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Work out with care

Not all exercises are for everyone

That exercise is beneficial for diabetics is not news. But, exercise can be tricky when your body is hosting an anarchic dance between blood sugar, drugs and insulin.Diabetes stamps its mark on virtually every organ in the body and can put limitations on activity. For example, coronary artery disease (CAD) is common in longstanding diabetics. Strenuous exercise, when you have unrecognised and untreated CAD, can precipitate chest pain, heart rhythm abnormality or even a heart attack.

Retinal abnormalities are also more likely in diabetics. Such people are at risk for retinal and vitreous bleeds and retinal detachment due to strenuous activity like lifting weights or exercises that involves breath holding.

Pre-exercise assessment is vital for all diabetics before they take up a new programme of exercise activity. This must include a neurological examination to detect peripheral nerve damage, a retinal exam and cardiac evaluation, including an exercise stress test to detect hidden cardiac disease.

Patients on sulphonylurea tablets or insulin must monitor sugar levels before exercise. Sugar levels above 250 mg/dl require correction before exercise. Levels below 100 mg/dl demand a restorative snack before exercise.

Hypoglycaemia is a real risk for exercising diabetics, and diabetics should learn to recognise its symptoms. They should always carry some biscuits or chocolates during exercise. Dehydration is also more dangerous for diabetics. Sweat loss must be replenished promptly.

Diabetics with peripheral neuropathy should avoid running, jogging and jumping: these activities can damage soft tissues and joints. Walking, swimming and cycling are safe.

Weight-bearing exercises can worsen arthritis in diabetics.

Patients with damaged autonomic nerves can have inadequate heart rate and blood pressure responses to exercise, and they can collapse from a sudden fall in blood pressure. Exercises in the recumbent posture and other gentle exercises are ideal for them.

Diabetics must monitor their feet daily for blisters and injuries. Treat all foot injuries promptly.

Footwear must be appropriate for the exercise being performed, and it should be comfortable. Absorbent socks made of cotton are ideal.

R. M.

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