Contributor: Dr. Staci-Marie Norman, PharmD, CDE
Making sure you are staying healthy while living with diabetes is more than just taking medication. Every aspect of life can affect blood glucose, from what you eat to those life stressors that seem to always pop up at the most unexpected times. Activity, or lack thereof, can also affect blood glucose. When we move our muscles, we stimulate the uptake of glucose out of the blood and into the muscle tissue for fuel. This can have the effect of lowering blood glucose for up to 24 hours! But when it comes to exercise, sometimes we have an all or nothing mentality. I’m here to tell you that even small amounts of increased activity can make a huge difference in your blood glucose management.
When I work with patients who haven’t been physically active, we start with very small goals. Maybe it is getting up during each commercial break while watching tv in the evening and taking a lap around their house (as long as the lap does not include opening the refrigerator door). Or, using some light hand weights or cans of soup to do armchair upper body exercise while watching a favorite show. A walk to the mailbox soon leads to a walk around the block or two or three, which then turns into a mile or more. Small changes may seem like they aren’t doing much, but inside those muscle cells, big changes are happening! I encourage using some type of step tracker. There are inexpensive pedometers that you can pick up at most “big-box” store or online retailers. Some of my patients prefer a wearable tracker, such as Fitbit, Apple Watch, or Garmin Vivo. These trackers can help not only count steps but give you the ability to track food and possibly blood glucose levels via apps. Either option can give you the instantaneous feedback of how you are doing throughout the day on meeting your activity goals.
Have you heard about taking 10,000 steps per day? This is an activity goal that has been around for a while to help people become more active. On average, 2,000 steps is about 1 mile, so if you were able to reach the goal of 10,000 steps per day, you would be walking about 5 miles each day. Can you imagine how well those muscle cells would be using glucose?! As with any large goal, you may need to start with smaller bites. If you have not been very active, maybe 2,000 steps daily should be the first goal and add 1,000 more daily steps every few weeks until you reach 10,000 steps per day. I have to admit that I wear a tracking device, and there are some days I don’t reach my goal of 10,000 steps. But being able to see throughout the day where I’m at is extremely motivating to get out and take a lap around the office or walk after work.
At this point, you’re probably asking yourself if exercise will have any effect on the medications that you take. Very good question, and yes, exercise can have an effect which is dependent on the medication you are taking. First and foremost, if you are taking a sulfonylurea (glipizide, glyburide, glimepiride) or insulin, when you exercise your blood glucose will decrease, and these medications have a direct effect on increasing the amount of insulin in your body that also pushes glucose into cells. Hypoglycemia can be a concern of which you need to be aware. When you are first starting out and doing small amounts of activity for short periods of time, this might not be a concern. But as your activity level grows, I would suggest you check your blood glucose prior to exercise. If your blood glucose is in the low-100s, you might consider a snack which includes some protein and fat prior to working out to make sure you maintain your blood glucose level. This could be a cup of yogurt or apple slices with peanut butter. Remember, exercise can lower your blood glucose for up to 24 hours, so be aware of your blood glucose possibly becoming too low later, especially if you skip a meal. If you take other medications for diabetes that are not insulin or sulfonylureas, then hypoglycemia with exercise typically is not seen. But, with increased activity and in conjunction with dietary changes, weight loss can occur. Just losing weight can lower your blood glucose because of the improved insulin sensitivity that occurs in the body. This might mean that your blood glucose levels overall improve and potentially bring a need for lower doses of medications. What a great “side effect” from becoming more active!
So, let’s all get out there and move more! Until next month, for now, I’m off to walk my Goldendoodle, Molly, and help my daily goal!
Dr. Staci-Marie Norman, PharmD, CDE received her bachelors from Purdue University (’94) and her Doctor of Pharmacy from the University of Oklahoma (’96). In 2000 Dr. Norman added to her credentials by becoming a Certified Diabetes Educator. She is currently the Clinical Coordinator and staff pharmacist for Martin’s Pharmacy. Dr. Norman is a national faculty member for the American Pharmacist Association, teaching certificate programs in both diabetes and cardiovascular disease. She serves on the advisory board that oversees development and revision of these programs. Along with teaching and development responsibilities for APhA, Dr. Norman serves as a peer reviewer for research grants and publication submission. Dr. Norman has also spoken for Abbott, Bayer, Lilly, Mannkind, and Lifescan as a diabetes specialist.