How should diabetic patients control blood sugar through exercise?

Author: Zhan Hong, Chief Physician of the First Affiliated Hospital of Sun Yat-sen University

Reviewer: Guo Shubin, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

As one of the most common metabolic diseases, the occurrence and development of diabetes are closely related to genetic factors, environmental factors and behavioral factors. At present, the globally recognized methods for treating diabetes include diet control, exercise therapy, drug therapy, blood sugar monitoring and diabetes education. But in fact, most diabetic patients place more hope on drugs and diet therapy in disease management, and often ignore an important therapy - exercise therapy. Today, let's talk about how diabetic patients can get moving in addition to diet control and drug therapy.

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1. Exercise has many benefits for people with diabetes

First, exercise can increase the body's sensitivity to insulin and reduce insulin resistance; improve glucose metabolism and lower blood sugar, especially postprandial blood sugar; restore blood vessel elasticity and promote blood circulation. Second, exercise can effectively improve the fat and protein metabolism of patients with type 2 diabetes. Regular exercise can significantly reduce body weight, total fat content, and visceral fat, reduce body weight, reduce fat accumulation, and increase fat consumption, thereby improving blood sugar control. Related studies have found that regular exercise for more than 8 weeks can reduce the glycated hemoglobin (HbA1c) level of patients with type 2 diabetes by 0.66%; regular exercise for 12 to 14 years can significantly reduce the mortality rate of diabetic patients. At the same time, exercise therapy also has significant benefits in terms of complications of type 2 diabetes. According to statistics, walking for 2 hours a week can reduce the all-cause mortality of diabetic patients by 39% [1].

2. How should diabetic patients exercise in their daily lives?

So, how should diabetic patients exercise in their daily lives?

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First of all, the patient should be assessed for any contraindications to exercise. The exercise plan should be based on each person's health level and usual exercise habits, following the principle of from less to more, from light to heavy, from sparse to frequent, and in a periodic manner.

In terms of aerobic exercise, diabetic patients can choose walking, cycling, swimming and jogging, etc., and insist on at least 30 minutes of moderate-intensity exercise at least 5 days a week or about 20 minutes of vigorous exercise at least 3 days. In terms of strength training, diabetic patients mainly exercise the strength of the upper and lower limbs. It is recommended to exercise for 20 to 60 minutes each time, with a rest of 2 to 3 minutes between each set of movements. It can be done non-consecutively for 3 days a week. Each time you exercise, the intensity is divided into low and moderate. Low: 2 to 3 sets of movements, 15 repetitions per set; moderate: 2 to 3 sets, 8 to 12 repetitions per set. At the beginning, warm-up exercises at a lower level are mainly used to achieve a feeling of exhaustion, but it must be based on the premise that you can continue to complete the next few sets of exercises.

In terms of flexibility training, diabetic patients should mainly stretch the main muscle groups of the limbs and trunk. It is recommended to do it 2 to 3 days a week, or at the end of each other training. Note that each stretching movement should be limited to not feeling pain or strong discomfort. Tai Chi, yoga, etc. are recommended.

3. Precautions for exercise for patients with diabetes

Diabetic patients should develop a practical exercise plan based on their own conditions and stick to it. It should be noted that the exercise method should be varied every day. For organized and regular activities, the duration and intensity of exercise should be appropriately increased, but overwork injuries and excessive fatigue should be prevented. At the same time, diabetic patients should ensure the proper use of medication, adequate sleep and a healthy diet.

In addition, diabetic patients should pay attention to increasing food intake appropriately after exercise to avoid hypoglycemia.

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There are many taboos for diabetic patients in exercise, as follows.

First, for adults with symptoms of cardiovascular disease, longer duration of diabetes, older age, or diabetes-related complications, it is recommended to complete a medical examination and exercise test before starting an exercise program.

Secondly, avoid exercising when blood sugar is >250 mg/dl (i.e. 13.9 mmol/L) and/or urine ketone levels are moderate or high.

Again, diabetic patients should drink plenty of water before, during and after exercise, and avoid exercising during the hottest times of the day or under direct sunlight to avoid heatstroke.

Finally, diabetic patients who use insulin or sulfonylurea drugs, or who have taken glinides 2 to 3 hours before exercise, must carry carbohydrates that can quickly raise blood sugar to help correct possible hypoglycemia, and may even need to carry glucagon [1]. During exercise, if diabetic patients feel obviously tired and have difficulty recovering, they should immediately reduce the intensity of exercise or stop exercising.

In short, diabetic patients should develop healthy living habits, increase daily physical activity, reduce sitting time, incorporate beneficial exercise into daily life, and persevere in order to truly benefit.

References

[1] Chinese Diabetes Society. Guidelines for the prevention and treatment of type 2 diabetes in China (2020 edition)[J]. Chinese Journal of Diabetes, 2021, 13(4): 315-409.