Diabetes. A world of possibilities coverThis is the first part of chapter 5 of my book “DIABETES. A world of possibilities”, which I’m publishing here for free. You can access all the chapters published until now here.

If you have read other books, or online articles, on how to treat diabetes, you have probably seen that in most of them, if not all, exercise or sport plays a major role. In fact, exercise is one of the three pillars recommended to manage diabetes; the other two being diet and insulin or medication, accordingly. Although traditional allopathic medicine generally considers the drugs as the main pillar, most naturopathic medicine puts more weight on diet and exercise.

Some of you might think now: “oh no, more of the same!” Yes, more of the same. If exercise is something recommended in virtually all types of diabetes treatments, from allopathic to naturists, vegan diets, low-carb diets, Paleo diets, etc. and in different cultures (Ayurvedic medicine, Chinese medicine, traditional western medicine), it is because it really is very important.

Also, I got comments on my website from people saying that it had opened their eyes to the importance of exercise. Oddly, either some doctors do not express it clearly to their patients, or those patients did not pay enough attention when the doctor told them about it. The fact is that some people still do not know about the importance of exercise to treat and control their diabetes, and they need to know it.

Also, if you are at risk for diabetes (by inheritance or otherwise), you should know that increasing physical activity can delay or prevent the onset of pre-diabetes, or even prevent type 2 diabetes. (2)

Now, if what you understand of exercise is pain, suffering, and running marathons, do not worry—it’s not that. In fact, many experts usually recommend aerobic exercises, where you don’t feel pain during the activity (I will explain the difference between aerobic and anaerobic later).

Depending on whether you have type 1 or type 2 diabetes, glycemic control during and after exercise can be different. Type 1s must be much more careful not to have hypoglycemia during or after exercise.

First of all, let’s see…

…how exercise helps in diabetes:

  • Improves blood pressure, and controls blood sugar, triglycerides, and insulin sensitivity.
  • Helps you lose weight.
  • Reduces “bad” cholesterol and raises “good” cholesterol.
  • Helps eliminate increased acids resulting from the metabolism of sugar, which would otherwise develop serious problems for different tissues.
  • Reduces cardiovascular risk factors (important because people with diabetes have a much higher risk of heart problems and even heart attacks).
  • Improves mood and reduces stress and depression.
  • Provides the body with strength and flexibility.
  • In many cases of type 2, it reduces the need for drugs, due to the improvement of glucose sensitivity.
  • Strengthens the immune system and eliminates fungi, viruses, and bacteria from the tissues.
  • Improves symptoms of osteoporosis and relieves arthritis pain.
  • Decreases insomnia.
  • Improves memory and prevents Alzheimer’s disease.
  • It can even protect against some forms of cancer.

As you can see, there are multiple reasons why exercise should be done regularly, especially if you have diabetes.

You might be wondering why I mentioned “10,000 steps” in the title of this chapter.
It seems that this number has something magical, and studies recommend walking 10,000 steps to improve health, and prevent obesity and even type 2 diabetes. There is a saying which states that it takes 10,000 hours of work or practice in any area to master it or to be an expert in a subject. According to Malcolm Gladwell, author of the book “Outliers: The Story of Success” this is even more important than the innate talent you might have. Gladwell delves into this subject in his book.

Some of the popular examples mentioned in the book are the Beatles, who played and rehearsed 10,000 hours in Germany before becoming famous; Tiger Woods, one of the most famous golfers, who spent his 10,000 hours in courses even before he was old enough to have a driving license; or Bill Gates, founder of Microsoft, who spent 10,000 hours programming before reaching success.

Of course, 10,000 is a round number, and you can be just as skilled with 9990 hours or get the same benefits in your health with 9,950 steps a day. The idea is to have that number as a target.

The next question you are probably asking is how far is 10,000 steps? The average person’s stride length is approximately 2.5 feet long. That means 10,000 steps is close to 5 miles. Depending on your height, your steps may be longer or shorter, so that amount may vary.

Don’t be scared! These are not steps to be taken in addition to the steps you walk each day to go to work or the grocery store, or at home. They are total steps in a typical day. A sedentary person walks on average about 1,000 to 3,000 steps per day. These people, for instance, would need to add 9,000 or 7,000 steps per day, to reach 10,000 steps.

But you are not expected to add 5, 6, or 7 thousand steps suddenly. It is better to do it slowly. If the ultimate goal is to walk that many steps each day, you could have a weekly goal to add 500 steps per day or an amount that you think is reasonable and that you feel comfortable with, but which also stretches you. You’ll see that, in a few weeks or a few months, you will get to the 10,000 steps almost without realizing it.

You can buy a pedometer that can help count the steps so that you can free up your mind from counting. They are not expensive and they count the steps as you walk. Some are more simple and some more sophisticated, with distance counter, calories burned counter, etc. The simplest ones might be all you need, but if you want to know how many calories you burn, you can purchase one of the most sophisticated. And if you do not have the money, it is not necessary to buy it. But it helps.

Here you have some examples of how to easily increase the number of daily steps:

  • Walking the dog.
  • Use the stairs instead of the elevator.
  • Go for a walk with your spouse and/or children.
  • Park your car further away from the grocery or better yet, go walking, if possible.
  • Go walking to visit friends.
  • Meet a friend to walk together (but do not stop walking if your friend does not come someday).
  • Get off the bus or train one stop earlier and walk the rest of the way.
  • Use an mp3 player for listening to music or audio books while walking (time will go by faster and you will be distracted or learning something at the same time).

It would be good to note somewhere at the end of the day how many steps you’ve taken, or how long you’ve been walking, to see your improvement, and perhaps write down if you feel health improvements. Seeing the improvements can motivate you to continue doing it every day or every other day.

If your physical condition is very bad now, or if you take medicines to lower blood sugar (pills, insulin), I would suggest to talk to your doctor because it is likely that you will need less medication, to avoid hypoglycemia.

If you have type 1 diabetes, besides possibly needing less insulin just before the last meal before exercise, maybe you should eat something before you go walking.
As a guide, consider that 1 gram of carbohydrate usually raises blood sugar 5mg/dl in people weighing approximately 143 pounds (Dr. Bernstein came to these numbers after testing thousands of patients and himself . But, as always, do a test because your blood glucose may rise more or less than this figure). A child with a weight of about 65-75 pounds experiences a rise of 10mg/dl, while an adult weighing about 285 pounds will experience a rise of about 2.5 mg/dl (3).

How much carbohidrates rise BG

It is recommended that what you eat before exercising should always contain the same amount of carbohydrate (CH) to eliminate one of the variables that can affect blood glucose during and after the exercise. Also, keep in mind how quickly the food transforms into glucose in the blood. If it takes more than 40 minutes, it will surely raise your blood sugar as it will start to take effect when you have finished the activity.

Therefore, it is better to take something that arrives more quickly into the blood. Of course, everything depends on how high your blood glucose is before starting the activity. It may even be advisable not to exercise if you have high blood sugar. My endocrinologist told me years ago that I should not play sports if my blood glucose is 250mg/dl or more. Dr. Bernstein suggests that no sport/exercise should be done with more than 170mg/dl.

I don’t know about you, but I (with type 1 diabetes) sometimes go walking and BG (blood glucose) drops 100 points, as lately when it dropped from 236 to 135mg/dl in 45 minutes of walking somewhat vigorously. Although that is not always the case. Another time, I went walking with 277 and came back with 288! So you have to check what works for you and what doesn’t, and try to find out why.

That’s something that has been bothering me a lot lately: I go to play sports, even with BG in normal ranges, and return with high BG (hyperglycemia). You lose the motivation to keep exercising! I think this is not usually the case with type 2 diabetes. But with type 1, there are more things to consider. You have to do a lot of trial/error to learn how your body works and how exercise affects it, food and insulin [continue here…]

(2) Tuomilehto, J., Lindström, J. et al. (2001) Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance, en: New England Journal of Medicine 3;344 (18), pp. 1343-1350.

(3) Bernstein, R. K. (2011) Dr. Bernstein’s Diabetes Solution. The complete guide to achieving normal blood sugars, New York: Little, Brown and Company, 4th edition, pp. 235-237.

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