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Diabetes and physical activity

The importance of correct monitoring.

Regardless of the type of diabetic disease, practising regular physical activity is important in maintaining a healthy life. Some of the benefits include increased self-esteem, improved blood sugar level and consequently insulin resistance which will reduce other risk factors (e.g. cardiovascular and kidney disease), and weight and body fat loss. In some cases, regular physical activity helps to reduce the dosage of medication.

To take advantage of all the benefits of practising physical exercise, some important aspects should be considered: blood sugar level before exercise, intensity and duration of the session, type and dosage of medication, time of day, time lapse between last meal and practice, emotional state, level of metabolic control and general health.

Hypoglycemia is the biggest fear of a diabetic when practising physical exercise. This risk can be reduced by maintaining a balanced diet. Complex carbohydrates (wholemeal bread and cereals, pulses, rice, potatoes, pasta), proteins (fish, meat, dairy products) and food containing healthy fat (seeds, olive oil, nuts) should be present in the daily diet.

Blood sugar level should be tested before, during (if the activity is long or intensive) and after practising physical exercise, enabling the diabetic to readjust medication and the quantity of carbohydrates.

If blood sugar levels are high, type I diabetics should correct them before initiating physical activity, drinking additional water and avoiding fatty food. Type II diabetics can increase the quantity of water they drink, and warming up exercises such as a short walks are also helpful.

If blood sugar levels are normal, before intensive physical activity (running, tennis), a simple carbohydrate-rich snack should be ingested: a banana, a slice of melon, a cereal bar or fruit juice.

In the case of hypoglycemia, it’s important to drink a glass of water where sugar has been added. After 10 minutes, the test should be repeated and once levels are controlled, a carbohydrate-rich snack (bread or crackers) should be taken.

Readjustments as to the quantity of carbohydrates ingested should also be taken into account (e.g. Regular breakfast: 60g whole meal bread + cheese + 1 fruit + cup of tea. Breakfast when exercising: 90g whole meal bread + cheese + 2 fruits + cup of tea).

During exercise, muscle and tissue glucose is burned up, which then causes a decrease in the blood sugar level. It is for this reason that energy must be replaced. Depending on the duration and intensity of the exercise, every hour or every half-hour, sugar, fruit juice with added sugar, jam cubes or dextrose tabs should be ingested.

After physical activity, to prevent fluctuations, it is also important to continue controlling blood sugar levels. A protein and carbohydrate-rich snack should be ingested 30 minutes after exercise (e.g. 1 boiled egg + 1 raw carrot + 2 cream crackers). After practising physical activity, the main meals can also be reinforced with carbohydrates: e.g. eat three potatoes instead of two for dinner. When taking insulin it should also be readjusted.

Greasy food (pizza, chocolate, chips, cake, ice-cream) should be avoided before, during and after practising physical activity. Although this type of food is rich in sugar, it is also rich in fats, which will consequently slow down sugar absorption, making it difficult to control blood sugar levels and causing late hyperglycemia.

Good hydration is also very important due to the fact that our body consists of 60% water and a quarter of this is lost daily in body fluids (perspiration and urine). Diabetics should drink water before, during and after physical activity.
Quantity depends on various factors, age, type and intensity, conditions of where the practice is taking place, climate, humidity and temperature.

Small quantities of water should be drunk throughout the day. You should not wait until you are thirsty to drink water. Colour and smell of urine, dark yellow or smelly, is a sign of dehydration. Avoid alcoholic and energy drinks as they can be rich in carbohydrates and cause hyperglycemia. Confirm with your nutritionist.

Each diabetic is unique. Correcting carbohydrates and medication readjustments will take time and require patience and persistence from both the patient and health professional.

By Marina Augusto Estevão
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Marina Augusto Estevão is a dietician at the Hospital Particular do Algarve Group