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(6) Diabetes

Exercise

I’ve heard that exercise is good for people with diabetes – is this true? If so, I’m not the ‘sporty type’ and have never found going to the gym has any appeal to me. What should I do?

Exercise is good for people with diabetes (and for everyone else as well), and indeed it is one of the few things that have been shown to actually reduce the risk of developing diabetes.

Exercise does not have to involve sports, and you can usually find something suitable to suit your lifestyle. The staff at your local fitness centre is specially trained to help you with this, and these centres are a good place to start. They will work out an exercise programme with you and show you how to improve your fitness. Here are some ideas that you can adopt right away:

• Walk wherever you can and avoid using the car.

• Climb stairs rather than take the lift.

• Walk to and from work.

• Take your dog for more/longer walks.

• Consider buying a bicycle.

• Make a point of taking at least three half-hour walks a week at a fast pace.

If I keep to a good diet, why do I need to exercise as well?

Regular exercise stimulates a series of events in the body that results in changes in body composition and increased ‘fitness’. Regular exercise increases the amount of lean tissue and reduces the amount of fat. Lean tissues consist of muscle, fibres and bone and all are enhanced by exercise. This increase in lean tissues increases your metabolic rate and the amount of exercise that you can do without getting tired/exhausted (fitness). This not only makes you feel better but it also reduces blood pressure and the ‘bad’ (low density) cholesterol and increases the ‘good’ (high density) cholesterol.

Increasing fitness also increases the body’s sensitivity to insulin and lowers blood glucose levels. It may also increase the tendency to develop hypoglycaemia and you might have to reduce your insulin dose as your fitness improves.

I have been to have a cholesterol check-up, but I noted that the doctor also wanted to check for HDL and LDL. What’s the difference between all these measurements and what are they?

Cholesterol is lipid (fat) and an important normal component of many body tissues. Its concentration in the blood, where it circulates attached to a protein (hence it is a ‘lipoprotein’), has been shown to be a valuable indicator of the risk of developing vascular disease.

High levels of cholesterol are associated with an increased risk of heart attacks. There are two major components of cholesterol known as low density lipoprotein (LDL) and high density lipoprotein (HDL). LDL is otherwise known as the ‘bad’ cholesterol as it is the most important risk factor for heart disease. HDL on the other hand is the ‘good’ cholesterol, since high levels of HDL are associated with a low risk of heart disease.

Thus a ‘high cholesterol value’ is ambiguous unless you know whether it is high because of increased LDL or HDL cholesterol.

This is important as HDL values are often high in people with Type 1 diabetes (insulin raises the HDL level) and as such do not indicate an increased risk of heart disease. Thus before contemplating any treatment for a ‘high cholesterol’, your doctor needs to know that it is the ‘bad’ cholesterol (LDL) that is to blame. It’s a complicated story and we hope that this explanation helps?

For those who seek more information, have a look at: http://www.lipidsonline.org/slides/slide01.cfm?tk=9

I have Type 2 diabetes and take the highest doses of metformin and gliclazide but am not well controlled. My doctor tells me that I could avoid insulin if I made a determined effort to improve my fitness and lose some weight. Is this true?

Yes, your doctor is right. It has been clearly shown that exercise can improve metabolic control in people with poorly-controlled Type 2 diabetes. If you are to succeed, you will need to adopt a fitness programme and continue this on a regular basis. If you wish to lose weight as well, you will need to combine this exercise programme with a calorie-reduced diet, as exercise by itself is not a good way of losing weight. If you want to pursue this line, we suggest you go along to your local fitness centre and sign up with a ‘Personal Trainer’ who will give you a suitable programme, encourage you and monitor your progress.

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