To diabetics: `Think of exercise as insulin'

Medical Matters

Medicine & Science

April 05, 2004|By Judy Foreman | Judy Foreman,SPECIAL TO THE SUN

FOR ORDINARY mortals, just finishing an Ironman Triathlon is almost unimaginable. You swim 2.4 miles, dodging hundreds of other adrenalin-crazed swimmers, then hop on your bike to pedal for 112 miles, then don running shoes and run, jog or limp your way through an entire marathon, all 26.2 grueling miles. If you actually want to win, it takes roughly nine hours.

But Jay Handy, 41, a financial adviser at Merrill Lynch in Madison, Wis., not only did all this - albeit more slowly than the winners - but he did it with Type 1 diabetes, which he has had since he was 13.

Diabetes, which is on the rise and strikes an estimated 18.2 million Americans, is a nasty disease in which the body doesn't make enough insulin, a hormone made in the pancreas that helps glucose, or sugar, get from the blood into muscles.

It's the sixth leading cause of death in the United States and the leading cause of adult blindness. It can lead to kidney failure and, when circulation to the extremities fails, to amputations.

In the old days, people with diabetes were often cautioned not to exert themselves, lest their blood sugar fall too low. But the thinking today is that, with some cautions, exercise is at least as crucial for people with diabetes as for those without it.

"Everybody with diabetes should be exercising as much as possible," said Dr. Christopher Saudek, a diabetologist at the Johns Hopkins University School of Medicine and former president of the American Diabetes Association. "The quip we use is that people with diabetes should ask their doctor before they stop exercising."

In Type 1 diabetes, the body makes no insulin, which means a person must monitor blood sugar several times a day and take insulin injections.

In the more common Type 2, which accounts for 90 percent of all diabetes in the United States, a person becomes "insulin resistant," meaning the body doesn't respond to insulin. Type 2 can sometimes be controlled by diet and exercise alone.

In people with diabetes, as in others, exercise makes the body more sensitive to insulin, which means less insulin is needed to escort sugar into cells. So diabetics might have to cut back on insulin before they exercise.

"Think of exercise as insulin," said Dr. Om Ganda, an endocrinologist at the Joslin Diabetes Center in Boston. With exercise, you can "get away with less insulin so the pancreas doesn't have to exhaust itself" trying to make enough.

The cautions for diabetics who want to exercise:

Because diabetes significantly raises the risk of heart disease, anyone with diabetes should have his or her heart checked by a doctor before beginning an exercise program.

Diabetic neuropathy also means that people with diabetes might not notice incipient blisters on the feet, which can become infected, and poor circulation can result in gangrene. Diabetics should check their feet often. Medicare will pay for special shoes if you are over age 65.

Diabetics should have their eyes checked because of diabetic retinopathy, in which blood vessels in the eye become leaky. Running or other high-impact sports can make this worse.

In some cases, regular exercise can get rid of the need for insulin in Type 2 diabetes.

"Fitness or how much you exercise is way, way more important than how much you weigh," said Dr. Timothy S. Church, medical director of the Cooper Institute in Dallas.

As for Jay Handy, he finished last fall's Ironman Wisconsin "dead last, but still alive." Excruciating leg cramps forced him off his bike several times. By the time he finished - 17 hours - the race crew was loading equipment into trucks.

But as he would write later: "I focused on the sheer ability to finish. I could never hold myself as an example to diabetic kids if I just quit."

Judy Foreman is a lecturer on medicine at Harvard Medical School.

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