Many people with diabetes, especially type 2 diabetes, would like to lose weight. But how much? You may decide that you want to lose just enough weight to improve your insulin sensitivity. Many people with type 2 diabetes find that losing just 2kg to 4kg can improve blood glucose control, blood pressure and cholesterol levels. Some people with type 2 diabetes even find that by losing all of their excess weight, they are able to stop taking their medications.
What You Should Do
The key to losing weight is burning up more calories than you take in. follow your meal plan and exercise schedule. Once you have set your goals, the biggest problem is getting started. Make sure your goals are realistic. It may seem like too much to think you have to lose 20kg and start a marathon training program. And it probably is. Instead, take small steps.
For example, for the first week, try to eliminate 250 calories from your total intake each day. That could be as simple as giving up that slice of apple pie at lunch and taking a 1-kilometer stroll every evening. Once you get used to it, you can add more exercise or further decrease your calorie intake to lose more weight. Or you can just keep on at the rate you’re going. Even with this modest change, you could lose 0.2kg or 0.4kg a week. It may not seem like much, but over the long haul, those kilograms can add up.
If you find you’re not making much progress with your meal and exercise plan, try some of the following suggestions:
If despite your best efforts, you are having a hard time losing weight, ask your doctor about appetite suppressants. Appetite suppressants are only recommended for people who are significantly overweight and who have health problems that result from being obese. Make sure to discuss the side effects of any medications you take with your doctor.
Many medications are available for weight loss, some of which work and are safe. Few weight-loss medications are safe for the long term, but carrying around a load of extra weight is not safe either. To get the most out of your weight-loss medications, it should be used along with your approved meal plan and exercise schedule. Usually, weight loss with medications begin to plateau at about 6 months.
However you plan to lose weight, you are bound to have setbacks on occasion. Don’t beat yourself up about them. Instead of looking back and chastising yourself as you seek comfort in a bowl of ice cream, think ahead. Visualize the person you want to become and try to use that image to get you back on track. Once you start losing weight and exercising more, you may find that you like being able to walk up the stairs without huffing and puffing. Pat yourself on the back for how far you have come and keep moving toward your goal.
If a drug company hawked a pill that made you lose weight, improved your circulation, protected you heart against heart disease and stroke, improved your blood glucose control, and made you feel great, people would be lining up on the streets to buy it. How much would you pay for such a miracle drug? Well the truth is exercise is as good as any pill, and depending on what activities you choose, it can even be a lot of fun. This is one miracle cure that really lives up to its advertising. And the best part is that it’s free.
Active movement, the kind that gets your heart pumping and makes you breathe deeper, improves blood flow to your blood vessels, improves your cholesterol profile, and protects against heart disease. For people with diabetes, this is good news in itself. But there is an added benefit. Exercise also helps clear glucose from your blood, both while you are exercising and several hours later. If you use insulin, this could mean that you need less insulin on the days you work out. If you have type 2 diabetes, regular exercise along with a healthy diet could mean that you can control your diabetes without insulin or oral agents, or that you can get by with less medication.
What You Should Do
Take your goals for exercise to your doctor or diabetes care team. After your meeting, you should be able to answer the following questions:
In choosing any exercise, pick one that you like to do. The simplest is walking. It is cheap, nonstrenuous and something you can do with a friend. Even if you would like to do something more vigorous eventually, walking is a good way to get started. Start walking 5 to 10 minutes at first and gradually increase your time. Try to get to the point where you walk for at least 30 minutes or 2 kilometers. Walk at a pace that is both enjoyable and invigorating for you. And if you want something more aerobic, just walk faster, incorporate hills, or throw in a little jogging.
You might prefer jogging because you only have to work a short time to get an invigorating workout. To start jogging, make sure you can comfortably walk for 30 minutes or 2 kilometers. Then eventually, jog for a little portion of your normal walk until you are out of breath. Walk until you feel more rested, then jog a little more. Every day you will find that you can comfortably jog more and more. You may want to switch to all jogging, or you may want to stick with a jogging-walking combination.
Before you start jogging, make sure to check with your doctor. Invest in a good pair of supportive, well-padded running shoes. Your shoes should feel comfortable the first time you put them on. Consider having your podiatrist check their fit before you use them. Avoid running on concrete—try the track at a local school or nature trail. If you feel any pain in your feet or legs, stop running and walk. Rest or take a few days off before starting again.
A good workout session should include 5 to 10 minutes of warm-up exercises and gently stretching. During the warm-up phase, move slowly at first, using low-intensity, easy movements. You can stretch gently, but don’t bounce. You are more likely to hurt yourself by doing this with cold muscles. You can follow this with at least 20 to 30 minutes of aerobic activity. When you are first starting, however, don’t overdo it. If you are not used to an aerobic workout, try getting your heart rate up for just 5 to 10 minutes. Then increase a little each day or each week.
The aerobic session is the fun part. It should rev you up and get your heart pumping, but it should not be so intense as to cause shortness of breath, weakness or intense pain. One easy guideline to follow is that during your workout, you should still be able to carry on a conversation with your workout partner. After the aerobic portion, end with a cool-down activity and gentle stretching. To see improvement, you will want to work out at least 3 to 4 times per week. If you are engaged in intense physical activity, you might want to alternate days of intense workouts with days of rest or light activity.
You might want to alternate days of aerobic activity with days of strength training and muscle toning. Weight training has come a long way. It’s not just for Arnold Schwarzenegger-wanna-be’s anymore. Anyone—young, old, male or female—can benefit from weight training. It is a good idea to alternate weight training with aerobic activity. There are several approaches to weight training. It can be as simple as a few light hand-held weights in your living room or as complex as membership at an expensive, well-equipped gym. Most weight-training programs involve sets of weight-lifting exercises. Each set consists of a series of repetitions. When you first start, do just one set each session. Eventually, work your way up to 3 to 6 sets each session.
As you become stronger, you will also find that you can lift more weight. Add more weight a little at a time. A general rule is to use a weight that you can repeat 8 to 12 times. At the end of your reps, you should feel like you can’t do anymore. If you are straining at 8 reps, you are using too much weight. If you are still raring to go after 12 reps, you need to add more weight.
Just make sure that whatever you do suits your style. If you are social and more motivated by others joining in, think about joining a health club, taking an aerobics class, or exercising with a friend. If you like to do things on your own, think about investing in some exercise tapes, online classes or home gym equipment and working out in your home. However, be careful about exercising alone. You will have to be extra careful that you avoid hypoglycemia, both during and after exercise.
If you have type 1 diabetes, you have to plan carefully when you exercise. You need to guard against having your blood glucose levels fall too low, as well as having them rise too high. During moderate exercise that doesn’t last too long, your blood glucose levels may fall during and after exercise. This is because the glucose in your blood is being used up faster than your liver can release it. This is one of the benefits of exercise.
But if you don’t have much glucose to begin with or you exercise too long, you could have an episode of hypoglycemia. To avoid this, make sure you test your blood glucose level before you exercise. If you work out for a long time, you may even want to test in the middle of your workout. If your blood glucose level is below 100mg/dl before you work out, eat at least 15 grams of fast-acting carbohydrate. Then test 15 to 30 minutes later. Don’t start exercising until your blood glucose is at least 100mg/dl. Check with your doctor to find out a safe blood glucose range for you to exercise in.
If you exercise too vigorously or if you have not given yourself enough insulin, you could develop hyperglycemia. Sometime during vigorous exercise, your nerves signal your liver to release stored glucose. This can cause your blood glucose levels to rise. If your blood glucose is a little on the high side to begin with, overly vigorous exercise can trigger hyperglycemia. If your insulin levels are low, this can happen even with moderate activity.
If you are exercising vigorously, think about testing in the middle of your workout. You may also want to consider eating a snack during the workout. Try a snack that is low in fat and has 20 to 25 grams of carbohydrate. You may need to repeat your snack every 30 minutes for extended workouts.
If your blood glucose goes over 250mg/dl, stop exercising and test your urine for ketones. If you have moderate to large ketone levels, this means you don’t have enough insulin. You will need another injection of insulin. Do not resume exercise until your ketone levels return to trace amounts.
In general, you don’t want to exercise within an hour of your last regular insulin injection. Try to avoid exercising when your insulin is working hardest. You also want to avoid exercising when your insulin levels are at their lowest. An intermediate time point is usually the best. Talk to your doctor about the best time to work out with your insulin and eating schedule.
If you have type 2 diabetes, regular exercise can improve your blood glucose control. If you use insulin, you may have to follow the same precautions as someone with type 1 diabetes. Check your blood glucose levels before exercising. You will want to avoid treating low blood glucose with extra snacks if you are trying to lose weight. Instead, try to time your workouts at your normal snack time or an hour or so after your meals.
Probably the hardest part of any exercise program is staying motivated. Here are a few tips to help you get started and stick with it:
A Word of Warning
If you have any kind of proliferative retinopathy, see your eye doctor before starting any physical activity. Get your retinopathy treated and your doctor’s okay before any exercise. If you have peripheral neuropathy, you should avoid exercises that jar your feet, such as running, jogging, or high-impact aerobics. You may injure your tissues and joints without knowing it. Instead, think of biking or swimming or light walking. If you have autonomic neuropathy, don’t exercise without your doctor’s okay. Your body may have a hard time compensating for the exertion of exercise. You may risk dehydration, hypoglycemia, and low blood pressure. You might be able to do light walking, but check with your doctor first. If you are pregnant, ask your doctor if you should modify your exercise routine
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Behaviour Change, Weight Loss and Remission of Type 2 diabetes: A Community-Based Prospective Cohort Study by A Day, G Irving et al
Diabetes Nutrition Therapy: Effectiveness, Macronutrients, Eating Patterns and Weight Management by Marion Franz
High-intensity Interval Training (HIIT) for Patients with Chronic Diseases by L Ross, R Porter and J Durstine
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