EXERCISE IN THE PRESENCE OF DIABETES COMPLICATIONS
If you have any complications of diabetes, you need to take them into account when you are
planning your exercise.
Nervous System Complications
Nerve damage to the feet can stop you from recognizing injury, and as a result you can develop
calluses, foot ulcers, or even a Charcot’s foot. If you have significant peripheral neuropathy, you should avoid
pounding the pavement and try non-weight-bearing exercises such as swimming, rowing, and cycling instead. When
you buy athletic footwear, choose shoes with cushioned midsoles and socks that wick away
moisture.
Autonomic neuropathy can dull the classic warning signs of hypoglycemia
(palpitations, sweating,
and shaking), and this may prevent you from recognizing exercise-induced hypoglycemia. Similarly, if you have
hypoglycemic unawareness due to recurrent hypoglycemic episodes, you should monitor your blood glucose more
frequently during and after exercise.
Autonomic neuropathy can also cause problems with blood pressure regulation, and you can get
light-headed with exercise. Dehydration can worsen the problem, so it is important to drink adequate fluids. The
heart rate is often increased even at rest, and this means that you cannot rely on taking your pulse rate to
monitor your exercise level. It may be best to judge the intensity of your exercise on your perception: if you
think the exercise is somewhat hard, this is equivalent to moderate exercise.
Diabetic Eye Disease
If you have retinopathy, vigorous exercise, weight lifting, or boxing may precipitate
bleeding, and therefore you should see your ophthalmologist before embarking on a vigorous exercise
program.
Heart Disease
Type 2 diabetes increases the risk of coronary artery disease, and therefore you should get an
evaluation for heart disease prior to starting an exercise program. Older people with type 2 diabetes who are
just planning moderate activity such as walking may not need any special evaluation. However, if you were
previously inactive and are planning a vigorous exercise program, or you have autonomic neuropathy or previous
heart problems, you should get a cardiac stress test. Your doctor may do a test called thallium-201
scintigraphy, which looks for areas of the heart that have insufficient blood flow.
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