Exercise can be a daunting challenge for many people, add diabetes into the mix, and you have a host of other things to worry about such as blood sugar levels before, during and after exercise, as well as other considerations such as mobility limitations.
dLife exclusively speaks with Christel Oerum, a Los Angeles, Calif. based personal trainer with a specialization in Fitness and Diabetes, to learn how to overcome some of the challenges to achieve your personal fitness goals.
Of course, the level of intensity will vary depending on your age, fitness level, and personal situation, so consult your doctor before starting any new exercise program.
1. How does exercise differ for patients with T1D vs. T2D?
Oerum says anyone living with Type 1 diabetes or Type 2 diabetes can benefit from engaging in both cardiovascular exercise and resistance training on a weekly basis.
“The main difference in what type of training is optimal comes down to what the immediate goal of the training is and whether you manage your diabetes with insulin or not,” she explains.
Oerum says if the immediate goal is to lower your blood sugar here and now, the optimal type of training is any form of steady-state cardio such as a brisk walk, biking, swimming or jogging.
She says if the goal is to improve your insulin sensitivity, meaning how efficient your body is at utilizing the insulin you either produce or inject, then resistance training is the way to go.
“If insulin is used for blood sugar management, it’s important to pay attention to your blood sugar levels and take the proper precautions in order to not experience dangerously high or low blood sugar as a result of exercise,” she advises.
As for how your diabetes is managed, the most important thing is to understand how exercise impacts the medication taken, if at all.
Insulin is, for example, significantly impacted by exercise and if not managed correctly, exercise can quickly result in low or high blood sugars.
2. How would you approach exercise for each of these groups?
When it comes to exercise, Oerum says it’s more important to look at age, fitness level, mobility, injuries, and how your diabetes is managed rather than whether you live with Type 1 or Type 2.
A good exercise plan, according to Oerum, should always be tailored to the individual in order to reduce the risk of injuries and to make it fun and enjoyable.
Let’s take a deeper look at some of the considerations for someone with diabetes:
For the beginner: If you are new to exercising, a good starting point could be walking on a treadmill or in a pool a few times a week. Then add in bodyweight resistance movement until enough strength is built to start a more structured exercise regime.
For injured or one with limitations: Oerum says when it comes to injuries or mobility limitations, it’s important to know that some sort of movement is always possible. “Often, I’d recommend that if you have injuries or severe mobility limitations, work with a physical therapist, and if that’s not an option, start very slow and be careful to listen to your body.”
For the weekend warrior: If you’re already active one maybe twice a week and would like to up your training volume, Oerum recommends you implement a structured resistance training and cardio combination.
“If you plan on exercising 4-5 times a week you could benefit from focusing on different body parts during different workout sessions,” she says. “A good split could be the upper and lower body so that you train each respectively twice a week,” she says.
The fifth day could be focused on cardio or stretching based strength training such as yoga or Pilates.
3. What’s the best way to exercise safely with diabetes to prevent highs or lows?
Watching out for highs and lows is only really an issue for people living with insulin-dependent diabetes.
Oerum says what’s important to understand is something she calls, “Finding Your Formula for Exercise and Diabetes.” This involves understanding the following:
How different types of exercise generally impact blood sugars.
How much you as an individual react to different types of exercise.
She explains that aerobic exercise (steady state cardio such as walking, swimming, jogging, biking, etc.) will generally make blood sugars drop, assuming there is insulin present in the system.
Anaerobic exercise (such as sprints, resistance training, boot camps, etc.), on the other hand, can make blood sugars increase during exercise only to come crashing down after (again assuming insulin is present in the system).
“This knowledge means that it becomes easier to predict how your blood sugar might react to exercise and create a proactive plan,” explains the fitness expert.
“There are basically only two ways to reduce the risk of high or low blood sugars when exercising, and that’s by either adjusting your insulin or your carbohydrate intake,” she says.
Oerum also recommends keeping a journal to find how much your blood sugars fluctuate during different types of exercise, time of day and amount of active insulin on board (IOB).
4. When is the best time of day to exercise?
The best time to exercise for you is when you feel the best and get it done. “If you’re not a morning person, planning 5 a.m. jogs probably isn’t the optimal choice,” Oerum says.
If you manage your diabetes with insulin and struggle with low blood sugars during cardio, Oerum says one option (aside from adjusting your insulin and carbohydrate intake) could be to exercise early and to fast.
“In the mornings, most people are somewhat insulin resistant and this is generally the time of day where we have the least IOB, meaning less risk of low blood sugar,” Oerum explains.
5. Is exercising more than one time a day a good idea?
As long as you get enough rest and eat accordingly, there is nothing wrong with exercising multiple times a day according to Oerum.
A good combination could be doing cardio in the morning and resistance training in the afternoon or evening.
Another important tip is to make sure to spread out your training so that you don’t work-out the same muscle group twice per day or even two days in a row. “Your muscles heal and get stronger when you rest,” Oerum says.
6. What is the biggest misconception regarding exercise and diabetes?
The biggest misconception, for those managing their diabetes with insulin, according to Oerum, is that the only way to get through more than 10 minutes of cardiovascular exercise is to consume large amounts carbohydrates.
“The truth is that although carbohydrates will help prevent hypoglycemia, so will adjusting the amount of insulin taken within 4 hours of exercise,” the fitness expert explains.
“How much your insulin needs to be adjusted will depend on your body and fitness level, so the key is to work on your insulin titration (through structured trial and error) until you hit your sweet spot,” she says.
7. What’s your advice to those who can’t get into any sort of exercise regime?
Oreum says it’s important to find something you enjoy doing, and you’ll be more likely to stick with it.
“I always recommend thinking back on what you enjoyed as a child, did you love dance parties, jump-rope, biking, basketball, roller skating?”
She says to try to remember what you enjoyed and start there. As you fall in love with being active again, you’re also more likely to venture out and try something new.
8. Should someone with diabetes consider a health coach?
Oerum says a health coach is not required for someone living with diabetes to exercise successfully.
However, there might be times and situations where it’s helpful to have a coach that can give support outside of what you get at the endocrinologist’s office.
“For many, finding their ‘formula for exercise and diabetes’ can be challenging and having a coach to help guide you can make the journey less frustrating,” she says, “others need a helping hand in staying accountable or to just get started.”
I’d recommend you always have that conversation with a potential coach to see if you’re a fit and if that coach will be a good resource for you.
Christel Oerum is the founder of DiabetesStrong.com.
She is a Los Angeles based speaker, writer, diabetes coach, and diabetes advocate. Christel has been living with Type 1 diabetes since 1997 and at an early stage decided that it wasn’t going to slow her down.
Her motto is “There is Nothing You Can’t do With Diabetes.” She also coaches people with diabetes from across the globe, online and in person, and supports them in meeting their health and fitness goals.