Most people who smoke find it difficult to quit; assistance is available from a number of sources. Health care providers have access to self-help materials and can help select a quit date, provide contact information for local support groups, and prescribe nicotine replacement treatment or other medicines if needed.

DIET AND TYPE 2 DIABETES. Changing the type and amount of food eaten can help people with diabetes to lose weight, improve blood sugar levels, and lower blood cholesterol levels and blood pressure.

A separate topic discusses the role of diet including meal planning, carbohydrate counting, and alcohol intake in more detail. See "Patient education: Type 2 diabetes and diet Beyond the Basics ". The day-to-day management of blood sugar levels can be complicated. Planning and performing these activities take time.

Make sure to talk to your health care provider about how to prioritize these activities and fit them into your daily life. Setting a routine — Successful management of diabetes should not take the enjoyment out of life. At first, it can be difficult to establish a routine that incorporates all aspects of diabetes care, although many people find that the routine becomes second nature over time.

Written schedules may help some patients to remember the details of a routine until they are committed to memory.

Some people may find that making too many changes at once is overwhelming and prefer to gradually incorporate various aspects of diabetes care into their life. Aside from day-to-day routine, it is also important to carefully manage situations that can complicate blood sugar control, such as sick days and vacations.

You and your health care team should reevaluate your management plan periodically to make sure it seems appropriate and reasonable to you and fits into your daily life. Medication regimens — People with diabetes may need to take several medications throughout the day.

Medications to lower elevated blood pressure and cholesterol levels, as well as low-dose aspirin may be used to manage and prevent complications. Your health care provider should talk with you about the benefits and risks of your medications, and you should jointly decide which ones are right for you.

Any medication is most effective when it is taken exactly as prescribed. If the medication schedule is complex, a pill organizer or written outline may be helpful for remembering to take specific medications at specific times.

Medical costs — Medications and diabetes supplies can be expensive, particularly if insulin is required. Many people with diabetes ration their insulin because of the cost.

It is a good idea to share any concerns about medication-related and other costs with your health care provider so they can help find ways to reduce these costs.

A few strategies to reduce costs include switching to a similar medication that is covered by insurance; taking advantage of a specific low-cost program, coupon, or discount card; or applying for financial assistance. ROUTINE MEDICAL CARE IN TYPE 2 DIABETES. Making changes in diet and exercise are an important step in diabetes management.

However, routine medical care is also important for long-term health in people with diabetes, particularly for preventing, detecting, and slowing the progression of complications. A health care provider can recommend a regular schedule for visits and screening and monitoring tests based upon the duration of diabetes, any diabetes-related complications, and other medical problems.

People with diabetes also should receive routine vaccinations to help prevent common infections. See "Patient education: Vaccines for adults Beyond the Basics ".

Your health care team can also recommend screenings to detect health problems that do not cause symptoms in the early stages. These screenings include eye examinations, foot examinations, blood and urine tests, dental examinations, and electrocardiograms, if needed.

See "Patient education: Cervical cancer screening Beyond the Basics " and "Patient education: Breast cancer screening Beyond the Basics " and "Patient education: Bone density testing Beyond the Basics ". See "Patient education: Prostate cancer screening Beyond the Basics " and "Patient education: Bone density testing Beyond the Basics ".

See "Patient education: Screening for colorectal cancer Beyond the Basics ". DIABETES DISTRESS. People with diabetes have to perform many daily tasks to manage their blood sugar and optimize their health.

In addition to these daily demands, diabetes often gives rise to concerns including medical costs and long-term health. These obligations and concerns often cause feelings of frustration, burnout, and stress. If these feelings become overwhelming and make the daily management of diabetes difficult or impossible, they are described as "diabetes distress.

Many people with diabetes experience diabetes distress. It is important to tell your health care provider if you feel overwhelmed by diabetes and its management for any more than a week or two at a time. Your provider can help find strategies to reduce your stressors and ease your concerns.

They may also suggest that you speak with a health care provider who specializes in helping people with diabetes distress. Sharing your feelings with family, friends, or other people in your support network can help reduce diabetes distress. Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition.

These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Type 2 diabetes The Basics Patient education: Treatment for type 2 diabetes The Basics Patient education: Diabetes and diet The Basics Patient education: Lowering your risk of prediabetes and type 2 diabetes The Basics.

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Foot care for people with diabetes Beyond the Basics Patient education: Glucose monitoring in diabetes Beyond the Basics Patient education: Diabetic neuropathy Beyond the Basics Patient education: Quitting smoking Beyond the Basics Patient education: Peripheral artery disease and claudication Beyond the Basics Patient education: Type 2 diabetes and diet Beyond the Basics Patient education: Cervical cancer screening Beyond the Basics Patient education: Breast cancer screening Beyond the Basics Patient education: Bone density testing Beyond the Basics Patient education: Prostate cancer screening Beyond the Basics Patient education: Screening for colorectal cancer Beyond the Basics.

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based.

Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Exercise guidance in adults with diabetes mellitus Nutritional considerations in type 1 diabetes mellitus Nutritional considerations in type 2 diabetes mellitus Overview of general medical care in nonpregnant adults with diabetes mellitus.

Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Patient education: Exercise and medical care for people with type 2 diabetes Beyond the Basics.

Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. Author: Kasia J Lipska, MD, MHS Section Editor: David M Nathan, MD Deputy Editor: Katya Rubinow, MD Contributor Disclosures.

All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Jan 20, TYPE 2 DIABETES OVERVIEW Diabetes mellitus is a chronic condition, but people with diabetes can lead a full life while keeping their diabetes under control.

EXERCISE AND TYPE 2 DIABETES Getting regular physical activity is very important for good health. QUITTING SMOKING Over 25 percent of people newly diagnosed with diabetes actively smoke. DIET AND TYPE 2 DIABETES Changing the type and amount of food eaten can help people with diabetes to lose weight, improve blood sugar levels, and lower blood cholesterol levels and blood pressure.

ROUTINE MEDICAL CARE IN TYPE 2 DIABETES Making changes in diet and exercise are an important step in diabetes management. glucose-raising hormone levels. Will your child come home from school today and do homework for an hour or want to bike with friends for an hour?

No matter the age, you can help children stay active. For example, encouraging infants in active play to explore movement and their surroundings supports physical and mental development. For toddlers, 30 minutes or more of physical activity a day with no more than 60 minutes of sitting at a time will help promote motor skills and muscular development.

Your health care team can help you find the balance between activity, food and insulin. When testing on your own to learn about your reaction to different activities, keep a record of your activity and your numbers. Your health care team can use that data to suggest adjustments and refine your plan.

If you are having chronic lows or highs, they may need to alter your insulin dose or make a change in your meal plan. Managing Your Blood Glucose When Exercising Planning ahead and knowing how your blood glucose blood sugar and body respond to exercise can help you keep your blood glucose from going too low or too high.

What to Do When Your Blood Glucose is High Blood glucose can also run high during or after exercise, particularly when you do a high-intensity exercise that increases your stress hormone i. If your blood glucose is high before starting exercise, check your blood or urine for ketones.

If you test positive for ketones, avoid vigorous activity. If you do not have ketones in your blood or urine and you feel well, it should be fine to exercise. Infants and Toddlers No matter the age, you can help children stay active.

Check pre-exercise blood glucose levels in active children since a young child may not be able to verbalize the symptoms of a low. Young Children and Adolescents Children and adolescents should have at least 60 minutes or more of physical activity each day.

Type 2 Diabetes Decision Tree: for use by an exercise specialist with diabetes knowledge. A distinct PDF of this figure can be viewed in Additional file 5.

The following recommendations are from a recent international consensus statement on type 1 diabetes and exercise [ 24 ]. These situations significantly increase the risk of a more serious hypoglycaemic episode occurring during exercise.

If glucose is between 2. However, even after treatment, if starting glucose was 2. swimming, skiing, surfing, rock climbing etc. The Action Plan Fig. Figure 1 provides examples of foods that are classified as fast- and slow-acting carbohydrate.

Figure 1 provides specific guidelines for monitoring glucose after exercise. Measuring glucose before bed and setting an alarm to wake up and check blood glucose e. As mentioned previously, it is recommended that the glucose trend be established prior to exercising with two to three glucose measures.

The glucose target for the start of exercise for a person with type 1 diabetes should be individualized based on the intended type, duration and intensity of exercise, when medications were used and food consumed, the trend in glucose and exercise experience.

Figures 1 and 4 provide advice for when the starting glucose is outside this range and for carbohydrate consumption during exercise. Hyperglycaemia during or following exercise may be associated with ketosis due to absolute or relative insulin insufficiency. If small to moderate levels of blood ketones are present 0.

More substantial ketosis is an absolute contraindication and may require medical attention. The Action Plan provides specific recommendations for the possible scenarios based on these measures.

Dehydration can result from frequent urination due to hyperglycaemia and may lead to symptoms of heat illness, especially when exercising.

Remaining hydrated is especially important when the glucose level is high. Elevations in blood glucose are more likely following high-intensity or resistance exercise [ 39 , 40 ]. This is likely due a number of mechanisms including an increased stress response leading to hormones such as catecholamines inducing gluconeogenesis and glycogenolysis [ 41 ].

A prolonged aerobic cool down has been recommended to minimize glycaemic excursions [ 24 ]. The following recommendations for people with type 2 diabetes are consistent with a recent position statement from the American Diabetes Association.

Glucose between 4. For individuals aware of their own response to exercise with this starting glucose level, this may be sufficient.

For those new to exercise, with glucose between 4. Sulphonylureas are insulin secretagogues that increase the risk of hypoglycaemia during moderate to high-intensity exercise.

This will be dependent on the duration and intensity of exercise, the carbohydrate intake and the glucose level prior to the start of exercise. If night-time hypoglycaemia is likely, check the glucose level before sleep, once during the night e. If the glucose level is frequently within the red area of the Action Plan, a Diabetes Healthcare Professional should be consulted to review the factors that may be causing the sub-optimal glucose control.

Extra fluid intake is advised if exercising with high glucose. If the high glucose is due to missed medications, exercise at a low intensity and ensure that the person catches up on the missed dose as soon as possible.

If the high glucose level is due to acute illness or infection, postpone exercise. The interaction of exercise with diabetes medications other than insulin and sulphonylureas has not been well studied [ 14 , 25 ].

Drugs such as biguanides e. metformin , thiazolidinediones e. rosiglitazone , alpha-glucosidase inhibitors e. acarbose , sodium-glucose transporter-2 SGLT inhibitors e. dapagliflozin, empagliflozin and glucagon-like peptide 1 GLP-1 agonists e. exenatide are thought to have a minimal effect on increasing the risk of exercise-induced hypoglycaemia when used alone.

However, these drugs can potentiate the hypoglycaemia effects of insulin and sulphonylureas. It is recommended that regular glucose monitoring is only necessary in individuals taking any of these medications when starting or changing an exercise program.

A doctor, nurse practitioner or diabetes educator should be consulted prior to changing medication dose. The effect of diabetes on the response to exercise is dependent on many variables. Table 1 provides a number of considerations that will improve the safety of exercise for an individual with diabetes.

In summary, exercise has major and widespread benefits for people with diabetes. For most people with diabetes, exercise is safe and beneficial. Avoiding hypoglycaemia and circumstances which may promote ketosis is important.

Glucose monitoring before, during and after exercise may be needed to inform strategies and maintain stable and safe levels.

The resources presented here are provided to maximize the safety of exercise training for individuals with diabetes and to realize the potential health benefits of exercise. Chimen M, Kennedy A, Nirantharakumar K, Pang TT, Andrews R, Narendran P.

What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Article CAS Google Scholar.

Bohn B, Herbst A, Pfeifer M, Krakow D, Zimny S, Kopp F, et al. Impact of physical activity on glycemic control and prevalence of cardiovascular risk factors in adults with type 1 Diabetes: a cross-sectional multicenter study of 18, patients.

Diabetes Care. Article Google Scholar. LaPorte RE, Dorman JS, Tajima N, Cruickshanks KJ, Orchard TJ, Cavender DE, et al. Pittsburgh insulin-dependent diabetes mellitus morbidity and mortality study: physical activity and diabetic complications.

CAS PubMed Google Scholar. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Lascar N, Kennedy A, Hancock B, Jenkins D, Andrews RC, Greenfield S, et al. Attitudes and barriers to exercise in adults with type 1 diabetes T1DM and how best to address them: a qualitative study.

PLoS One. Guyton HJE. Hall textbook of medical physiology Guyton physiology. Philadelphia, PA, USA: Elsevier; Google Scholar. Riddell M, Perkins BA.

Exercise and glucose metabolism in persons with diabetes mellitus: perspectives on the role for continuous glucose monitoring. J Diabetes Sci Technol. McMahon SK, Ferreira LD, Ratnam N, Davey RJ, Youngs LM, Davis EA, et al.

Glucose requirements to maintain euglycemia after moderate-intensity afternoon exercise in adolescents with type 1 diabetes are increased in a biphasic manner.

J Clin Endocrinol Metab. Briscoe VJ, Tate DB, Davis SN. Type 1 diabetes: exercise and hypoglycemia. Appl Physiol Nutr Metab. Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure in diabetes.

N Engl J Med. Segel SA, Paramore DS, Cryer PE. Hypoglycemia-associated autonomic failure in advanced type 2 diabetes. Hawley JA, Lessard SJ. Exercise training-induced improvements in insulin action. Acta Physiol Oxf.

Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al.

Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Mendes R, Sousa N, Almeida A, Subtil P, Guedes-Marques F, Reis VM, et al.

Exercise prescription for patients with type 2 diabetes-a synthesis of international recommendations: narrative review. Br J Sports Med. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al.

Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association ADA and the European Association for the Study of Diabetes EASD.

ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the task force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology ESC and developed in collaboration with the European Association for the Study of Diabetes EASD.

Eur Heart J. Hordern MD, Dunstan DW, Prins JB, Baker MK, Singh MA, Coombes JS. Exercise prescription for patients with type 2 diabetes and pre-diabetes: a position statement from Exercise and sport science Australia.

J Sci Med Sport. Plotnikoff RC, Taylor LM, Wilson PM, Courneya KS, Sigal RJ, Birkett N, et al. Factors associated with physical activity in Canadian adults with diabetes.

Med Sci Sports Exerc. Vancampfort D, Stubbs B. Physical activity and metabolic disease among people with affective disorders: Prevention, management and implementation. J Affect Disord. Mikines KJ, Sonne B, Farrell PA, Tronier B, Galbo H. Effect of physical exercise on sensitivity and responsiveness to insulin in humans.

Am J Phys. CAS Google Scholar. DeFronzo R, Fleming GA, Chen K, Bicsak TA. Metformin-associated lactic acidosis: current perspectives on causes and risk. Lalau JD, Kajbaf F, Protti A, Christensen MM, De Broe ME, Wiernsperger N. Metformin-associated lactic acidosis MALA : moving towards a new paradigm.

Diabetes Obes Metab. Riddell MC, Gallen IW, Smart CE, Taplin CE, Adolfsson P, Lumb AN, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. Zinman B, Ruderman N, Campaigne BN, Devlin JT, Schneider SH, American Diabetes A.

PubMed Google Scholar. American College of Sports Medicine. ACSM's guidleines for exercise testing and prescription. Batimore: Wolters Kluwer; If your blood glucose is trending down before a workout, have a pre-exercise snack.

Always carry a carbohydrate food or drink like juice or glucose tabs that will quickly raise your blood glucose. It may take a while to figure out what works best for you. This is especially important if you took insulin recently and if you will be exercising for longer than 30 minutes.

If you use an insulin pump, you may be able to avoid adding an extra snack by lowering your basal insulin rate during the activity. And if you have repeated problems with your blood glucose dropping during or after exercise, consult your doctor.

Blood glucose can also run high during or after exercise, particularly when you do a high-intensity exercise that increases your stress hormone i. glucose-raising hormone levels. Will your child come home from school today and do homework for an hour or want to bike with friends for an hour?

No matter the age, you can help children stay active. For example, encouraging infants in active play to explore movement and their surroundings supports physical and mental development. Exercise helps control weight, lower blood pressure, lower harmful LDL cholesterol and triglycerides, raise healthy HDL cholesterol, strengthen muscles and bones, reduce anxiety, and improve your general well-being.

There are added benefits for people with diabetes: exercise lowers blood glucose levels and boosts your body's sensitivity to insulin, countering insulin resistance.

Many studies underscore these and other benefits from exercise. Following are some highlights of those results:. In general, the best time to exercise is one to three hours after eating, when your blood sugar level is likely to be higher.

If you use insulin, it's important to test your blood sugar before exercising. Testing again 30 minutes later will show whether your blood sugar level is stable.

It's also a good idea to check your blood sugar after any particularly grueling workout or activity. If you're taking insulin, your risk of developing hypoglycemia may be highest six to 12 hours after exercising.

Because of the dangers associated with diabetes, always wear a medical alert bracelet indicating that you have diabetes and whether you take insulin. Also keep hard candy or glucose tablets with you while exercising in case your blood sugar drops precipitously.

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