same time each day, and evenly spaced out each day
– Select high-fiber foods, whole grains, and vegetables
– Carefully plan insulin injections to avoid
hyperglycemia or hypoglycemia
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Nutritional considerations (cont'd)
• Protein
– Should constitute about 15–20% of a diabetic’s total
energy intake (75–100 grams on a 2000-kcal diet)
– If suffering from kidney disease, limit protein intake
even more
– Choose lean meats, chicken, and plant-based
proteins like soy
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Nutritional considerations (cont'd)
• Fat
– Limit total daily fat intake to 20–35% of total kcal
– Limit saturated fat intake to <7% of total daily kcal
– Limit dietary cholesterol intake to 200 mg/day
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Nutritional considerations (cont'd)
• Alcohol
– Moderate alcohol consumption is safe
– Consume with foods if taking insulin
– Be aware that many drinks like wine coolers and
mixed drinks contain juices that are high in
carbohydrates
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Nutritional considerations (cont'd)
• Vitamins and minerals
– Needs match those of the general population (see
Appendix B)
– If at high risk for cardiovascular disease, limit
sodium intake to <2000 g/day
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Nutritional considerations (cont'd)
• Water
– Recommendations resemble those for the general
population
• 2–3 eight-ounce glasses 2 hours before exercise
• 1–2 cups 10–15 minutes before exercise
• 1–1½ cups during exercise
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