Exercise is Medicine for your Diabetes

If you have type 2 diabetes, regular physical activity is essential for controlling your blood glucose and managing your weight. Exercise also improves how well your body responds to insulin, which may reduce the need for medication because your muscle and fat will do a better job of taking glucose out of the blood.

Furthermore, exercise may help protect you against heart disease, which often accompanies type 2
diabetes, by reducing body fat, blood pressure and improving your cholesterol levels. It will help you better understand your diet and exercise if you closely monitor your blood glucose levels to  understand how you respond to different types of activities.

If the benefits of exercise could be put into a pill would you take it?

If so why would you take it? Most likely because you know that pill is extremely helpful.  It would make your muscles stronger, including your heart muscle thus decreasing risk of death from heart disease. It would lower your bad cholesterol, triglycerides, blood pressure and blood sugar, and increase the good cholesterol. It would improve your memory. It would slow osteoporosis. It would make you less likely to have falls. It would improve your mood and lessen symptoms of depression.

Exercise is Medicine!

Exercise does all this and more, however it is extremely difficult to get people to follow exercise advice or adhere to an exercise program? Why? Because taking a pill is so much easier, and maybe because the cost of medicine is covered by insurance. So many take such care to take medications, vitamins, eat healthier, but still find it difficult to adhere to medical advice to exercise. It could be do to the information out there seems conflicting, or too complicated.

Exercise the Diabetes Drug

You take your diabetes medications every day correct? Most people also have concerns about the side effects and the cost of their medication. Yet exercise is one of the best medications out their with minimal side effects. Just like most diabetes drugs it has to be taken regularly to get the benefits, and there is a specific dosage.

Frequency of use: 6-7 days per week.

• This regulates the body, you need  a certain amount of energy to do this from your body and its energy sources (food and insulin). The more regular you exercise the less wild blood sugar swings.

Intensity:

•  To a level that feels fairly light to somewhat hard, but not hard. Bring your heart rate up above your resting heart rate, break a light sweat, breath a little harder – yet be able to carry on a conversation

Time or Duration:

• 30 minutes or more per day. It can be broken up or done all at once.

Type:

• Aerobic – meaning continuous movement that requires oxygen – walking, biking, hiking, spinning, swimming, rowing, elliptical, recumbent equipment, steppers, tia chi, yoga, karate, pilates, belly dancing, dance classes, circuit training, cross country skiing, snow shoeing, kayaking, rollerblading, ice skating….you get the idea.
• Resistance training – it doesn’t have to be heavy body building weight training, but working with your body as resistance, dumbbells, resistive bands, weight machines, free weights all help to maintain and build muscle. Try doing some sort of resistive training 2-3 days per week.

Side effects:

While there are many benefits to exercise for people with diabetes, it should be noted that there are several potential risks as well, including a worsening of eye complications in people with conditions such as proliferative retinopathy when doing specific exercises (such as weight lifting- with heavy weights that create a large amount of strain), hypoglycemia (low blood glucose), and hyperglycemia (high blood glucose).

Building the Routine

Most people take there medications at a certain time every day, brush their teeth at a certain time, go to appointments because they are scheduled at a certain time. Exercise needs to be scheduled and worked into the daily routine. What works for you? First thing in the morning? Most studies show people who exercise first thing in the morning are more likely to stick with the routine for the long haul. Can you develop a routine –  a walk after dinner, hitting the gym on the drive home from work, fifteen minutes at lunch and fifteen after work? Keeping a log helps, and be accountable to someone with the log, make sure you bring it to your doctors appointments and discuss.

Can you stick with if for the long-term?

It takes six months of exercise to establish a habit.

In medicine we talk about the stages of change

. 

Where are you in the stages of change when it comes to exercise?

http://exerciseismedicine.org/documents/EIMPSA_03.pdf   

The Diabetes and Heart Relationship

How does diabetes increase my risk for heart problems?

Both type 1 and 2 diabetes accelerate the progression of artherosclerosis – hardening of the arteries.  Having type 1 diabetes increases the risk for heart disease 10 fold. Heart attacks account for 60% of deaths in patients with diabetes while strokes account for 25% of deaths. Nearly all patients with type 2 diabetes have developed resistance to their own insulin, their pancreases churns out insulin which is a critical hormone in an effort to move glucose into cells, but it is more than the cells can utilize. High levels of insulin in the blood causes damage to the lining of blood vessels that leads to atherosclerosis. Hardening  of the arteries occurs and  sets the stage for plaques  to build.   Evidence shows that patients with diabetes have an increased level of low-grade inflammation of their arterial lining, a process that initiates the blood vessel changes leading to heart disease. Some of the increased susceptibility to blood vessel damage that people with diabetes have  is due to the long-term effects of inadequate control of blood glucose levels on the tissues or as a result of other cell damage related to diabetes.  A chemical reaction between glucose and proteins  exists in the body  to produce compounds called advanced glycosylation endproducts, or AGEs.  Diabetes increases the amount of glucose in your blood that’s available to be glycosylated, people with the disease tend to have high concentrations of AGEs. These compounds  damage arteries, making them more likely to create blockages, in addition to increasing the risk for a long list of other common diabetes complications.

Know your numbers

In the last 10 years, large-scale research studies around the world have shown that optimal control of LDL cholesterol (the “bad” cholesterol) and blood pressure can prevent adverse cardiovascular outcomes by 30% to 50%. The American Diabetes Association and the American Heart Association recommend an LDL cholesterol goal in all adults with diabetes at less than 100 mg/dl. In people who already have heart disease, a more desirable LDL cholesterol goal should be less than 70 mg/dl, based on evidence from more recent studies.

At least half of patients with diabetes have hypertension – high blood pressure. Chronically elevated blood pressure forces your heart to work too hard, which may cause it to weaken over time. High blood pressure also increases wear and tear on the arteries. The blood pressure goal in all patients with diabetes is less than 130/80. In most patients with diabetes, reaching these targets for blood pressure could require two or more medications. With diabetes, high blood pressure  usually develops if the kidneys become damaged. Kidney disease (nephropathy) is a very serious complication of diabetes. With this condition, the tiny filters in the kidney (called glomeruli) become damaged and leak protein into the urine. Over time this can lead to kidney failure. Urine tests showing microalbuminuria (small amounts of protein in the urine) are important markers for kidney damage. Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD), occurs in about 20 – 40% of patients with diabetes.

Hemoglobin A1C tests— measure of average blood glucose levels over the preceding two to three months—the goal is less than 7%. Intensive control of blood glucose and keeping glycosylated hemoglobin (HbA1c) levels below 7% can help to prevent complications due to vascular (blood vessel) abnormalities and nerve damage (neuropathy) that can cause major damage to organs, including the eyes, kidneys, and heart.

A healthy eating plan, exercise and medications are the cornerstones of managing diabetes.

Blood sugar regulation through monitoring the diet and exercise  and the relationship to blood sugars levels is what diabetics need to understand to decrease the risk of heart disease. Exercise should be viewed as a medication with the goal of getting the proper dose every day to get the sustained benefits. The more regular one is with exercise the better one can control their blood sugars. Exercise requires close monitoring of blood sugars. They should be measured before, occasionally during and after exercise.

When not to exercise

If your fasting blood glucose is more than 300 mg/dl, no matter what type of diabetes you have, it is in poor control. It may be best to bring your blood glucose level back down or to check with your health care provider before exercising. If you decide to exercise, use caution. Make sure you are negative for ketones and re-check your blood glucose to make sure it is dropping in 10-15 minutes. Drink plenty of water, this can’t be emphasized enough the water helps to “wash out” the ketones from the blood stream.

If you have type 1 diabetes and your blood glucose results are 250 mg/dl before exercise, stop and check for ketones. If you have moderate or large amounts of ketones, do not exercise. Ketones are a sign that your insulin level is too low. Exercise could cause the body to make more ketones.  Ketones add acid to the blood. When too many ketones are produced, they disrupt your body’s chemical balance. This can be  very dangerous. Wait until your tests show negative or trace ketone levels before beginning to exercise.

If your blood sugar is lower than 100 before exercising it is considered too low to safely exercise. Exercise uses the circulating blood sugars to provide sustainable energy for the muscles to function. When the blood sugar drops too low this can be extremely dangerous.  The recommendation is to eat a snack containing carbohydrates and protein 30 minutes before the exercise to sustain prevent the blood glucose levels from crashing. If the exercise is prolonged greater than 30 minutes or symptoms develop such as profuse sweating, shakiness, vision changes, nausea, angina it is best to  stop and check the glucose levels again. Some will require a small amount of carbohydrates during the exercise to sustain the blood sugars above 100. If blood sugars repeatedly drop with exercise a medication adjustment may be required and this should be discussed with your healthcare provider. This is a common issue especially as one becomes more fit. Again many pre-diabetics or type 2 diabetics are able to reduce or stop medication through exercise and diet.

Resources

• www.diabetes.org — American Diabetes Association
• www.niddk.nih.gov — National Institute of Diabetes and Digestive and Kidney Diseases
• http://www.nhlbi.nih.gov— National Heart Lung and Blood Institute
• www.jdrf.org — Juvenile Diabetes Research Foundation
• www.nei.nih.gov — National Eye Institute
• www.eatright.org — American Dietetic Association
• www.kidney.org — National Kidney Foundation
• www.diabetestrialnet.org — Type 1 Diabetes International Clinical Trial Net
• www.medicalert.org — Bracelets or neck chain emblems with personal medical information
• www.childrenwithdiabetes.com — Children with diabetes online community

What are my chances of getting Heart Disease?

The Multiplier Effect

• 1 risk factor doubles your risk
• 2 risk factors quadruple your risk
• 3 or more risk factors can increase your risk more than tenfold

By doing just 4 things – eating right, being physically active, not smoking, and keeping a healthy weight – you can lower your risk of heart disease by as much as 82 percent

Heart of Diabetes

 Exercising daily and eating a well balanced diet with the proper portion sizes are the best prevention for diabetes.

The relationship between diabetes and heart disease is striking. Many do not even know they have diabetes or are pre-diabetic. If you are overweight, or have a family history of diabetes it is important to work with your health care practitioner to watch your blood sugars control.  Many clients I have worked with through the years were able to get their pre-diabetic blood sugar values back to normal through diet and exercise. Many diabetics can reduce the medications for blood sugar control as well if they are able to adhere to the lifestyle choices of exercise and following a diabetic diet of good food choices and portion control.

Those that have diabetes need to be extra cautious to keep there blood sugars in the tightest control possible, as when the blood sugars are chronically elevated this sets the stage for dramatic increases in the prevalence of heart disease. Overeating sets the stage for insulin resistance. An analogy to help understand this is  filling a gas tank, you can only put so much gas in before it spills out. When we consume more calories than the body can use the body secretes more insulin and it circulates in the blood stream. The cells get adapted to the increased insulin this is called insulin resistance. This allows higher concentrations of blood sugar to circulate in the body. The higher blood sugars assault  the body, the eyes, heart, kidneys, nerves, arteries  throughout especially those to the legs and kidneys, setting the stage for not only heart problems but peripheral vascular problems, the most common reason for amputations. Exercise is critically important and should be adhered as it gets rid of the high concentrations of sugar circulating in the blood stream, and prevents them from doing more damage.

It becomes even more challenging too, as the most common symptom of heart problems – chest discomfort is less likely to be experienced by the diabetic patient, as the nerves that send the pain  signal to the brain do not relay the message. Thus symptoms are more likely to be shortness of breath, flu like symptoms, extreme fatigue, weakness in the diabetic patient. The hemoglobic A1c value is especially important to understand. The values are listed below.

Holiday Sweets

http://nomoreaddedsugar.com/2011/12/why-is-santa-fat-infographic/

The average American consumes 50 pounds of cookies a year and a lot of these will be consumed over the holidays.

How much added sugar is in a cookie? That all depends on the cookie of course but one little Oreo is 7 grams of added sugar. A homemade cookie can contain twice that.

So when you are craving cookies, how about clementines, grapes, pomegranate,  chestnuts, almonds dusted in chocolate powder, a cup of cinnamon tea, flavored coffee. If you do indulge try to keep in mind serving sizes. Follow it up with a walk or using some weights.

Reducing the risk for a second heart attack

Many patients come through their heart procedures and feel they are cured. Unfortunately for most, heart disease is a chronic progressive disorder of the arteries in which deposits of cholesterol, calcium, and abnormal cells (that is, plaques) build up on the inner lining of the arteries.  Heart disease usually progressively deteriorates over time, whether due to normal bodily wear or lifestyle choices such as exercise or eating habits. This is a hard concept to grasp, and it doesn’t mean it is a death sentence either.

You can do everything right and still have further heart issues.

When patients struggle with this, I point out doing everything right may be why they survived, as approximately 50% of people do not survive their first heart attack.   It is so important for each person to know their body’s signs and symptoms and not ignore them. We don’t really know what makes coronary artery disease aggressive, there seems to be several factors. These factors include inflammation, c- reactive proteins, genetics, lifestyle to name a few.

Some patients will have multiple issues for years requiring frequent interventions and then be fine for many years before having another issue. On average coronary artery bypass  grafts  10 years out will be 50% blocked. Some patients will go 20-30 years before needing another intervention, yet others may not even go a week or month before having symptoms. Thirty percent of open heart surgery patients will continue to have angina symptoms after surgery. The drug eluding stents have  much lower rates of re-stenosis than the bare metal stents which average 25-30% re-stenosis rates, but in both cases the vessels often continue to develop blockages in other locations in the artery. If the bare metal stents are going to re-stenos the usually do so in the first 3-6 months.  It is vital to stay on the platelet inhibitors – Plavix (clopidogrel) as prescribed to prevent complications. Frequently second heart attack occur when patients stop taking their platelet inhibitor medication.

 

Try to adhere to lifestyle changes that will reduce your long-term risk after another heart attack. These  are known  risk factor reduction measures and they include achieving and maintaining an optimal weight, beginning a heart-friendly diet, ending tobacco use, achieving excellent control of diabetes and high blood pressure, and adhering to regular exercise. Lifestyle changes are much more challenging to start and adhere to.  If it were only as easy taking a pill. Keep your risk factors in the best control possible. Try to get blood pressure, blood sugar, cholesterol numbers to national guidelines. Exercise regularly. Eat a rainbow of color in fresh fruits and vegetables each day. Don’t let stress effect your health, manage your stress as best as possible, consider counseling.  

Listen to your body are symptoms creeping up on you?

Be on the lookout for new symptoms, for changes in energy patterns, note if you are becoming less active due to fatigue. I believe many can stave off a second heart attack if they are very tuned in to their bodies signals. Keep a diary or log of your symptoms, look or patterns especially increasing fatigue, increasing shortness of breath, increased use of nitroglycerin,  episodes of sudden weakness or profuse sweating. If you note a pattern don’t wait, contact your healthcare practitioner to discuss. They key is to prevent any further loss of heart tissue by preventing another heart attack. If you think you may be having another heart attack follow the emergency steps listed below:

• Call 911 and describe what symptoms you’re feeling and where you are located.

• Chew an aspirin (325 mg) at the first sign of an attack. Aspirin makes blood platelets less likely to stick to each other, assisting blood flow and reducing clots. Chewing the aspirin gets it into your blood stream much faster than if you drink it down with water.