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Managing Diabetes with Exercise

Two years ago, when Jennifer Auyer's father died at age 64 from complications related to type 2 diabetes, she faced a turning point in her struggle with the disease.

Her father's diabetes had led to heart disease, a quadruple bypass, a foot amputation, and vision problems, among other serious health troubles. "It was a really painful experience, for him and all of us," says Auyer, 40, of Nashua, N.H.

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Four years ago, she, too, was diagnosed with type 2 diabetes, shortly after giving birth to her child, Grace. "If I were to pass away in 20 years, where would my daughter be?" she asks.

Deciding to "Do Differently" with Type 2

When Auyer was growing up, she never saw her father, a heavy man, exercise. She had become overweight, too. In addition to caring for Grace, she commutes to Boston to work as director of sales for a hotel company. But she eventually decided her busy life could no longer be an excuse to keep from getting into shape.

"I said, 'I don't want to go through what he went through.' I was following the same path, and what am I going to do differently? I wanted to find something to help me. I was desperate."

When she found out about a weight loss and exercise class at Joslin Diabetes Center in Boston, she signed up fast. In the course, Jacqueline Shahar, MEd, a clinical exercise physiologist at Joslin, taught her to do the best exercises for people with type 2 diabetes.

Strength and Interval Training for Diabetes

For example, Auyer is now a believer in resistance training and works out with elastic bands to improve muscle strength. This form of strength training helps patients use glucose more efficiently, Shahar says. "If we can get them to do some resistance training, they're going to be able to increase their muscle mass so they're actually burning more glucose."

Other payoffs come, too. "They increase their metabolism and they lose weight," Shahar says. Resistance training also helps people with diabetes improve their cardiovascular health, lower blood pressure, and reduce abdominal fat. It benefits posture and helps strengthen muscles to prevent injuries.

In another big step, Auyer began interval training, which involves repeatedly mixing bouts of high-intensity aerobic activity with less intense work -- the segments are called "intervals." For example, you can pedal fast on a bike for 30 seconds, and then go at a slower speed for 90 seconds. Altering the speed and intensity of the workout challenges the muscles, helping burn more calories, boost fitness, and improve insulin sensitivity, according to Shahar. "That's my favorite," Auyer says of interval training. "It keeps everything fast-paced and fresh."

At home, long stretches of treadmill walking bored her. But now, she'll walk on the treadmill for 10 minutes, then run for another few minutes. "Then I'll jump off and do the resistance bands for a few minutes, then squats or side steps, then maybe I'll jump back on the treadmill for 10 minutes," Auyer says. "The next thing you know, an hour has gone by, and I feel so invigorated

Exercise and Blood Glucose Levels

Shahar advises Auyer and other diabetes patients to exercise at least three or four times a week. Blood glucose levels can keep dropping up to 48 hours after exercising, she says. "I always use this analogy in people with diabetes: Their muscles are kind of sleeping, so they're not burning glucose or calories. But if they exercise, they keep their muscles awake all the time. They keep burning calories, they lose weight, they make the glucose work more efficiently in their body."

Auyer is delighted with her improved blood glucose levels. "Almost immediately, I noticed a change in my morning blood sugars, which are always really high," she says. But after she started exercising, "they were dropping from an average of about 140 to 110. I was so excited one day -- I had one under 100."

She exercises in class once a week to make sure she's doing it right, then repeats the routines at home. She aims to lose weight gradually -- she has about 80 pounds to go -- and hopes to eventually run a 5-kilometer race. 

Grace is already following by example, playing with the resistance bands when her mom exercises in her playroom. "Kind of funny -- she's 4 years old and she wants to exercise, too. Honestly, growing up, I didn't have that," Auyer says. "One of my goals, besides making myself healthy, is to instill that in my daughter so that she doesn't have to go through what I'm going through.

"I'm setting her up for potentially having diabetes as well because of the history in my family," Auyer says. "Hopefully, that won't be her curse, but if we can cut it now -- get her to see that this is what Mommy does, we exercise -- then it's not so foreign."

Like every working mom, Auyer sometimes gets off her exercise routine for a few days. But she gets back on track by reminding herself why she started. "For me, that reason was my father. This is what he would want and this is important," she says. "That's the motivation to keep going."

Starting an Exercise Program

Ready to get fit? Shahar offers these tips for getting started.

·         Talk with your doctor. People with heart problems might need a stress test, while those with hypertension should make sure their blood pressure is stable. If you have retinal problems, ask your eye doctor if you should avoid certain exercises that increase pressure on the retina, Shahar says. If you have orthopedic problems, such as knee pain, back problems, or foot issues, an exercise physiologist can teach you appropriate exercises, including using a stationary recumbent bike.

·         Check your blood sugar before and after exercise. "No. 1: It's a motivation tool. When you exercise and see your blood glucose improve, you'll probably do more because it's going in the right direction," Shahar says. In time, your doctor might be able to reduce your insulin or oral diabetes medication. But you should also be checking to make sure your blood sugar isn't too high or too low.

·         Keep snacks on hand for low blood sugar. Be prepared. Bring fast-acting snacks to the gym or along on your outdoor workout in case your blood sugar drops too low while you're exercising.

·         Wear a diabetes ID. Wear a bracelet or necklace or carry something that identifies you as having diabetes. List an emergency contact, and indicate whether you take insulin.

·         Wear comfortable shoes. Good shoes will help you avoid foot problems, which can be more serious when you have diabetes

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