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Diabetes Medications & Exercise
Tuesday, September 11, 2007
Diabetes is a common, chronic medical condition. It is estimated that 7% of Americans have diabetes. There are two common forms of this condition: type 1 and type 2. In type 1 diabetes, insulin is not produced properly. Insulin is a hormone normally found in the body that regulates blood sugar level. It is produced by the pancreas. Type 1 diabetes is often diagnosed in childhood, but it can also manifest itself later in life. This form of diabetes accounts for approximately 5 to 10% of cases of diabetes. The more prevalent form of diabetes is type 2 diabetes. In this condition, which used to be referred to as “adult-onset diabetes”, the body is resistant to the action of insulin. Insulin is produced, but it is not able to exert its normal modulating effects. There is a strong correlation between type 2 diabetes and obesity. Approximately 90% of individuals who have type 2 diabetes are either overweight or obese. The increasing prevalence of obesity in the US population has also been accompanied by an increasing in number of cases of diabetes. Statistical trends suggest that the number of Americans with diabetes is expected to increase to more than 30 million by the year 2030.
Common to both type 1 and type 2 diabetes is elevation of blood sugar levels. The mainstay of treatment for type 1 diabetes is insulin therapy. The purpose of giving this medication is to supply the hormone that persons with this condition cannot produce naturally. There are different ways to administer insulin, but it is often injected.
Many of the medications given for type 2 diabetes are taken by mouth. Currently, there are six broad classes of oral drugs used to treat type 2 diabetes. These medications are designed to assist the body in moderating blood sugar levels. Some of the drugs, such as a class called sulfonylureas, promote insulin secretion from the pancreas. Another class of drugs called thiazolidinediones increase sensitivity of tissues to the action of insulin, especially the skeletal muscles. Biguanides are another group of medications used for management of diabetes. These drugs decrease output of glucose from the liver and make the liver and muscle more sensitive to the action of insulin. Other drugs are available that work in the small intestine to slow digestion of carbohydrates; stimulate insulin release; and decrease the effect of glucagon, a hormone that raises blood sugar levels. Many individuals with type 2 diabetes eventually require the use of insulin.
A program of regular physical activity has been shown to be helpful for individuals with either type 1 or type 2 diabetes. For those taking insulin, a few things should be kept in mind. Moderate intensity physical activity has an “insulin-like” effect, in that it tends to lower blood sugar. Insulin dose may need to be adjusted before engaging in exercise. Self-monitoring of blood glucose levels is crucial. Blood sugar should be taken before exercise. Speak with your health care provider to get clearance before participating in an exercise program. Once you have begun a regimen of physical activity, take the time to keep a diary of your blood sugar levels and observe how they are affected by exercise. Chart in the diary such things as: the time of day that you administer medications, when you exercise, how long you exercise, and what type of activities you do, as well as when and what you last ate. Make notes about how you felt during and after the exercise session. Importantly, keep track of your blood sugar levels after exercise. It is useful to exercise around the same day each day. Many individuals find that if they exercise within two hours of administration of a rapidly acting insulin medication, they will need to lower their insulin dosage. In general, it’s best not to administer insulin within an hour of starting aerobic exercise.
Inject insulin into an area that you are not planning on exercising. The abdominal region is often a good site.
Vigorous physical activity can produce elevation - rather than a drop - of the blood sugar level. This is because of release of hormones in the body, such as epinephrine and cortisol, which raise blood glucose. Type 1 diabetics competing in athletic events or exercising strenuously may need to adjust their insulin dosage and the timing of their meals accordingly, in anticipation of a rise of blood sugar levels. Speak with your doctor before making any changes to your medication dosages.
Fundamental to proper management of type 2 diabetes are proper diet and regular exercise. Some studies have shown that proper diet, routine exercise, and lifestyle modifications are more effective than drug therapy used alone in managing mild forms of type 2 diabetes. Physical activity performed on a consistent basis increases the body’s sensitivity to the action of insulin. A program of physical activity also aids in weight loss. Often a 5 to 10% reduction in body weight results in better glucose control and a reduced need for diabetes medications. Studies have shown that even exercising without weight reduction has resulted in improvement in blood sugar levels. An additional benefit of exercise is that it can improve circulation, often impaired in those with diabetes.
Current exercise guidelines from the American College of Sports Medicine are similar for type 2 diabetics as for those of the general adult population. Those with type 2 diabetes are encouraged to engage in moderate intensity physical activity 3 to 7 days a week, for at least 150 minutes per week. It is also helpful for those with type 2 diabetes to engage in a strength (resistance) training program at least three days a week, to complement the benefits of an aerobic exercise program. Strength training increases muscle tone, improves bone health, and aids in maintenance of a healthy bodyweight.
Some oral medications taken by those who have type 2 diabetes are more likely to cause a drop in blood sugar (hypoglycemia) in those who exercise than other medications. Your health care provider can help discuss the side effects of medications you may be taking and make adjustments to your medication if you are planning to participate in an exercise program or if you have been noticing low blood sugar levels when you have been working out.
Avoid exercising if your blood sugar level is greater than 250 mg/dl. If your blood sugar level is less than 100, have some carbohydrates and postpone exercise.For more on diabetes and exercise, please visit the following links: