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It’s 2 p.m. You ate lunch at your desk, and now your eyelids weigh heavy. If you’re living with diabetes or prediabetes, fat slump might be your blood sugar talking. If this isn’t you and you’re listening for someone else, a parent, a partner, a child, if you’re caring for someone with diabetes, you’re juggling their health on top of your own workday and worrying about them in between meetings, this episode is for you. Welcome back to 925 Wellness. I’m Aisha Tahir, a clinical exercise physiologist and a corporate wellness consultant. I’m speaking at Rhode Island World Diabetes Day Convention, which reminded me that the World Diabetes Day is coming up on November 14th as I was prepping the slides and prepping my speech. So I figured I want to talk to you guys about exercise as one of your most powerful prescriptions for diabetes and how to use it without the sugar crash. So let’s dive into it. Let’s start with the question I get asked most. Can you exercise with diabetes safely? Yes. For most people, exercise isn’t just safe, it’s one of the best things you can do for your diabetes. Regular movement helps control blood sugar, blood pressure, weight, and cholesterol, and that lowers your risk of diabetes-related complications. But safe comes with a little homework. Talk to your doctor before you start a new program, especially if you take insulin or sulfaneuria or other medications that lower blood sugar, or if you have heart, eye, foot, or nerve concerns. We’ll come back to why that heart piece matters so much. So, how does exercise actually help or actually work for patients with diabetes? Think of your muscles as the biggest fuel tank in your body. When you eat, carbs break down into glucose. Even if you don’t have carbs in your diet, everything in food breaks down. And normally it breaks down into some form of glucose, which is sugar. So then it enters your bloodstream. Your body’s job is to move that sugar out of your blood and into storage or use it as energy, mostly in your muscles if you are storing it. Normally, insulin is the key. It knocks on the muscle cell’s door and the cell opens gates to let sugar in. With type 2 diabetes, here’s where it becomes a little bit of an issue. The lock gets rusty. So glucose is knocking on the cell doors, and guess what? The cells aren’t opening up. That’s insulin resistance, because insulin helps you open those cells up. Insulin knocks, but the door only opens partway. So sugar backs up in your bloodstream, like rush hour traffic, with only one lane open. Here’s what I love: when your muscles contract, when you walk, squat, or climb the stairs, they open those gates on their own. Yes, you don’t need as much help of insulin to open those cell doors or cell gates. Your muscles and your body can now use glucose just on its own. No extra insulin needed. How awesome is that? It’s like your muscles have a backdoor, and the movement that you’re doing is the key. So do that consistently. And two things happen. Your cells get more sensitive to insulin. So the rusty lock starts working better, and your average blood sugar comes down over time. And that is what we want to happen within your physiology, within the healthy body’s physiology, and for you to stay healthier over time. Now, how does that show up? In your blood work, it shows up as a lower A1C. So, what is lower A1C? It’s also called hemoglobin A1C. On your cell walls, we go in and read how much sugar you can actually have or hold at a certain time. That’s the glucose. That is called your A1C levels. If you were to start moving or exercising for, let’s say, over two to three months. After that, you get your blood drawn, and you your doctor is like, okay, let me check your A1C levels. They look at it and they’re like, oh, Susan, what have you been doing? Because all of a sudden your A1C dropped, and I haven’t seen your blood work as healthy as it is right now. That’s exactly what you want, right? That two to three month snapshot that your doctor has been tracking, you want that to show lower A1C levels. Okay, now we have been talking about cardio a lot in our exercise physiology field and in medicine too, that oh, you should run, you should walk, you should cycle, you should swim. But now we have started shifting focus towards strength training, and there is a reason why. So I want to touch upon that. When you build muscle with resistance training or strength training, you’re literally building a bigger fuel tank. So your body has, you know, a fuel tank, right? Where you’re uh storing energy in form of carbohydrates mostly, andor glucose. So more muscle means more places to store sugar. Now that small little pantry that you had in the corner, it just grew bigger. And who doesn’t love that, right? More space to store sugar. And that sugar, actually, you can use it. That sugar or glucose, you can use it very readily for energy. So anytime you move your or you’re doing your work on your project at your desk, guess what’s being used? That glucose that’s stored in your muscle fibers because with resistance training, you worked hard and your muscle fibers grew bigger and more efficient at storing sugar. So we call that a glucose sink. Let’s get back to your heart, because that’s exactly where everything starts. Heart disease is the number one cause of death among people with type 2 diabetes. A cardiologist friend of mine was explaining it to me because I was like, hey, I need some help because I’m presenting at a World Diabetes Day Convention, and I need some help from you because I want to make sure I’m explaining it well to the patients over there. And he helped me understand it, and I want to share that with you. This is how my cardiologist friend explained it to me. Your heart is an engine, and your arteries are the fuel lines. High blood sugar and high cholesterol let gunk or plaque buildup in those fuel lines. So imagine, like you have those pipes running, right, within your body, which we are all familiar with that they’re they’re there, which are your arteries. And over time, if you’re not taking care of your health, you’re not moving, you’re not doing strength training, you’re not doing cardio exercise, guess what? That sugar builds up within your pipes. If that plaque ruptures, which we believe that, you know, if there’s too much plaque over time, it can form like a big ball and form a clot over time, and it will block blood flow to the heart muscle. That’s a heart attack. You’re like, hey, Aisha, I kind of knew about the mechanism of the heart attack, and I understand that. Here’s the part a lot of people are unaware of that people with diabetes have a higher risk of silent heart attacks. Silent heart attacks are the ones without the classic chest pain or symptoms of pain. Even though diabetics might be having a heart attack, they cannot feel many symptoms. And that means, guess what? If you can’t feel that something is off in your body, you’re not gonna call for help. You can you’re not gonna ask for help. That’s why it matters to have a good relationship with your doctor or cardiologist, especially if you or a loved one has diabetes. For some patients, we highly recommend that you know they should get further testing, especially a stress test, which I which is my like wheelhouse. So if you ever come to a cardiologist’s office for a stress test, you’ll be seeing me in New York City. Before starting more intense exercise, it’s always a good idea to get your stress test done just so that you know where your heart is, how the walls are looking from inside. Here’s the message of hope. Regular exercise and good nutrition can dramatically lower your heart attack risk and slow the progression of diabetes and heart disease. That’s early action in real life. Why does exercise sometimes raise blood sugar? If you’ve done a hard workout and watched your number climb, a lot of patients now wear CGMs and they often come to me and they’re like, we’re a little puzzled here because we’ve been working out, and if we sometimes when we work out, all of a sudden we’ll see our glucose levels shoot up. Don’t worry, there’s nothing wrong. I want to answer that question right here. Intense exercise triggers stress hormones like adrenaline and cortisol. They tell your liver to release stored sugar for fast fuel. It’s your body’s emergency energy system. That spike is usually temporary and comes back down afterwards. One of the reasons it can also happen is because while you’re working out, and if that workout is super intense, you’re dehydrated. So dehydration can make it worse too. Less water in your blood means the sugar is more concentrated, and everyday stress, like a deadline or a tense meeting, releases the same hormones, adrenaline and cortisol. And guess what? Yes, your inbox can raise your blood sugar too. Anytime you have high sugar levels in your blood, you’re gonna start seeing that CGM beep, that, oh, your blood sugar is high. And it releases the same stress response, just like when you eat sugary foods does. So try to keep your stress levels down. That’s another key for diabetics. And if you’re taking care of someone who has diabetes, something to be aware of and something to tell them. Next up, another question that I want to answer that I get so much from my patients is what does this look like in real life when your calendar has no white space? Like you are completely swamped with work. First, let’s look at the big picture targets from American Diabetes Association. Aim for 150 minutes of moderate aerobic activity. So 150 minutes a week of moderate aerobic activity. That’s brisk walking, cycling, swimming, or dancing. Add strength training two to three days a week to that moderate activity if you can. You’re like, I am already super busy though. We’re gonna talk about how we can make all of this work. I have a few strategies for you. But before I go into that, let me just address the intensity part. Because a lot of times people are like, how do I know that it’s moderate intensity? I’m not sure. Sometimes I feel like I’m going too easy. Sometimes I feel like I’m just going way too hard. I don’t know what we mean. What do you mean by moderate? So it’s easy to understand what moderate is. There’s a test that is called the talk test. You should be breathing hard enough that you can’t easily sing along to your music, but you can still talk. So it will be a little choppy. You might be a little winded, but you can still say sentences, a little choppy sentences. Okay. And if you want to learn more about exercise intensity, I have a full episode on RPE and heart rate training on the pod. It’s episode number 184. So give it a listen and you will learn a lot about intensity in that. Okay, back to diabetes and exercise. What exercise is best for diabetes? This is another question that I have been getting a lot of. And I know we all want to optimize exercise when we are short on time. So here is what an ideal exercise plan will look for a diabetic. The best plan is a combination of cardio and strength. Aerobic fitness, which is your cardio. We are talking about a rate of perceived exertion of four to six. Again, going back to that talk test, you should be able to talk or say sentences, but they would be choppy and you would feel winded. That is what you need as far as cardio is concerned. On top of that, I would like you to add at least two 30-minute strength training or resistance training exercise sessions. So that’s what I want you to strive for. Let’s talk about strength training. We do strength training to build that glucose sink. But don’t forget and don’t forget flexibility work like stretching, yoga, or tai chi, which is great for lowering stress. And swimming and cycling are especially great if your joints or feet need a break. Because I know a lot of diabetics have neuropathy. Neuropathy means nerve pain or shooting pain. And a lot of them feel it in their feet. So if you know it working out is hard for your feet, guess what? You can go for cycling or you can go for swimming. Both of them are very good activities to keep your heart healthy. At the same time, they’re very easy on your feet. One other reminder for all of you if you have neuropathy associated with diabetes. Make sure you have supportive socks and you have supportive shoes that help you bring that feeling back in your foot and it doesn’t aggravate your nerve pain. Okay, let’s come back to our exercise question. How much and what type of exercise you should be doing? Guess what? The best exercise is the one you’ll actually do. So if you’re just starting, start small. Even 4,000 steps a day is a great first goal. Then build slowly, don’t jump straight into high-intensity workouts. Here are my three desk friendly strategies. Okay, we’re gonna go over these quick. The first one is 101010 rule. 30 minutes a day looks like a lot because if it’s 150 minutes a week, divide that by five weekdays, it’s 30 minutes a day. And I know you guys are busy, so split it. Take a 10-minute walk after breakfast, after lunch and after dinner, or 10-minute walk after breakfast and lunch, and after dinner, lift weights for 10 minutes. That’s 30 minutes done. If you’re breaking your aerobic activity into 10-minute sessions, my suggestion is to do it post-meals because that’s when your blood sugar is gonna shoot up and that’s when you need it the most. Now, before I give you my second strategy, I want to share something that helps you further. I’ve been building a course on my website, Tone and Strengthen, called Exercise Prescription for Diabetes. And it drops the end of November, actually November 30th, to be specific and exact. Everything we touched on today, the science, the safety checks, how to build on your aerobic and strength training week by week. We go much deeper in that course step by step. So watch out for it. Follow me on Instagram, tone underscore and underscore strengthen, and you can learn more about it when it drops. Let’s get back to the strategies. My second strategy on the go is the chair squat strength check. No weights required. Stand in front of your chair, feet hip width apart, sit back slowly until you lightly touch the seat, then stand back up. Do 10 of those and try to take a squat break every hour. Do 10 every hour. If you’re working for eight hours, guess what? You have 80 squats in every day. Isn’t that awesome and easy? Okay, then you can also add, eventually, if you would like to, you can also add 10 counter push-ups or desktop push-ups against your desk. That’s it. Do this once or twice a day, or as I said, every hour, and you will start seeing how your fuel tank starts building up, which is your muscle mass, one squat and one push-up at a time. Third strategy: the stress reset. Remember, stress hormones raise blood sugar as well, and stress also makes you more likely to eat the whole bag of chips and skip the workout. So between meetings, take two minutes, roll your shoulders, stretch your hamstrings against the wall, and breathe. Yes, take a deep breath. In through your nose for four counts, out through your mouth for six. You’re calming your nervous system and helping your blood sugar at the same time. Now let’s make sure you can do all of this without the crash while staying safe. How do you stay active with diabetes and avoid crashes? The crash or the low blood sugar or hypoglycemia, as we like to call it, happens when sugar leaves your blood faster than your body can replace it. It’s most common if you take insulin or other medications alongside to lower your blood sugar. Okay, so some of the signs to look out for after your workout are shakiness, sweating, like uncontrollably, not the sweating that you have while you’re working out, erasing heartbeat. Yes, that’s something you should be watching out for. Sudden hunger, like you’re super hungry, if you’re irritable, or if you start feeling like you’re confused. So here are my golden rules I share with my patients and clients. Check your blood sugar about 30 minutes before you work out. Ideally, you want it to be between 100 and 250 milligrams per deciliter. You should carry your blood glucose monitor on you when you go for your workouts, if you don’t have a CGM on you. If your blood sugar levels are under 100, have a fast-acting carb snack like a small piece of fruit, like half an apple, half a banana, an apple, a few crackers, or a slice of bread. If you’re over 250, check for ketones. If ketones are present or you don’t feel well, hold off until your levels come down. Your care team can personalize these numbers. Check again after exercise two. Your muscles keep refilling these fuel tanks for hours, which can cause a delayed drop in your blood sugar. That’s especially important after evening workouts. So if you tend to work out in the later part of the day, like towards the end or at night before going to bed, make sure you check your blood sugar. Keep fast-acting sugar like glucose tabs or juice on your end table so that you know if you don’t feel well during the night, you can just drink that. Make sure that you recheck if you feel like your blood sugar is dropping. Drink water before, during, and after you move. If it’s too hot out, take your walk indoors at a cooler time of the day. Um, last one, this is a big one for desk workers. Take care of your feet. Diabetes can slow healing and raise your risk of infection as well. So if your walking shoes are actually dress shoes, switch them. Keep supportive sneakers and moisture wicking socks at your desk and check your feet for blisters or cuts. To wrap it all up, exercise is your early action prescription, not just exercise prescription. Your muscles are a built-in blood sugar sponge. Move them after meals, make them stronger a few times a week, and check your numbers so you can move with confidence instead of fear. And if today’s episode got you thinking, okay, I want a real plan for this, I’ve got something for you. I’ve been building a course on my website, Tone and Strengthen, called Exercise Prescription for Diabetes. And it drops end of November. Everything we touched on today, the science, the safety checks, how to build your aerobic and strength training week by week. We go much deeper there, step by step. And if you’re a caregiver, I’ll give you the tools to support your loved one without guessing. Keep an eye on my Instagram. My handle is tone underscore and underscore strengthen, and I’ll let you know the minute the course goes live. Quick reminder before we say goodbye, this episode is for education, not medical advice. Everybody and every diabetes plan is different. So talk with your doctor or diabetes care team before changing your exercise routine or medication. If this episode helped you, follow or subscribe to 925 Wellness wherever you listen to your podcasts. So you never miss an episode. And share it with someone in your life who’s managing diabetes or that coworker who always is fighting the 2 p.m. slump. I’m your host, Aisha Tahir. Thanks for spending part of your workday with me. Now go take that one minute walk. See you next time.