Dietary Goals and Exercise

[For detailed information, including diabetic exchange lists and carbohydrate counting, see In-Depth Report #42: Diabetes diet.]

Healthy Weight Control

Weight gain is a potential side effect of intense diabetic control with insulin. Being overweight can increase the risk for health problems. On the other hand, studies suggest that more than one-third of women with diabetes omit or underuse insulin in order to lose weight. Eating disorders have become a serious problem within the general population and are especially dangerous in patients with diabetes. Some evidence suggests that they contribute to about 20% of cases of recurrent ketoacidosis in young women. Ketoacidosis is significant complication of insulin depletion and can be life-threatening.

Exercise

Aerobic exercise has significant and particular benefits for people with type 1 diabetes. It increases sensitivity to insulin, lowers blood pressure, improves cholesterol levels, and decreases body fat. Because glucose levels swing dramatically during workouts, people with type 1 diabetes need to take certain precautions:

• Monitor glucose levels carefully before, during, and after workouts.
• Avoid exercise if glucose levels are above 300 mg/dL or under 100 mg/dL.
• To avoid hypoglycemia, inject insulin in sites away from the muscles they use the most during exercise.
• Before exercising, avoid alcohol and if possible certain drugs, including beta-blockers, which increase the risk of hypoglycemia.
• Insulin-dependent athletes may need to decrease insulin doses or take in more carbohydrates, especially in the form of pre-exercise snacks. Skim milk is particularly helpful. They should also drink plenty of fluids.
• Good, protective footwear is essential to help avoid injuries and wounds to the feet.

Resistance or high impact exercises should be avoided. They can strain weakened blood vessels in the eyes of patients with retinopathy. High-impact exercise may also injure blood vessels in the feet. Because patients with diabetes may have silent heart disease, they should always check with their doctors before undertaking vigorous exercise.

A 2006 study of over 19,000 children with type 1 diabetes found that regular physical activity helps improve blood sugar levels without increasing the risk of severe hypoglycemia. The researchers suggest that doctors recommend regular exercise for pediatric patients with type 1 diabetes.