The therapeutic use of exercise for diabetes mellitus was prescribed as early as 600 BC by the Indian physician Sushruta, and was widely recommended by physicians of the 18th century. Elliott Joslin identified exercise along with dietary management and insulin administration as one of the three components of good therapy in the 1920’s. Today exercise is recognized as one of the established principles of diabetes treatment.

We all know exercise is important for everyone’s health, and it can be especially important if you have diabetes. In some ways, exercise has greater benefits for a person with diabetes since it has an important effect on blood sugar control.

Diabetes and Exercise

How does exercise work on diabetes?

• Exercise can lower the blood sugar and improve the body’s ability to use glucose. With regular exercise, the amount of insulin needed decreases.
• Exercise can also help reverse the resistance to insulin that occurs as a result of being overweight. There is an increase in the number of insulin receptors improving the body’s ability to utilize insulin.
• Exercise improves risk factors for heart disease and decreases the risk of heart problems, which is a major health concern for people with diabetes. This includes the reduction of low density lipoprotein cholesterol (LDL), or bad cholesterol, which forms plaque that obstructs blood vessels. Exercise promotes the good cholesterol, high density lipoprotein cholesterol (HDL), which is protective against heart disease. Blood pressure is also lowered through exercise and exercise has been shown to improve mild to moderate high blood pressure.
• Exercise, when combined with a meal plan, has the ability to control Type 2 diabetes without the need for other medications.
• Regular physical exercise and activity provides an effective way for a person with diabetes to manage their blood sugars.

Diabetes and Exercise: What can exercise do?

In addition to the benefits specific to diabetes, a person with diabetes will experience the same benefits and enjoyment everyone else gains from exercise.

• Improved Physical Fitness. Exercise increases the efficiency of the heart, lungs and circulatory system both at rest and with exercise. The body’s improved ability to transport oxygen provides increased stamina and endurance. You have more energy for greater productivity at work and reserve energy to do the leisurely things you enjoy each day.
• Weight Control. Exercise can help you to lose weight or maintain your weight. Exercise burns excess calories, which are stored as fat cells. This means that at rest you burn more calories than a sedentary person, increasing your weight loss. An exercise program during weight loss is essential to ensure that the weight lost is fat and not lean body tissue or water weight, which often occurs from dieting alone. As you become leaner, you will look better and feel better.
• Psychological Benefits. Exercise is a means of dealing with life’s everyday stresses. It also aids in relieving depression and building self-confidence. Through exercise, you have more energy, you are more relaxed and you feel less fatigued.

Before beginning an exercise program, it is important to obtain medical clearance. It is absolutely imperative if you are 35 years of age and/or have had diabetes for 10 years or more.

Your blood sugars must be adequately controlled before beginning a new program in order to produce the desired blood sugar results.

So Why Exercise?

Exercise is something that you can do yourself to help your diabetes. A regular exercise program can bring dramatic results. If you exercise properly, you can lower blood sugar levels and improve your blood glucose control. You can also maximize weight loss and decrease your risk of heart disease. An exercise program should be individually tailored and designed to compliment your lifestyle and to achieve your desired goals. This requires the proper adjustment of your insulin and extra food (snack) consumption. Many factors such as the time of day you exercise or the type and duration of your exercise will determine whether adjustments should be made in your insulin dose or your meal plan. Discuss your exercise program with your exercise physiologist to determine the type of adjustments you need to make.

Diabetes and Exercise: Getting Started

Exercise is beneficial for most people. But it is especially important for people with diabetes. There are educators available on the Joslin team to meet with you and determine the best exercise plan for you (in cooperation with your doctor). It does not matter how old you are or how long you have had diabetes — it can still help you better control your blood glucose and overall health. What is important is that you pick an exercise that you enjoy.

Diabetes and Exercise: Tips on Exercise when you have diabetes

1. Consult your doctor before starting any exercise program.
2. If you are over 35 you may need a stress test.
3. Test your blood glucose before and after exercise.
4. Do not exercise if blood glucose is over 250 and there are ketones in your urine.
5. If blood glucose is over 250 but no ketones are present, you should follow these guidelines:

• Type 1: Do not exercise if blood glucose is 300 or more
• Type 2: Do not exercise if blood glucose is 400 or more
• Exercise 1 – 1 1/2 hours after eating
• Check blood glucose before and after exercise and follow snack guidelines
• Always carry a carbohydrate snack with you (Glucose tablets, juice, etc.)
• Drink plenty of fluids
• Wear shoes and equipment that fit well

6. Plan exercise to prevent low blood sugar reactions

Our body has many different types of sensory nerves.  Some allow us to feel sharp, shooting pain.  Others help us feel light touch.  Others help us feel vibration and pressure, while others help us know where our body is in space.

 Neural Prolotherapy: How does it work?

Small nerve fibers called “peptidergic c-fibers” are found throughout our body and are responsible for feeling dull, achy pain.  In addition to pain sensation however, peptidergic c-fibers are unique in that they also help maintain tissue health by releasing proteins and various growth factors into areas that the nerve fibers sense are damaged.  Sometimes these nerve fibers can become constricted in the various fascial layers as they travel from deep inside the body into the superficial skin.  Just like a dam in a river, if a nerve gets constricted, the entire length of nerve downstream from that constriction point can become unhealthy and can consequently affect the health of the tissue that that nerve subserves.  In addition to constriction injuries, a chronically irritated nerve (simply from being in a state of chronic pain) will begin to lose its ability to regulate the delicate balance of growth factors that it releases making an already injured area even sicker.

It has been shown that peptidergic c-fibers have receptors that are responsive to dextrose (a simple sugar).  Near nerve injections of dextrose can immediately begin to properly regulate the release of growth factors from the nerve as well as reduce swelling at sites of constriction.  By targeting the tender areas of cutaneous nerves all along their known pathways, many patients will experience an almost immediate reduction or even resolution of their pain.  The immediate pain reduction only lasts for a couple of hours or at most a couple of days, but the real work continues to take place at the level of the injured tissue as the growth factors slowly begin to facilitate healing of all the deeper structures beneath the nerves.

What conditions may benefit from Neural Prolotherapy?

Almost any musculoskeletal or nerve related injury may benefit from a trial of neural prolotherapy.  This is a relatively new treatment that has only been around for the last several years and we continue to learn new ways in which NPT may be helpful.  One of our LRMC providers actually developed the protocol for aborting acute migraines with NPT with a success rate that exceeds 90%.

Contraindications to Neural Polotherapy

Infection at the injection site

How Often Do I Need to Have the Treatment?

Injections are optimally spaced about 1 week apart and often 8-12 sessions are required before an area is completely healed, though improvements in pain should be noticeable throughout the treatments.

The purpose of foam rolling exercises is to soften muscle tissue, keep it elastic and pliable. Think deep massage!

For foam rolling exercises, roll back and forth for 30 seconds to a minute.  For tennis ball exercises, find pressure points and keep as much weight as possible on the ball for one minute.

Foam Rolling Exercises

If you’ve never done foam rolling before, you may find it painful at first.  You should ease into it, doing only as much as is reasonably comfortable.  It should become much less painful after a few sessions of your foam rolling exercises.

Quads Foam Rolling  – Cross your legs so that most of the weight is on one leg.  After rolling on one leg, switch to the other.  If this is too painful at first, roll on both legs simultaneously.

IT band Foam Rolling  – Lie on your side and place the tennis ball in a sensitive spot on the outside of your leg near your hip joint.  After the desired time, move the ball farther down your leg.  Switch legs and repeat.

Hamstrings Foam Rolling  – Cross your legs so that most of the weight is on one leg.  After rolling on one leg, switch to the other.

Calves Foam Rolling  – Cross your legs so that most of the weight is on one leg.  After rolling on one leg, switch to the other.

Glutes Foam Rolling  – Find a sensitive spot and put as much weight as possible on the ball.  After the desired time, move to a new sensitive spot.  Switch to the other side and repeat.

Arch Foam Rolling  – Place the ball under your foot and, with as much weight as possible, move the ball back and forth 50 times.  Repeat on other foot.

Front of Shins Foam Rolling  – Keep as much weight as possible on the roll, not on your hands, while you roll back and forth.

Side of shins Foam Rolling  – Roll by alternately bringing your knees to your chest and extending your legs.  Repeat on other side.

TFL Foam Rolling  – Extend one leg out to side for support.  On the other leg, target the very top of your quadriceps near your hip, just outside the center of your leg.  Don’t skip this one; improper firing of the TFL muscle can cause IT band sydrome and knee pain!

Adductor Foam Rolling  – Lie mostly flat and place the roll under your thigh.  To roll back and forth, you may need to lift yourself up with your arms a bit.

Arthrocentesis is the clinical procedure of using a syringe to collect synovial fluid from a joint capsule. It is also known as joint aspiration. Arthrocentesis is used in the diagnosis of gout, arthritis, and synovial infections.

Arthrocentesis (synovial fluid aspiration) can be performed either diagnostically (for identification of acute arthritis) or therapeutically (for pain relief, drainage of infected fluid, or injection of medications).

Arthrocentesis Indications:

• Evaluation of joint fluid
• Identification of intra-articular fracture or ligament tear
• Pain relief by removing excess fluid or blood
• Injection of medication (eg, corticosteroids, antibiotics, or anesthetics)
• Drainage of infected fluid

Contraindications for Arthrocentesis

• Skin lesion or dermatitis in affected area
• Inability for blood to clot
• Cellulitis (infection of skin) overlying the joint

What Does Meditation Do For Me?

• It relaxes the muscles of your body.
• It reduces tension.
• It reduces stress.

Step One

• Either relax in a comfortable chair or lay flat on the floor or on your bed at home.
• Progressively relax the muscles of your body. Starting at your feet and working up OR starting at your head and working down.
• Make sure to keep your breathing even. When you relax your muscles, you are releasing adrenaline and other stress hormones from them and exhaling it to release it from your body.

Step Two

• As you begin to relax, be mindful of where your muscles ache, where they are stiff or sore and pay attention to those areas and coax your muscles to relax. You may need to adjust your position in order to relieve strain on certain body parts that are sensitive or sore.
• Be aware of your breathing. Breathe gently in so that your lungs fill as completely as possible and your belly rises and falls with each breath.
• Mindfully relax any muscles which have become tense again.  Do this as you notice the tightness recurring until your whole body is relaxed.

Step Three

• Once your body is relaxed, let your mind drift. Acknowledge any thoughts that cross your mind and let them drift on. Do not focus on them or judge them, just let them drift out of your mind.
• Once your whole body and mind are relaxed, remain this way for a few minutes and savor the moment.

Finishing Up

• When you are ready to end your session, slowly rouse yourself.
• Move slowly and quietly to your belly and allow your body to regain its balance before rising.
• Never simply rise from your relaxation as you may become dizzy and unbalanced.

The More Often You Meditate And Engage In Muscle Relaxation, The Faster Your Body Will Learn To Respond To Releasing Its Stress And Tightness. Once Relaxed, You May Add Guided Imagery To Your Relaxation And Use It To Further Relax And Release Stress.

What Is Guided Visualization?

• It is a form of meditation that allows your mind to create a stress free, beautiful place for you to mentally visit and escape the stress and chaos of the world around you.
• It helps your thought process slow down so you can focus on one image at a time or one thought at a time.
• It allows you to focus on positive thoughts.
• It enhances the connection between your conscious and unconscious mind.

What Are The Benefits Of Guided Imagery?

• Reduce stress & anxiety.
• Decrease pain.
• Lower blood sugar levels.
• Decrease breathing problems.
• Enhanced sense of self control.
• Decrease the level of cortisol (a stress hormone).
• Decrease severity of headaches.
• Enhance healing of wounds.
• Enhance sleep.
• Enhanced self confidence.
• Assist in working through loss.
• Enhanced quality of life.

Guided Imagery Also Helps To:

• Decrease heart rate.
• Decrease blood pressure.
• Decrease breathing rate.
• Increase oxygen consumption.
• Regulate brain waves.
• Regulate body temperature.
• Balance hormone levels.
• By replacing negative thoughts and images with positive images, we begin to slowly replace the negative images all together.

How Do I Do Guided Visualization?

• Once your muscles are relaxed and your mind begins to clear, begin to think of a place that is visually appealing to you such as a meadow, lake, beach, etc.
• It may be a place from your past or it may be a place you make up in your mind.
• You may use a piece of gentle background music, some favorite instrumental music such as jazz or classical, or music especially designed for relaxation.
• The purpose of this is to block out the external environment and allow you to focus inward.
• The imagery may include other people who are special to you such as loved ones or those who have passed and that you miss.
• You may include people in your imagery who have simply crossed your path in positive ways such as someone who smiled at you in a store or who has been helpful to you in some small way. Think of how these people enhanced your life simply by crossing your path.
• You may paint the image any way you desire as to level of detail and complexity. Just don’t get wrapped up in the image and miss the relaxation.
• Use all of your senses in painting the image. How does the sky look? Can you hear birds singing or peoples voices? What do the textures of the image feel like?

Closing the Imagery

• When you are ready to return to reality, begin to gradually end the imagery by walking back the way you came in the image.
• Say good bye to those people you may have encountered in the image.
• Slowly rouse yourself to wakefulness as you did when you did not engage in the visual imagery.

It’s no secret regular exercise is beneficial to heart failure patients. Not only does exercise build strength and endurance, but it improves balance, reduces stress, and increases self-confidence and feelings of well-being. Before you start any exercise program talk to your doctor: he or she may recommend a supervised cardiac rehabilitation program. Your healthcare provider will determine a safe level of exercise specific to your diagnosis and stage of heart failure.

Exercise and Your Health

EXERCISE TIPS:

• Try to exercise three to five days a week (only if you feel well). You may need a day of rest in between workout sessions.
• Make exercise a part of your daily routine, like weighing yourself everyday and taking your medication.
• Start out slowly: alternate between 2-5 minutes of easy walking followed by 2-5 minutes of rest. Continue as tolerated. Keep your effort light and comfortable. You should be able to walk and talk at the same time. Do not push yourself.
• As your endurance increases, boost your walking time and decrease your resting time. For example: walk for 5 minutes and rest for 2 minutes.
• Keep this up until you are able to walk continuously for 20 minutes (that means no stopping). Once you have achieved this, slowly increase your walking time to 30-40 minutes.
• You don’t have to do all your activity at once. You can split up your work outs throughout the day. Go on two short walks, instead of one.
• Set goals you can reach. If you expect too much, you are likely to become discouraged and stop exercising.
• If you have trouble breathing or feel worn out—STOP, rest, and make sure to do less next time.

ADDITIONAL TIPS:

• Stretch for 10-15 minutes prior to your workout to warm up muscles and to increase your flexibility. Stretching reduces your chances for injury.
• Choose an activity you enjoy: walking, cycling, swimming, and “low to no-impact” aerobics.
• Strength train using light weights; this will increase the tone and strength in your muscles.
• Remember to cool down for a minimum of 5-10 minutes. Gradually slow your pace in increments of 1-2 minutes.

STOP EXERCISING IMMEDIATELY IF YOU FEEL ANY:

• Pressure or pain in your chest, neck, arm, jaw, shoulders, or upper back.
• Dizziness, lightheadedness, or nausea.
• Unusual shortness of breath.
• Unusual heartbeat—too fast or too slow, or feeling like your heart is “skipping a beat.”

CALL your HEALTHCARE PROVIDER FOR:

• SHORTNESS of breath lasting 10 minutes or more.
• DIZZINESS, lightheadedness, nausea, vomiting, or cold sweat.
• CHEST PAIN.