Weight Management

Being over weight is a major risk factor in NIDDM. As many as 80% to 90% of Type II diabetics are not only overweight, but obese. This is a self-perpetuating problem for diabetics because fat cells secrete hormones that may reduce the effectiveness of blood sugar control. Knowing that weight is a major risk factor, lifestyle modifications need to address methods of weight reduction. These include improved nutrition and increased physical exercise. Reducing stress and stopping smoking are also important aspects of diabetes prevention.

Improving Nutrition

The first step in making dietary changes is to view your diet as a way of life, rather than a short-term restriction. It is important to find a healthful balance in your diet that you can manage to maintain for the rest of your life. One method to help you identify more diabetic-friendly foods is to use the Glycemic Index, a measure of how quickly foods are converted into glucose in your body. By emphasizing foods with lower glycemic index values, you will be able to enjoy a variety of foods while maintaining stable blood sugar levels. A more comprehensive discussion of the Glycemic Index is offered in the next chapter.
     Unfortunately, North Americans are bombarded daily with unhealthy food choices, and although governments are working toward more accurate labeling standards to enable consumers to make informed decisions, these changes are slow to occur. The next chapter will help you to develop an eating plan that will allow you to manage your blood sugar levels and prevent diabetic complications, but we recognize that making these changes within our societal context is challenging.

Increasing Physical Exercise 

Exercise will help you to lose weight, while offering the added benefit of increasing your sensitivity to insulin. Because muscles are sensitive to insulin, maintaining muscle mass normalizes glucose flow and enables it to be used efficiently as energy. Additionally, exercise is particularly important for diabetics who are already at a significantly increased risk for the development of cardiovascular disease.

Clinical Studies: Diabetes and Exercise

Several studies have demonstrated the importance of regular physical activity in delaying or preventing the onset of diabetes. Among them is a study of almost 6,000 male subjects whose physical activity patterns were measured for walking, stair climbing, and sports. The researchers identified a protective effect of exercise in preventing Type II diabetes, especially in those at higher risk.
     Another 2.8-year study of 3,234 non-diabetics separated subjects into three groups. The control group was administered a placebo, while the other groups were either given Metformin (a weight loss drug) or assigned to 150 minutes of weekly physical exercise. Significant reductions in the incidence of diabetes occurred in both the drug group (by 31%) and the exercise group (by 58%), with the exercise component clearly the more effective preventive measure.
     The key appears to be consistency. A study that examined the effect of exercise on insulin resistance syndrome in 79 obese children found that the protective aspects of exercise were not retained once activity ceased. The children were randomly assigned to one of two groups. The first group participated in 40 minutes of exercise 5 days per week for a period of 4 months, followed by an inactive period of 4 months. The second group was inactive for the first 4 months, followed by organized activity 5 days weekly. The researchers found that while regular exercise improved plasma triglyceride and insulin concentrations, these benefits were lost once the children returned to inactivity.


Exercise Precautions
Since diabetes is a metabolic disorder, it is important for diabetics to take precautions when exercising. Do not skip meals before exercising to ensure that your blood sugar level is adequate to meet energy needs. You may need to consume a carbohydrate-rich snack prior to activity or pack something to take with you. Physical activity lowers your blood sugar, and if your blood glucose drops too much, hypoglycemia can result.
    Be aware of symptoms that may indicate the onset of hypoglycemia, such as shakiness, weakness, confusion, irritability, headache, dizziness, or anxiety. These symptoms, if due to hypoglycemia, typically come on when a meal is delayed or missed, and typically improve when food is consumed. Hypoglycemia may also create a strong craving for sweets or simple carbohydrate, which, of course, should be avoided.
    Diabetics are also prone to foot problems, so it is worthwhile to invest in a comfortable pair of properly fitted athletic shoes to avoid injury and blistering. A medical bracelet or necklace that identifies you as a diabetic should always be worn.

Exercise Routine

It is recommended that diabetics partake in a half hour of exercise every day. Even moderate exercise, such as walking, will offer health benefits, so start slowly and work at a pace that is comfortable. Here are some other ideas to help you get started and to encourage you to continue with your exercise regime:
· If you are starting an exercise program, it is a good idea to get a physical exam, including an EKG or stress test from your healthcare practitioner.
· Set your alarm a few minutes early to allow yourself some time to stretch, do yoga postures, or take a quick walk around the block. By starting your day with physical activity, you’ll be more energized to continue being active throughout the day.
· Schedule your activity just as you would schedule any other appointment. You may find it beneficial to find an exercise partner to help you to keep your commitment to be active.
· Don’t forget to warm up before exercise and cool down after. In general, 12 to 15 minutes of warm up is a good idea. During warm up, your heart rate is increasing slowly toward your training heart rate. The cool down is also 12 to15 minutes, which allows your body to adjust after the exercise period.
· If you are exercising to lose weight, increase the duration of exercise as your fitness improves, notthe intensity. Fat burning is optimized after 20 minutes. Therefore, it is better to do 30 minutes at a slower pace (such as 120 beats/minute heart rate) than 15 minutes at a fast pace (such as 140 beats/minute heart rate). Maintaining your heart rate at or below the training rate helps prevent injuries and overtraining. It also encourages the body to burn fat.
· Make exercise a family affair. Choose physical activities that everyone can enjoy, such as long hikes, camping trips, or ski vacations.
· Plan a daily walk or other activity that allows you to talk with your children while you exercise.
· Encourage your children to join sports teams, dance classes, or swimming lessons. Provide supervised park time or a safe backyard play space to encourage outdoor physical activity instead of quiet indoor play.
· Plan family events that are focussed on an activity, such as skiing, canoeing, hiking, or biking. Develop family traditions based on these activities, such as a Sunday walk or a New Years ski day.
· If you can’t afford to join a class, rent or purchase an exercise video. There is a wide selection of activities to choose from, including yoga, pilates, power walking, and aerobic dance. Children’s videos are also available.
· Make every step count. If you’re walking back and forth between offices, put on your walking shoes and do so at a brisk pace. Take the stairs between floors. Do errands on foot whenever possible. Park in a distant parking space instead of circling for a closer one. Little activities throughout the day count toward your daily exercise goal.
· Get a heart rate monitor. This device will let you know if you are pushing your heart and cardiovascular system too hard. In general, training heart rate should be restricted to 180 minus your age for non-competitive athletes.
· Value yourself and your health. Set a positive example for those around you by committing to daily activity.