When she first discovered she had diabetes, Lorraine lost 17 pounds. She found her weight has levelled off. Although she watches her diet carefully, Lorraine checks her blood sugar levels three times a week, but last week at her doctor's office, she learned her latest hemoglobin A1c was 8.3 per cent*. Six months ago, her A1c was 8.6 per cent. She is concerned that there hasn't been any significant change.

In talking with her doctor about her diabetes regimen, Lorraine admitted she used to walk 30 minutes every day, but last fall she slackened off and she hasn't resumed her daily exercise.

“Cooler weather and icy sidewalks," Lorraine explained. "I thought that as long as I follow my meal plan and take my medications, my weight and diabetes control would continue to improve.”

Lorraine's doctor responded, “Becoming more physically active is something all Canadians should strive for. Physical activity is also an important component of the diabetes treatment plan. Working muscles use glucose (sugar), which they store for energy. As this stored glucose is used, extra glucose continues to be supplied from the liver. When muscles use glucose faster than it can be supplied by the liver, blood glucose levels will fall.”

Lorraine nodded. “I understand that, but I thought I had things under control.”

Her doctor smiled.

“You have two-thirds of the elements of managing diabetes under control, diet and medication. The other, but equally important, third is making your body more efficient at burning calories and improving your cardiovascular fitness. You need to add aerobic exercises that use large numbers of muscles and raise the heart rate.

"Aerobic,” he added, “is loosely defined as 'with oxygen.' That refers to exercise done at such a pace that the heart can keep up with the muscles' demand for oxygen. These are things like dancing, swimming, walking, skiing - either downhill or cross-country - and armchair exercises.

“Before you start any exercise program, though, Lorraine, I want you to have a physical check-up, which I recommend for anyone over 35. I also recommend checkups for anyone who has had diabetes for more than 10 years. I'd like to include an exercise ECG, an electrocardiogram, for you, so we can be aware of any signs of possible coronary heart disease.

“When I give you the green light, I also want you to speak with your diabetes counsellor about renewing your physical activity program and how to plan for and adjust for increased activity.”

Lorraine completed the exam and ECG, and got the go-ahead for her plan to once again become more physically active. She reviewed Canada's Physical Guide to Healthy Living and other related pamphlets her doctor gave her, acknowledged she was ‘out of shape,’ and planned to slowly resume walking.

She even hauled out the stationary bike stored in her basement. Lorraine talked with her diabetes educator and was provided with some guidelines for adjusting food based on the length of exercise, its intensity and her blood glucose levels. She learned that there were numerous studies clearly demonstrating the benefits of increasing physical activity, including:

Improved cardiovascular fitness
Lowered mild to moderate high blood pressure
Increased endurance and muscle strength
Aided in weight loss (due to a decrease in appetite and extra calories burned)
Relieved stress and tension
Heightened feelings of well-being and alertness
Lowered triglycerides and LDL cholesterol (the unhealthy cholesterol) and raised HDL cholesterol (the healthy one)

Exercise, she also learned, additionally benefits people with either Type 1 or Type 2 diabetes, as low to moderate intensity exercise has been found to lower blood glucose levels both during and after exercise. For the individual with diabetes, there are some risks to consider. Lorraine sees her doctor regularly to monitor the following conditions:

hypoglycemia
worsened diabetes control
worsened existing complications
heart and circulatory complications.

Lorraine also talked with her grandson, Jordan, who has Type 1 diabetes. He is involved in numerous sports at school, after school and on weekends. He told her that he and his parents have found that blood glucose monitoring is the most effective tool for making decisions about when to increase what he eats or to reduce his insulin doses appropriately.

For instance, when Jordan plays hockey, his parents reduce the amount of insulin he takes. He has half a sandwich and an apple before the game, and depending on the intensity of the game, may eat the other half of the sandwich during the game - and at times he has needed to eat extra food after a game.

Jordan's parents also told Lorraine that Jordan's teachers and coaches are familiar with his condition, and with the signs and symptoms of hypoglycemia, or low blood sugar. Lorraine has now made sure her husband understands the basics of her diabetes control program and how her physical activities can affect it.

With her new-found knowledge and reinforcing what she already knew, Lorraine began her fitness regimen carefully, finding she needed 10 - 12 weeks of slowly progressing activity before she could exercise at the recommended intensity and duration. She ensures she starts each walk or turns on the stationary bike with a five- to ten-minute warm-up, and includes stretches to warm her body up and prevent injuries. Each session ends with another five- to ten-minute cool-down, which may include slowing her walking pace and some arm and leg stretches.

Lorraine tries to make sure she exercises at about the same time every day, scheduling it so she has enough time for the important warm-ups, cool-downs and stretches, and also to monitor her blood sugar levels.

When she goes for walks, she goes with her partner, a neighbour across the alley, who is good company, but is also aware of the signs of low blood sugar and how to help Lorraine if it becomes a problem. Lorraine always keeps some light snacks or drinks handy when exercising to counter any drop in blood sugar. She makes sure she carries identification with information on her medical condition, whether she's exercising or not.

Lorraine has now lost an additional eight pounds and admits she feels better than ever! She had gradually increased her activities from an initial five-to-10-minute duration three to four times a week to 20 to 30 minutes of exercise five to six times a week. And next winter when the snow flies and sidewalks ice up? Lorraine has already signed for swimming classes at a nearby indoor pool.

Get Physical The third element of diabetes care

Lorraine, 58, was diagnosed with Type 2 diabetes two years ago. She takes two different medications to control her diabetes. The first she started when she found out she had diabetes. The second one was added approximately three months ago.

Get Physical
The third element of diabetes care