Maria Ibarra couldn't control her blood sugar. Now 40, the Sacramento, California, medical records specialist was diagnosed with Type 2 diabetes five years ago and started on medication. But a year later her A1C -- a measure of blood sugar levels over time -- was rising. And that wasn't OK.
Ibarra came from a family with a strong history of diabetes (although they didn't talk much about it). She had seen what diabetes can do if unchecked. Her late mother, who'd lost a sister to the condition, took medication and walked for her health. But Ibarra's brothers, diagnosed as adults, suffered serious complications: Both have had toes amputated, and one is now blind. "So I knew what the future held," she says, "and I didn't want to be that."
Exercise on the Agenda
Medication to lower your blood glucose, a healthy diet and exercise are three mainstays of diabetes treatment. "Exercise provides multiple benefits," says Deborah Greenwood, president of the American Association of Diabetes Educators. "It lowers blood glucose, or blood sugar. It can lower blood pressure and lower blood fats -- and all of those are important in managing diabetes."
Among other complications, diabetes is a risk factor for cardiovascular conditions such as heart attack and stroke. "Physical activity helps all those pieces as well as weight loss, which is often an issue for people with Type 2 diabetes," Greenwood says. "Exercise is a free medication -- it's free treatment, if you will, for diabetes."
Exercise can boost endorphins, and over time, many patients are surprised to find how much working out improves their mood.
Seeking Help
At first, Ibarra thought she could get a handle on diabetes with routine care. But after a year with poor results, she knew she needed major lifestyle changes.
Diet was one issue. Raised on traditional Mexican cooking with plenty of rice, cutting calories and carbs wasn't easy for Ibarra. Exercise was the other area for improvement. Walking was her main activity, she says, but not that far or often -- maybe a mile or so a few times a week.
Her physician suggested classes. That's how Ibarra connected with Greenwood, the program coordinator and diabetes clinical nurse specialist with the Sutter Health Integrated Diabetes Education Network in Sacramento.
If you've been recently diagnosed with Type 2 diabetes, Greenwood says, you should meet with a diabetes educator, who can help you develop a personalized management plan. Insurers and Medicare cover diabetes education, she says, but it's vastly underused, so ask your physician for a referral.
Active and Aware
By working with a diabetes educator, Ibarra learned to connect the dots between when and what she eats, the activity she does and her blood glucose afterward. "My health is definitely better now," she says. "My A1C is well controlled, and so is my regular blood sugar."
These days, along with her younger daughter, she works out at the gym four or five days a week, splitting cardio between walking and an exercise bike. Then she makes the short circuit of weight machines. Ibarra sticks with her routine: "It keeps it simple and easy -- but wow, what a workout."
Fitbit is her friend. "It's really helped me stay accountable," she says. She tracks her daily 10,000 steps with the device and uses it to connect with her fitness buddies, including co-workers who don't necessarily have diabetes but also need a boost to stay active. They encourage one another with "Hey, keep going" messages.
If 'Exercise' Is a Four-Letter Word
You can't change certain diabetes risk factors, such as genetics or ethnicity. Although you can change obesity and a sedentary lifestyle, it's not easy -- especially if you don't like exercise and never have.
For an exercise plan to work, it has to be sustainable, says Dr. Edward Phillips, a specialist in physical medicine and rehabilitation, and founder and director of the Institute of Lifestyle Medicine at the Joslin Diabetes Center in Boston.
And, Phillips says, the person has to buy in. "What changes are you ready, able and willing to make?" is his approach with patients. "Exercise has a negative connotation for many, many people," Phillips says. "So people think, 'I have to sweat; I have to be out of breath. I have to put on that funny fabric -- I don't look good in it. I'm going to be embarrassed." They may carry memories of childhood hurts, like being picked last for teams at recess.
When Phillips picks this up in a patient, he tweaks his message: "'Did I say 'exercise?' How about: 'Could you just be a little more physically active?'" The attitude shift is "powerful," he says. "People get visibly calm and say, 'That sounds OK -- what do I have to do?'" Something like taking daily breaks from a sedentary desk job to go for a 10-minute walk can seem doable and ease people in.
The ideal workout plan combines aerobics, weightlifting and flexibility/stretching. But finding activities you enjoy (or can at least live with) matters most -- whether it's walking, dancing, hiking, swimming laps, gardening or spinning while watching your favorite TV show.
What to Keep in Mind
Compared with what people with Type 1 diabetesmust do to prepare for exercise, people with Type 2 have it relatively easy. But there are a few things to look out for.
"Taking care of your feet is important your whole life with diabetes, but especially in relation to exercise," Greenwood says. Along with checking your feet daily, she says, it's important to wear good-quality, comfortable shoes that fit well. People who have developed peripheral neuropathy -- a diabetes complication involving reduced sensation in their feet -- need to be even more careful. One suggestion is using seamless socks, which eliminate rubbing against the skin.
One of the great benefits of exercise is that it lowers blood sugar. If blood sugar gets too low, however, it's called hypoglycemia -- which needs to be treated. Remember to keep glucose tablets or a sugary snack handy while working out. If possible, Phillips says, work out with other people around, whether it's at a gym or with a running buddy outdoors, especially when you're just starting out.
Some Type 2 diabetes patients who modify their diet, ramp up their activity and lose excess weight may lower their blood sugar to the point that their oral medications can be reduced. "You would mindfully and carefully cut back on them," Phillips says. "We don't talk about curing -- we talk about reversing the diabetes."
Hang in There
If you've just learned you have diabetes and want to get active, Ibarra advises: "Start with small steps; something achievable. That's what I did." Four years ago, she says, walking 10 minutes left her "exhausted." But by tacking on another block here, an extra quarter mile there, she eventually built up to going three miles "without a problem." If she's ever tempted to slack off, her daughters hold her accountable. They'll check whether their mom has done her 10,000 steps that day, and if she's fallen a bit short, they say, "Let's go."
