"If exercise were a pill, it would be the most beneficial and prescribed medication in the world."
-- Robert N Butler, MD
No matter the type of diabetes -- pre-diabetes, gestational diabetes, type 1 diabetes or type 2 diabetes -- exercise is routinely recommended to support good health. While exercise is associated with improving cardiovascular risk factors, weight loss efforts, and physical and mental well-being, it is exercise’s impact on blood glucose control that frequently motivates many would be sedentary persons with diabetes to get up and move.
Insulin sensitivity is your body’s ability to pull glucose out of the blood stream and put it into your cells so that glucose can be used for energy or fuel for the cell. While glucose is not a bad thing, too much glucose is not a good thing. Controlling blood glucose is associated with healthy outcomes. Including exercise in your daily routine will decrease blood glucose and support keeping glucose in a healthy target range. While you may feel overwhelmed and would rather find an excuse than a gym, no excuses. Just move!
Exercise increases insulin sensitivity not only during the actual physical activity but also in the time following that activity called exercise recovery. Exercise recovery could be a few minutes or several hours in length. The effect of exercise on insulin sensitivity may vary from the following:
- Frequency of physical activity: Exercise induced insulin sensitivity diminishes after the activity. This fact alone supports exercising on a regular basis.
- Intensity and duration of physical activity: Intensity, how challenging the activity is to the individual, and duration, the time exercising, may be the greatest influencer of insulin sensitivity during and post exercise. A long duration activity performed at a low or easy intensity can be substituted for a short duration activity performed at a higher or more challenging intensity to achieve similar metabolic results and insulin sensitivity outcomes. An example of this might be the activity of working in the garden two to four hours compared to a thirty to sixty-minute walk. While duration and intensity are very different, the outcomes could be very similar. No excuses. Move!
- Type of physical activity: There are multiple options for being active:
- Aerobic exercise supports increased endurance and includes continuous movement of large muscle groups. Aerobic activity increases heart rate and makes you breath faster.
- Weights / resistance exercises cause muscle contraction against an external force. The external force could be as simple as lifting one’s arms and/or legs, leg squats, and/or pushing and pulling against a weight or resistance bands.
- Flexibility and Balance exercises, while slow and deliberate, support good range of motion and injury prevention.
The big questions are: How much? How often? What can you expect? To answer these questions I recommend adding a few short notes to your blood glucose logbook. Include what you did (activity), how long you did it (+, ++, or +++), and how did you feel while you did it – this is an indication of how difficult you found the activity (😟, 😐, 😊). Your logbook may look a little like this:
7:00 am Glucose mg/dL
12:00 pm Glucose mg/dL
6:00 pm Glucose mg/dL
9:00 am Gardening +++ (a lot -- 4-5 hours) 😐 (challenged but okay)
*Check BG before bed
There is considerable individual variability to physical activity and insulin sensitivity. By writing notes in your logbook, you will begin to see patterns emerge. A certain type of activity may not effect blood glucose. Another activity tends to lower glucose for hours. The best way to prepare for your response to exercise is to keep simple notes and look for repeated patterns. You will also find that glucose monitoring will have greater value as you can see the difference different activities have on your blood glucose. Take the logbook with you to the doctor and share your discoveries. There’s absolutely no size fits all here. Additionally, the support of a credentialed diabetes care and education specialist is beneficial while learning the meaning to the patterns you experience.
If you find yourself sitting in front of a computer monitor most of the day, dedicated time for physical activity may not seem doable. Remember: no excuses. Everyone can do something. Try standing up and stretching every ten to fifteen minutes (add a reminder to your cell phone or set an alarm); when you walk anywhere, walk tall with shoulders pulled slightly back; don’t take the elevator for a single floor, take the stairs; instead of walking to the closest restroom, go to a more distant location; and anytime you park the automobile, park away from the entrance and get a little more activity while coming and going. Bottom line: if you can’t focus on being more active then focus on being less inactive. It means, whenever you have a chance to move and stretch your body in the course of your day then move. In short, it's any and all physical movement, that promotes health and insulin sensitivity.
Remember to move multiple times a day everyday even if only for a few minutes each time (little things do add up!). Movement is exercise and when you exercise, your body increases its ability to pull glucose into your cells and use that glucose for energy. This investment in insulin sensitivity lowers glucose not only while you’re exercising but it’s also an investment into the time afterward. If you’re exercising every day, insulin needs will decrease and you’ll find it easier to keep blood sugars in your target range.
No excuses. Commit to avoiding long periods of inactivity every day. You’ll feel better at the end of the day!