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Exercises for Diabetics

The effect of exercise

In diabetes, exercise is a must. Regardless of the type of diabetes, exercise must be performed. However, there are risks of exercise from diabetes, so exercise with caution.

Exercise controls blood sugar in type 2 diabetes. Steady exercise improves glucose metabolism and increases insulin sensitivity. In other words, it makes insulin work well. It has been proven that strength training, as well as slow aerobic exercise, regulates blood sugar in diabetics. Exercise also prevents type 2 diabetes.

Exercise reduces insulin resistance, preventing or delaying type 2 diabetes. This effect is remarkable in obesity, especially abdominal obesity. Increased insulin sensitivity lasts up to 72 hours after exercise. Therefore, repeating the exercise at least within 72 hours will help maintain increased insulin sensitivity.

In type 1 diabetes, exercise lowers insulin requirements. That means you can get less insulin if you exercise. However, there is no evidence that exercise itself controls blood sugar in type 1 diabetes. Therefore, it is important to gain several benefits, such as reducing insulin dose and preventing atherosclerosis, rather than trying to control blood sugar itself through exercise.

Exercise prevents heart and circulatory disorders. This can mean less angina, myocardial infarction, and stroke. If you recall that the purpose of treating diabetes is not to lower blood sugar itself but to prevent various circulatory complications, you may feel the importance of exercise. Other risk factors for coronary artery disease, such as hypertension, dyslipidemia, and obesity, are also improved by exercise.

Exercise lowers total cholesterol, triglycerides (TGs) and high-density lipoprotein cholesterol (HDL). High-density lipoprotein cholesterol is a good cholesterol for us, which helps carry and remove arterial debris from the liver. Some studies have shown low cholesterol, low density lipoprotein (LDL).

Exercise builds up a lot of muscles, which increases your metabolism, so you can eat less of the same amount of food to gain weight. In addition, exercise consumes calories, so diet and exercise at the same time can effectively reduce weight.

Here are the effects of exercise in diabetes:

Benefits of Exercise in Diabetics

  • Lower your blood sugar during and after exercise.
  • Lower your usual insulin and postprandial insulin levels.
  • Improve insulin sensitivity.
  • Lower glycated hemoglobin in type 2 diabetes.
  • It has a blood lipid-improving effect.
  • Lower your blood pressure.
  • Increase energy consumption.
  • Improve cardiovascular function.
  • Strengthen.
  • Good for mental health, such as anxiety and depression.
  • Has anticancer effect.
  • Good effect on musculoskeletal system.

How to exercise in diabetes

1. Aerobic Exercise

People with diabetes are advised to exercise moderately safely. High intensity, or vigorous exercise, can be dangerous. Of course, if you have good diabetes control, no complications, and good motor skills, you can exercise vigorously. Here is a detailed description of how to exercise based on moderate exercise intensity.

1) Type of exercise

The type of exercise you choose depends on your current athletic performance, personal interests and economic situation. Exercises can be divided into high- and low-impact exercises, depending on the degree of impact. Shock is the load on your body the moment your feet hit the floor. Diabetics can be injured by high-impact exercises, such as running, jumping, and competing sports, such as beginners, seniors, overweights, osteoporosis, arthritis, and other chronic illnesses. You should.

In particular, patients with peripheral neuropathy are not good at high-impact exercise, such as running or jogging, and physical contact is contraindicated in patients with proliferative retinopathy. Obese people are advised to swim, bike, water, and exercise with lower risk of joint damage.

Scuba diving, hang gliding, parashooting, and car racing are most likely to be caused by hypoglycemia or sudden hyperglycemia.

2) Intensity of movement

The intensity of the exercise should be set so that it does not overload, giving it enough stimulation to improve cardiopulmonary function. Exercise intensity is often determined based on maximal oxygen consumption reserve (VO2R) or heart rate reserve (HRR). Recommended exercise intensity is approximately 40-50 ~ 85%. If you are young and healthy, 50% to 85%. If you are older or have never exercised or have chronic illness, 40% to 50%. In other words, it is safe to exercise at a moderate intensity of 40-50% in diabetes.

The maximum free oxygen consumption is the maximum oxygen intake (VO2max) minus the stable oxygen intake, and the maximum free heart rate is the maximum heart rate (heart rate) minus the stable heart rate. Therefore, the target exercise intensity calculation is as follows.

  • Target oxygen consumption = exercise intensity (%) x (maximum oxygen consumption-stable oxygen consumption) + stable oxygen consumption
  • Target heart rate = exercise intensity (%) x (maximum heart rate-stable heart rate) + stable heart rate

Maximum oxygen consumption and maximum heart rate can be accurately measured by yourself. However, measuring directly requires equipment such as a gas analyzer. In most cases, it is realistic to apply the maximum heart rate using the estimation formula. People’s maximum heart rate is โ€˜220-ageโ€™ regardless of their physical strength.

Therefore, the estimated maximum heart rate is โ€˜220-ageโ€™. However, note that this is an error of 12 to 15 times per minute.

For example, let’s find the target heart rate for a 60-year-old man who has no athletic history with a steady heart rate of 70 beats per minute. First, your estimated maximum heart rate is 220-60, or 160. When trying to do moderate intensity workouts (40-50%), the target heart rate (THR) is:

  • Minimum Target Heart Rate: 40% x (160-70) + 70 = 106
  • Maximum target heart rate: 50% x (160-70) + 70 = 115

You can exercise enough to keep your heart rate at 106-115 per minute.

During exercise, heart rate is measured by multiplying the pulse rate for 10 seconds using the carotid artery in the neck or the radial artery in the wrist while walking or resting for 5 minutes. However, heart rate cannot be used as an indicator of exercise intensity in situations that affect exercise-related heart rate changes, such as beta-blockers, pregnancy, or autonomic complications. In this case, it is better to use subjective exercise intensity.

The subjective mark of how hard it is in units of 20 points is called the ratings of perceived exertion (RPE).

In other words, ‘comfort comfort’ is 0 points and ‘can’t do any more’ as 20 points, and the expressions such as ‘normal’, ‘slightly hard’, ‘tender’ are expressed as intermediate scores. Subjective exercise intensity is a measure developed by the psychologist Borg, and in healthy people, multiplying each score by 20 out of 10 gives an approximate heart rate. In general, high intensity corresponds to hard (15 points) and medium intensity corresponds to slightly hard (13 points).

Sometimes you can measure the intensity of your exercise. In moderate-intensity aerobic exercise, you breathe a little bit more than usual, and in high-intensity aerobic exercise, you breathe much more than usual. It is inaccurate to measure enough to sweat. This is because the degree of sweating varies from person to person.

Exercise intensity is also expressed as MET (metabolic equivalent). MET is defined as 1 MET, which is the amount of oxygen consumed by adults in a stable state, 3.5 ml / kg / min, and indicates how many times the intensity is.

Moderate physical activity is 3-6 METs, or 3-6 times more active than when you are at rest. For example, breaking news (3-4 mph or 4.8-6.4 km / h), biking (< 10 mph or less than 16 km / h) by fun or transportation, swimming, warming up (gymnastics), racquet sports, table tennis, golf (cart) Dragging, carrying clubs), fishing (standing fishing, tossing fishing lines), leisure canoeing, mowing with electric machines, and home repairing (painting).

3) Exercise time

A moderate amount of physical activity, over several minutes in total, for at least 30 minutes each day or nearly every day is effective in maintaining good health. However, to control your weight, it’s best to exercise at least 60 minutes a day.

You should warm up for 5 to 10 minutes before starting this exercise. Warm-up exercises help your muscles, heart, and lungs adapt to the condition that gradually becomes appropriate to exercise, preventing musculoskeletal injuries and cardiovascular disease during exercise. Warm-ups can be done at 50% of your low intensity walking or biking, or by stretching your muscles.

Then, after 30 minutes or more of this exercise, the exercise is organized. Clearing exercises should be performed for at least 5 to 10 minutes so that your heart rate gradually drops to pre-exercise levels to reduce the risk of cardio and musculoskeletal complications after exercise. In general, it is similar to a warm-up exercise, and walking, stretching and slowing are often used.

However, walking is the main exercise, and if you do not have enough time, you can skip the warm-up and grooming exercises and do this exercise. Even in this case, it is safe to walk slowly at first and later.

4) Exercise frequency

Medium intensity exercise should be done at least five times a week, almost every day. Type 1 diabetes is recommended to continue at a constant intensity and at a certain time each day. Because it is easy to control the amount of insulin injected.

5) Speed of movement increase

If you are in poor health, weak stamina, or beginners, gradually increase your workout. During the first two to six weeks, you should do it three times a week (daily in type 1 diabetes) as an adaptation period, but at a mild intensity. Stretching and doing a lot of light exercises are recommended. After the adaptation period, you can reach your target intensity in most cases.

Enhancement periods range from one to six months, with three to four workouts a week, increasing exercise intensity and duration every two to four weeks.

About six months later, you will exercise about 1,000 calories a week during your maintenance period. At this time, you should choose the sport you are interested in and keep on exercising. In other words, you should be able to work out at lunchtime or to break up on your commute. It’s also nice to have a partner who works out together, and even better with the help of a family.

2. Strength training method

Strength training improves strength, endurance, flexibility, body composition, lowers cardiovascular risk factors, and prevents diabetes. Therefore, diabetics also have the right to use strength exercises to prevent musculoskeletal pain and improve their quality of life.

Strength training is a strength and strength endurance exercise using your weight, dumbbells, weights, weight equipment or elastic bands (such as Theraband). To gain strength, you need to work out with a weight that is at least 2/3 of your maximum strength. Strength training Beginners are advised to exercise at 60% weight of their maximum abilities in order not to overdo it, and experienced ones can exercise at 80-100% of their maximum abilities. Maximum strength is the largest weight you can carry at one time, or 1 repetition maximum (RM).

The method of exercise depends on your purpose, but if you want to strengthen your strength, it is effective to do one to three sets of six to eight reps with 80-85% of your maximum strength. If your goal is to strengthen muscle endurance, we recommend 1-3 sets of 15-20 reps with weights less than 60% of your maximum strength. If your purpose is to build muscle power, that is, a strong force in a short time, it is recommended to set one to three repetitions of 3-5 times.

Strength training should be done 2-3 times a week. Your muscles, ligaments, tendons, and joints need to rest, and you need time to strengthen.

There are many ways to strengthen your muscles. The simplest way to do it is to: First, choose a weight that can only move eight times. This will vary from muscle to muscle. Perform two sets of eight movements. Muscle exercises in different parts of the body are performed in the same way. If you continue to exercise for weeks, you will be able to move the same weight 12-15 times. In this case, increase the weight to the weight that can move only eight times. Repeat in the same way.

Rest time is also important during strength training. In general, you should rest 1-2 minutes between sets for light weight workouts and 3-5 minutes or more for heavy ones. Short breaks will not allow your muscles to rest sufficiently, and long breaks will result in less warming up and injury.

In strength training, it’s best to exhale as you pull toward your body and to exhale when you move out of your body. If you’re not used to it, you can take care not to hold your breath.

Strength training is a good way to do all your major muscles. In other words, the upper body, back and shoulders, shoulders, chest, etc., torso, abdomen, side, waist, lower body should be before and after thigh, calf, hip muscles.

Necessity of examination before exercise

Before you work out, you need to predict in advance whether your workouts will deteriorate or hurt you. Because exercise has a good effect on the mind and body, but there is also a risk of adverse effects. Problems caused by exercise include heart attack, exacerbation of existing diseases, and damage to the musculoskeletal system. Therefore, before you exercise, you should identify your risk factors and take appropriate action.

Sudden deaths during exercise may be caused by damage to the head or chest, but most of them are caused by heart disease. The causes of cardiac death vary with age. In other words, under 35 years old, there are many anatomical congenital heart and blood vessel abnormalities. Therefore, you should check for congenital heart disease, blood vessel abnormalities, and arrhythmias before exercising. You should also check for ischemic heart disease such as angina or myocardial infarction, such as coronary artery disease and whether it is present but not likely.

It is difficult if the existing disease worsens by exercise. Therefore, people with diabetes, asthma, high blood pressure, infectious diseases, etc. should exercise carefully beforehand.

For example, if your blood sugar is over 290 mg / dl regardless of your diet, you may not want to exercise. Diabetics who are being treated with insulin should reduce their insulin doses to prevent hypoglycemia from exercise, and should be able to consume carbohydrates immediately once they develop symptoms of hypoglycemia. Also, on exercise days, injections should be placed in the abdomen rather than muscles, such as arms and legs, to prevent excessive insulin absorption.

When exercising outdoors, asthma sensitive to pollen requires precautions such as bronchodilators. Asthma is easily caused by exercise in cold weather, and myocardial infarction is also frequent, so exercise indoors if possible.

If you have high blood pressure or complications, you should refrain from exercising until it is controlled.

Exercise should be stopped during the acute phase of illness caused by infection. Even a simple illness, such as a cold, is a good idea to avoid exercising when you have a fever.

If you use anticholinergic drugs such as antispasmodics or antihistamines, you should be aware that sweating is suppressed and your body temperature can easily rise.

1. Examination before exercise

Before you work out, you need to predict in advance whether your workouts will deteriorate or hurt you. If you continue to exercise without any problem, you do not need to take a pre-workout test. However, even if you do not have symptoms, it is safe for you to have a pre-workout test if you have a high risk of heart.
A simple way to assess your pre-exercise risk is the Physical Activity Readiness Questionnaire (PAR-Q) developed in Canada.

The Physical Activity Readiness Questionnaire (PAR-Q)

  • Have you heard from your doctor that you have a heart disease?
  • Do you often feel pain in your chest?
  • Have you ever felt dizzy or severely dizzy?
  • Have you ever heard that your doctor has high blood pressure?
  • Have you ever heard from your doctor that you have joint or bone disease that worsens when you exercise?
  • Are there any other physical problems not listed above that you do not want to exercise?
  • Have you been 65 or older and have never exercised severely?

* If any of the above apply, it’s a good idea to see your doctor first before exercising.

2. Physical examination

Before you work out, it’s a good idea to determine your strength and type of exercise by measuring your fitness and physique. Exercise tests include basic body measurements such as height, weight, torso ratio and body fat, cardiopulmonary endurance, strength, muscle endurance, flexibility, balance, quickness, agility and coordination. Essential are cardiopulmonary endurance, strength and endurance, flexibility and balance.

1) Cardiopulmonary endurance

Cardiopulmonary endurance is assessed as the maximum oxygen intake. There are direct and indirect methods. The direct method is a method of directly measuring oxygen intake by analyzing a respiratory gas after maximum exercise load using a treadmill treadmill and a bicycle ergometer.

The indirect method measures heart rate at the maximum exercise load and estimates the maximum oxygen intake proportional to it.

2) Muscle strength and endurance

Muscle strength is isotonic muscle contractile force measured by bench press and leg press, and isometric muscle contractile force that measures gripping force or back muscle force using muscular dynamometer. (isokinetic) muscle strength.

Muscular endurance can be divided into dynamic and static. Dynamic muscular endurance can be measured by sit-ups, push-ups, sit-ups, etc. Static ones can be measured or suspended using a tension meter.

3) Flexibility

Children can be measured by sit and reach test, and adults can be measured by forward bending.

4) Equilibrium

You can measure easily with your unicycle with your eyes closed.

3. Contraindications to exercise

If you find exercise contraindications in your pre-workout practice, you should not exercise. As a rule, exercise is delayed if your blood sugar is above 290 mg / dl or below 60 mg / dl, regardless of whether you eat. You may want to postpone exercise even if your blood sugar is above 250mg / dl and you have ketoneosis. Exercise contraindications in diabetics are shown in the table below.

Exercise contraindications in diabetics

  • Long-term contraindications
    • Major heart disease
    • If you have autonomic neuropathy and orthostatic hypotension, cycling and swimming are good, but running and hiking should be avoided
    • Severe peripheral neuropathy
    • Retinopathy-prohibited sudden exercise of strength
  • Temporary contraindications
    • Blood sugar > 290 mg / dl or < 60 mg / dl
    • Hypoglycemia before exercise
    • Dehydration
    • Acute infection

* If any of the above apply, do not exercise or stop temporarily.

Exercise in Diabetes Complications

People with diabetes are advised to have a physical examination and examination before exercise to check for diabetes complications that may be exacerbated by exercise and for personal exercise prescription, especially the cardiovascular system, retina, kidney and nervous system.

1. Cardiovascular system

If you are going to have moderate or high intensity exercise, you may want to use progressive exercise ECG to determine whether you have cardiovascular disease.

  • Age over 35 years old
  • Type 2 diabetes more than 10 years old
  • Type 1 diabetes older than 15 years
  • Accompanied with other risk factors of coronary artery disease
  • Microangiopathy (retinopathy, nephropathy including microproteinuria)
  • Peripheral Vascular Disease
  • Autonomic neuropathy

If you have an abnormal finding on the ECG test, or if you have a non-specific ST and T wave abnormality on the steady state electrocardiogram, you should have a closer examination. It is recommended that a clinician determine whether an electrocardiogram should be taken.

2. Peripheral Arterial Disease

If you walk or exercise for a while, you may have a history of intermittent claudication that causes pain in your legs, cold feet, or atrophy of your subcutaneous fat.You should stop smoking if you have intermittent claudication. It’s a good idea to exercise under the guidance of an athlete, because touching the pulse doesn’t rule out foot ischemia, so if you suspect you should have a close examination, such as Doppler pressure measurements on your toes and ankles.

3. Fundamental Disease

Excessive intense exercise in patients with proliferative diabetic retinopathy can result in vitreous hemorrhage or tractional retinal detachment, so diabetics with proliferative retinopathy complications should be avoided.

4. Diabetic Nephropathy

Exercise prescriptions for diabetic nephropathy have not yet been developed and there is no evidence that high-intensity or high-intensity exercise can harm you, but I think it is safer to exercise less than moderately.

5. Diabetic Peripheral Neuropathy

If you have diabetic peripheral neuropathy, your foot sensation will be lost.If your foot is injured, it will not hurt, and you will be left to worsen. Repeated exercises can eventually lead to ulcers and fractures.

Low-impact exercises with less shock are recommended.Treadmills, jogging, climbing up and down stairs, and walking for long periods of time are not recommended, and weight-free exercises such as swimming, biking, rowing, and upper body exercises are recommended.

6. Autonomic Neuropathy

Autonomic neuropathy can impair motor performance and lead to circulatory disorders during exercise. Heart autonomic lesions have a steady state pulse (more than 100 beats per minute) or orthostatic hypotension (20 mmHg when standing more than sitting) Suspicion of abnormalities) and should be taken into account for symptoms of autonomic disorders of the skin, eyes, digestive organs and genitourinary system. Sudden death, asymptomatic myocardial infarction is common in patients with cardiac autonomic lesions.

Patients with autonomic neuropathy develop hypotension or hypertension after active exercise, and because of poor thermoregulation, do not exercise in a hot or cold environment and always drink plenty of fluids to prevent dehydration.

Risk of Exercise in Diabetes

Improper exercise by diabetics can lead to hypoglycemia, complications, and worsening high blood sugar, and worsening of heart disease that you did not know because of the usual symptoms. Therefore, it is necessary to follow exercise precautions. This risk is especially severe if you are receiving insulin treatment or have complications.

Type 1 diabetes is more likely to develop severe hypoglycemia within 6 to 14 hours after exercise, and even up to 24 hours are at risk of hypoglycemia. This is known to be due to increased insulin sensitivity after exercise and the active entry of glucose into the muscles. Patients with type 2 diabetes have a relatively low risk of developing hypoglycemia due to exercise, but when using oral hypoglycemic agents or insulin, you still need to consider the risk of hypoglycemia.

Patients with diabetes-related complications should be careful because exercise can make their complications worse. For example, ocular complications, ie, an increase in blood vessels in the retina, can result in bleeding from the eye due to vigorous exercise.

In addition, in extreme exercise, patients with poor blood sugar control may be able to exacerbate high blood sugar by increasing catecholamines (excited hormones) during exercise and inhibiting insulin action and increasing glucose synthesis in the liver. This free release may lead to an urgent complication called diabetic ketoacidosis.

Coronary artery disease, or arteries that supply blood to the heart muscle, is thinned by arteriosclerosis, resulting in angina or myocardial infarction. If the blood vessels are not narrowed by more than two-thirds, there are usually no symptoms. In particular, diabetics may not feel chest pain because their nerves become dull. Therefore, it is wise for patients who have been diabetic for a long time to check for cardiovascular complications, such as exercise ECG, before and after exercise, regardless of symptoms.

Exercise of diabetic patients

  • Hypoglycemia (when taking insulin or hypoglycemic agents)
  • Worsening of diabetic complications
    • Proliferative Retinopathy: Vitreous Bleeding, Retinal Detachment
    • Nephropathy: Increased proteinuria
    • Peripheral neuropathy: damage to muscles, tendons or joints
    • Autonomic Neuropathy: Dehydration, orthostatic hypotension
  • High blood sugar (when vigorous exercise)
  • Worsening of cardiovascular diseases: angina, myocardial infarction, arrhythmia, sudden death. Hypoglycemia

* Exercises for diabetics have many benefits, but there are risks that must be done with caution.

Points to note when exercising

The main problem with exercise is hypoglycemia. Patients, as well as guardians or colleagues who work out, should be aware of the symptoms of hypoglycemia in the usual way and should respond in case of an emergency. People who use insulin are more likely to develop hypoglycemia, even if they use diabetes medications.

Diabetics who are being treated with insulin should reduce their insulin doses to prevent hypoglycemia from exercise, and should be able to consume carbohydrates immediately once symptoms of hypoglycemia develop. Patients with autonomic neuropathy and digestive problems should consume carbohydrates, especially in the form of simple sugars. Simple sugars are found in sugar, candy, honey, chocolate, caramel, cola, yogurt, juice, apples, pears, grapes, canned lobsters, canned pineapples, and more.

If you’re struggling with exercise, try taking 15-30 g of carbohydrates (equivalent to a slice of bread or 60-120 calories of fruit or crackers) every 30 minutes and a carbohydrate snack right after your workout. Also, on exercise days, injections should be placed in the abdomen rather than muscles, such as arms and legs, to prevent excessive insulin absorption. If you have injected fast-acting insulin into your arm or leg muscles, it’s a good idea to exercise them after about an hour.

Do not exercise late in the evening as it increases your chances of developing nighttime hypoglycemia.

If your blood sugar is below 100 mg / dl before your workout, take a snack that contains 15-30 g of carbohydrates. It is best not to exercise on an empty stomach, so try to eat 2-3 hours before exercise.

When working with insulin-consuming diabetics, it is best to use insulin-prepared blood sugar data to control your insulin levels.
The second thing to notice is dehydration. Because dehydration raises blood sugar levels and impairs heart function, special care should be taken to prevent dehydration when exercising diabetics. If you’re going to work out on a hot day, or if you’re going to exercise longer, get 500 cc of water two hours before exercise, drink 1-2 cups 30 minutes before exercise, half a cup every 15 minutes during exercise, and drink as much weight as you lose after exercise. Must be replenished.

Care should also be taken to prevent foot damage from peripheral neuropathy. First of all, wear well-fitting shoes, check your feet regularly before and after exercise, and treat any problems early. To prevent foot damage, you should prevent blisters and keep your feet dry.

Drinking alcohol can accelerate hypoglycemia and encourage dehydration after exercise, so be careful.

Regular exercise not only lowers blood sugar, but also reduces weight and promotes blood circulation to prevent various complications. If you exercise, you can reduce insulin use by 5-10% compared to before. In addition, exercise will relieve mental and physical stress, giving you vitality and confidence in your life.

In conclusion, exercise is essential for diabetics because it helps regulate blood sugar and improves quality of life. However, because of the risks associated with exercise, you should use pre-workout examinations to identify coronary artery disease or complications and to exercise appropriately. In addition, precautions should be taken to prevent hypoglycemia, dehydration and foot damage.

Frequently Asked Question

1. What exercise should I do?

Aerobic exercise, such as walking, running, climbing, jumping rope, swimming, biking, and aerobics, is a good way to use oxygen constantly. If you don’t like your favorite exercise, walk, break, etc.
Walking; More than 45 minutes in total, almost daily
Breaking News: 30 minutes or more, almost every day
Strength training can also help. You can do dumbbells, rubber bands and weights.

2. When should I exercise?

The best time is between 30 minutes and 1 hour after eating.

Avoid fasting or pre-meal exercises.

If you are using insulin, you should consider losing insulin to prevent hypoglycemia from exercise, and avoid exercise within 60 to 90 minutes after insulin injection.

Have your own blood glucose measurements before and after your exercise to check for changes in your blood sugar.

3. What is the intensity of exercise?

40 to 50% of spare heart rate is moderate in intensity exercise for people with diabetes. In the following formula for determining your target heart rate, set your workout intensity to 40-50%. Your maximum heart rate can be estimated at โ€˜220-age.โ€™

If you’re having difficulty measuring your heart rate, it’s best to feel a little bit harder or colder than usual. (If you have autonomic neuropathy, or if you can affect your heart rate, such as beta-blocker blood pressure medications or pregnancy, you can’t estimate exercise intensity by heart rate.)

4. How many times a week do you want to exercise for a time?

Do this regularly at least five times a week (or daily if you need to lose weight). When you first start, start every two days and gradually increase.

Warm-up: Helps your muscles, heart, lungs, and joints adapt to your workout before you start. Do aerobic exercise and stretching, such as walking or cycling for about 5 to 10 minutes.

Main exercise: Following the warm-up exercise, the main exercise is performed for 30 minutes or more. If you are starting for the first time, only 15 minutes and slowly increase.

Clearing Exercise: Suddenly stopping exercise after this exercise increases the risk of cardio and musculoskeletal complications. Exercise at least 5-10 minutes to keep your heart rate slowly down to pre-workout levels. In general, it is similar to a warm-up exercise, and walking, stretching and slowing are often used.

5. What are the precautions when exercising?

If you have chronic complications of diabetes, you should consult with your doctor to determine how much exercise you will need based on the extent of the complications.

When it’s very hot or cold, it’s best to postpone exercise if you have poor blood sugar control (more than 250mg / dl of ketoneosis and your blood sugar is above 290mg / dl or less than 60mg / dl, regardless of ketoneosis).

Make sure you carry emergency foods (sugar, candy, honey, chocolate, caramel, cola, yagurt, juice, etc.) in preparation for the risk of low blood sugar.

Before and after each day, check your feet for any injuries, wash your feet clean, and dry them between your toes.

Wear comfortable sneakers that fit your feet to protect your feet and choose shoes with wider fronts to keep your toes wide.

When choosing a shoe, check the inside of your shoe for repeated irritation to see if it can hurt you.

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