Module 8

EXERCISE IN DIABETES
 Contents
Sr. No Title Page No.

1 Introduction 2
2 Role of diabetes educator 2
3 Exercise 3
4 Pre-exercise assessment 5
5 Types of exercise 7
6 Setting realistic goals 10
7 Special considerations in people with 14
diabetes while exercising
8 Special populations and exercise 16
9 Starter walking plan 20
10 Role of yoga in diabetes 22
11 Maintenance of exercise programme 23
12 Summary 24

13 References 25
14 Role plays 26

1
 1. Introduction

It has been known since a long time that physical exercise has a positive
impact on diabetes. Exercise is the cornerstone for the management of
diabetes.1,2 Due to increased activity, the cells become more sensitive to
insulin and can work more efficiently. The body cells also remove glucose
from the blood during exercise. Hence, exercising consistently can lower
blood glucose levels and improve glycated haemoglobin (HbA1c). Lowering
of HbA1c also allows reduction in number of diabetes medication, including
3
insulin.
Unfortunately, majority of people with diabetes do not engage in
regular exercise. The reasons for not exercising could be due to lack of
awareness about exercise benefits or lack of time to incorporate daily
exercise in routine.

2. Role of diabetes educator

The role of diabetes educator (DE) is to:

• Highlight the importance of exercise as a part of mainstream
therapy for diabetes
• Motivate the patient to take up physical activity voluntarily
• Answer patient queries related to exercise in diabetes
management
• Discuss precautions prior to undertaking exercise
The aim of this module is to make the DE understand the importance of
exercise in prevention and management of diabetes, to discuss the health
benefits of physical activity, and to create awareness about the correct use
of different exercise modalities.

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 3. Exercise
It is well known that regular physical activity may prevent or delay diabetes
and its complications.4 Exercise along with diet, medication and education
forms the four pillars of diabetes management.
Being active is an important part of being healthy. Exercise not only means
strenuous workout in gym; a simple walk for 30 min/day can be also
considered as exercise. If done correctly as advised, exercise has immense
benefits in diabetes in terms of a positive effect on physical fitness,
morbidity and mortality.5
Overall benefits of exercise
• Improves cardiovascular health: Regular exercise
makes the heart stronger and the lungs fitter
• Reduces weight: Exercise, along with diet and
behavioural changes helps in weight loss and
maintains weight control over a long period of
time
• Improves blood cholesterol and blood pressure
levels
• Prevents coronary artery disease, osteoporosis,
diabetes, cancer, etc.
• Improves sleep and quality of life, reduces stress and improves self-
esteem
• Exercise may also help boost self-esteem by improving a person’s overall
health and appearance
• Improves physical fitness and stamina
• Exercise may also improve balance by increasing strength of the tissues
around joints and throughout the body, thus helping in preventing falls

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• side-effects
Benefits of exercise in diabetes

maintenance.6
• n

• Improves insulin sensitivity, improves glucose utilisation by th

body
•
• levels
•
(OADs)

4
 4. Pre-exercise assessment
Before increasing usual patterns of physical activity or prescribing an
exercise programme, the people with diabetes should undergo a detailed
medical evaluation with appropriate diagnostic tests. This assessment
should be aimed at screening for the presence of macro- and
microvascular complications that may be worsened by the exercise
programme. It is particularly important for patients who have not been
recently physically active and are intending to start exercising. Such
patients should see a healthcare professional in order to identify the
risks associated
exercise the means for managing these risks.7
with
and explore
A careful medical history with physical examination and laboratory
investigations should be performed to verify the following:
• Blood glucose control
• Stable cardiac function
• Normal kidney function
• Absence of retinopathy
• Healthy feet
Identification of areas of concern will allow
the design of an individualised exercise prescription that can minimise risk
to the patient.7
Tests for cardiac function assessment
The following are common tests for cardiac
assessment:
• Blood pressure
• Lipid profile
• Resting electrocardiogram (ECG)

5
• test)
• needed)

precipitated.7
When is stress testing recommended?
•
years
• years
• Presenc o a additiona ris facto fo coronar arter disease
suspected/know coronar arter disease
• Presenc o microvascula o neurologica complication o diabetes

6
 5. Types of exercise
Aerobic
exercises
Types of exercise can be classified into three
groups: aerobic, anaerobic and flexibility Exercise
types
Aerobic exercise Anaerobic Flexibility
exercises exercises

Aerobic exercise uses large muscle groups

that require oxygen for sustained periods.
Aerobic exercises help the body to use insulin better and reduce the risk of
heart disease by lowering blood pressure and blood glucose with
improvement in cholesterol levels. Brisk walking is probably the most
common form of aerobic exercise.
Other forms of aerobic activity include:
• Cycling
• Swimming
• Running
• Cross training
• Dancing, etc.4
It should be intense enough to increase the pulse rate and respiration
rate.8
Resistance (anaerobic) exercise
Resistance exercise uses large muscles that do not require oxygen for short
periods of exercise. Resistance exercises improve muscular strength and
stamina (endurance) and increase glucose
utilisation in the body.
These exercises include:
• Weight-lifting
• Dumbbells

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• Barbells
• Push-ups
4
• Pull-ups, etc.
It makes the body more sensitive to insulin and can lower blood glucose.
Resistance training does not necessarily require expensive equipment.
Progressive resistance training has shown benefits when people progress
to 3 sets of approximately 8 resistance type exercises at moderately high
intensity (8 repetitions at the maximum weight that can be lifted 8 times).
In resistance training, it is better to use repetitive light weights than heavy
weights.8
Flexibility exercises
They help by reducing the possibility of injury related to exercise. They
reduce stress by lowering counter-regulatory hormones. They also improve
insulin sensitivity and thereby lower blood glucose.8
Flexibility exercises keep the joints flexible, prevent stiffness and reduce
chances of injury.
Flexibility exercises include:
• Stretching
• Ballistic stretching
• Proprioceptive neuromuscular facilitation

Physical Activity Recommendations- ADA 2021

• Children and adolescents with type 1 or type 2 diabetes or prediabe-
tes should engage in 60 min/day or more of moderate- or vigor-
ous-intensity aerobic activity, with vigorous muscle strengthening
and bone-strengthening activities at least 3 days/ week.

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• Most adults with type 1 and type 2 diabetes should engage in 150
min or more of moderateto vigorous-intensity aerobic activity per
week, spread over at least 3 days/week, with no more than 2
consecutive days without activity. Shorter durations (mini-
mum75min/ week) of vigorous intensity or interval training may be
sufficient for younger and more physically fit individuals.

• Adults with type 1 and type 2 diabetes should engage in 2–3

sessions/week of resistance exercise on nonconsecutive days.
All adults, and particularly those with type 2 diabetes, should
decrease the amount of time spent in daily sedentary behavior.
Prolonged sitting should be interrupted every 30 min for blood
glucose benefits.

• Flexibility training and balance training are recommended 2–3

times/week for older adults with diabetes. Yoga and tai chi may be
included based on individual preferences to increase flexibility, mus-
cular strength, and balance.

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 6. Setting realistic goals

S M A R T
Setting realistic exercise goals is important
to achieve success. Goals should be
specific, measurable, achievable, realistic L

and timed.
Goals should be:
Specific Measurable Achievable Relevant Time-based

• Specific: Exactly what they will do?

• Measurable: How long, how often?
• Achievable: The person thinks he/she can do it
• Realistic: Appropriate for an individual's fitness level
• Timed: State when they will start
Encourage people to reward themselves when goals are met.
Suggest simple everyday activities to start with, such as:
• When going shopping, park at the far end of the parking lot
• Walk instead of going by car
• Cleaning the house
• Walking up one flight of stairs instead of taking the elevator
Tips to start physical activity
• While physical activity is important, it is
important that the activity is safe and
enjoyable for the person with diabetes
• The middle-aged and older individuals
with diabetes should be encouraged to be
physically active
• The ageing process leads to a degeneration of muscles, ligaments, bones

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 and joints; coupled with this, disuse and diabetes may exacerbate the
problem
• Before beginning any physical activity programme, the individual with
diabetes should be screened thoroughly for any underlying
complications as described above7
• The type, frequency, duration and intensity of exercise should be
adjusted according to individual fitness levels
• In general, training should be modulated to achieve an
energy expenditure of 1000–2000 calories/week and
150–500 calories/session

Fitness level Recommendations

Sedentary
Walking (2–2.5 mph or 3.2–4 km/h)
Household activities, walking downstairs, gardening (lifestyle exercise)
Sedentary individuals should start slowly. They can start by increasing daily
physical activity (for example, using stairs instead of elevators) plus daily short
sessions of between 5–10 mins

Active

Walking (3–3.5 mph or 4.8–5.6 km/h)

Light swimming, dancing, aquagym, walking up and down the stairs

Trained

Walking (4–5.5 mph or 6.4–8.8 km/h)

Moderate swimming, energetic dancing, tennis (singles), rowing

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Each exercise session should include a 5–10 min pre-exercise warm up and
a 5–10 min post-exercise cool down of low-intensity aerobic activity
(walking, cycling), and slow, rhythmic and stretching exercise to prepare
the skeletal muscles, heart and lungs for a progressive increase in exercise
intensity and to gradually bring the heart rate down following the activity.
Rate of progression

Initial conditioning of 4–6 weeks; if a person has not been physically active,
it may take him/her 4–6 weeks to become conditioned. The improvement
phase may last 4–5 months; over this time the person gradually builds up
the level of activity to his/her goal time and intensity.

Maintenance

For the initial exercise prescription in relation to the fitness level, together
with the appropriate screening of the person (medical history, physical
examination), it is important to determine the exercise habits using a valid
and appropriate assessment tool, such as a physical activity questionnaire
to rank individuals from the least to the most active.8
Before starting exercise

• If blood glucose is >252 mg/dL, strenuous exercise is not recommended

as it may cause the blood glucose to increase. If there is not enough
insulin in circulation, the liver will respond to exercise by releasing more
glucose. In type 1 diabetes, it may also lead to accelerated fat
catabolism and ketone formation
• If ketones are present, the person should NOT exercise
• Also, exercise is not recommended when an individual is sick
• To reduce the risk of hypoglycaemia, people on oral agents or insulin
should eat before exercising if the blood glucose is <108 mg/dL (at least

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 15 g of carbohydrates). More food may be needed during the exercise
• It is important to maintain adequate intake of water, especially when
exertion is prolonged or occurs in a hot environment
• Footwear must be appropriate to protect feet from injury and moisture
• Person with diabetes should wear some
form of diabetes identification, such as a
bracelet or carry an ID card. Exercise
partners should know how to recognise
and treat hypoglycaemia
• Carbohydrate food must be carried
together so that a glucose source is readily
available throughout the activity
• Prevention or treatment of hypoglycaemia is sometimes difficult when
physical under-water activities are undertaken, such as scuba diving,
hand gliding, rock climbing, etc.8

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 7. Special considerations in person
with diabetes while exercising

Hypoglycaemia
• In individuals taking insulin and/or insulin secretagogues, physical
activity can cause hypoglycaemia if medication dose or carbohydrate
consumption is not altered. This is particularly so at times when
exogenous insulin levels are at their peaks and if physical activity is
prolonged7
• Hypoglycaemia may occur for up to
24–36 hours following activity7
• It is recommended that additional
carbohydrates should be ingested if pre-
exercise glucose levels are <100 mg/dL,
especially for individuals on insulin and/or
an insulin secretagogues or combination
of these with other OADs7
• Hypoglycaemia is also a concern when the physical activity is
unplanned. As much as possible, physical activity should be planned for
and proactive changes made to insulin dose or carbohydrate intake8
• Common symptoms of hypoglycaemia include shakiness, weakness,
abnormal sweating, anxiety, tingling of mouth and hunger.
Neuroglycopaenic symptoms may include headache, visual disturbance,
confusion, seizures and coma8
Hyperglycaemia
• Common symptoms of hyperglycaemia include polyuria, increased
thirst, weakness, fatigue and acetone breath
• It is recommended that physical activity be avoided if fasting glucose

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 levels are >250 mg/dL and ketosis is
present
• However, if insulin deficiency is not
severe, light- or moderate-intensity
exercise would tend to decrease plasma
glucose
• Therefore, provided the patient feels well, the patient is adequately
hydrated, and urine and/or blood ketones are negative, it is not
necessary to postpone exercise based solely on hyperglycaemia7
• Dehydration resulting from polyuria, a common response of
hyperglycaemia leads to compromised thermoregulatory response
• Therefore, it is important to drink one cup of water every
20–30 mins during exercise, especially if it is hot and humid8

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 8. Special populations and exercise
In case of long-term diabetics who have developed micro- or macro-
vascular complications, exercise and physical activity must be planned
carefully. A detailed physical and laboratory evaluation to identify areas of
concern can help in developing an individual exercise plan for individuals
with long-term diabetic complications. Following section describes specific
areas of concern when prescribing exercise plan for people with diabetes.
Peripheral neuropathy
• These patients have loss of protective sensation in feet. Decreased pain
sensation in the extremities would result in increased risk of skin
breakdown and infection
• Therefore, in the presence of severe
peripheral neuropathy (foot injury or open
sore), it may be best to encourage non-
weight-bearing activities such as
swimming, bicycling, arm exercises and
moderate walking
• Weight-bearing exercises such as treadmill walking, prolonged 10

walking, jogging or step exercises should be avoided

• However, 150 min/week of moderate exercise can be permitted in
patients with milder forms of neuropathy
Autonomic neuropathy
•Regulation of blood pressure with
change in position may be lost causing
postural hypotension, impaired night
vision; impaired thirst, which
increases the risk of dehydration;
gastroparesis with unpredictable food

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 delivery and higher susceptibility to hypoglycaemia
• Cardiovascular autonomic neuropathy is also an independent risk factor
for cardiovascular death and silent myocardial ischaemia. Therefore,
individuals with diabetic autonomic neuropathy should undergo cardiac
investigation before beginning physical activity9,10
• Individuals with autonomic neuropathy are recommended to undergo
non-weight-bearing exercises and resistance training, and avoid weight-
bearing exercises8
Nephropathy
• Exercise that increases blood pressure, and therefore renal perfusion, is
contraindicated in people with
nephropathy8
• There is no evidence that vigorous
exercise increases the rate of progression
of diabetic kidney disease, and there
appears to be no need for specific exercise
restrictions for people with diabetic kidney
disease
• Since microalbuminuria and proteinuria are associated with increased
risk for cardiovascular disease, it is important to perform an exercise
ECG stress test in previously sedentary individuals with these conditions
before beginning exercise9
Diabetic retinopathy
• If proliferative diabetic retinopathy or
severe non-proliferative diabetic
retinopathy is present, then vigorous
aerobic or resistance exercise may be
contraindicated because of the risk of

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 triggering vitreous haemorrhage or retinal detachment
• Low-impact activities like swimming, walking, low-impact aerobics,
stationary cycling and endurance exercises can be performed
• Strenuous activities/pounding or jarring such as weight-lifting, jogging,
high-impact aerobics, isometric exercise or racquet sports are not
recommended8
• Patients who have undergone laser photocoagulation for proliferative
diabetic retinopathy are advised to wait for 3–6 months before initiating
or resuming resistance type of exercise10
Elderly people
• Exercise prevents decrease in insulin
sensitivity with ageing. Elderly diabetics
benefit from appropriate training with
improved metabolic responses
• Low intensity short duration aerobic
exercises, non-weight-bearing aerobic
exercises at least thrice/week and
resistance exercises at least twice/week may be performed
• Exercises involving vigorous movements, for e.g., jumping, jogging, sit-
ups, etc. are better avoided7
Obese individuals
• Exercise can help in losing intra-abdominal fat.
Resistance exercises promote weight
reduction7
• The recommended caloric expenditure is
300–500 kcal/day. Walking within tolerance
limit, non-weight-bearing activities and
resistance training along with aerobics are

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 recommended
• The target weight loss should be 5–10% of weight in initia

intensity
•

avoided8

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 9. Starter walking plan
Walking is a great way to exercise and has several advantages:
•

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 Table 1: Starter walking plan
Start out by keeping track of how much you currently walk for a few days.
Use a pedometer or a watch to determine how many minutes of walking you already do or how many steps you take.
From there, you can follow the following plan and add more walking into routine.

Start out slow, increase to a brisk walk, then cool down with a slow walk at the end.

Slow Brisk Slow Total per day

Daily walk Minutes Steps Minutes Steps Minutes Steps Minutes Steps

Week 1 5 500 0 0 5 500 10 0–1000

Week 2 5 500 5–8 500–800 5 500 15–18 1500–1800
Week 3 5 500 8–11 800–1100 5 500 18–21 1800–2100
Week 4 5 500 11–14 1100–1400 5 500 21–24 2100–2400
Week 5 5 500 14–17 1400–1700 5 500 24–27 2400–2700
Week 6 5 500 17–20 1700–2000 5 500 27–30 2700–3000
Week 7 5 500 20–25 2000–2500 5 500 30–35 3000–3500
Week 8 5 500 25–30 2500–3000 5 500 35–40 3500–4000
Week 9 5 500 30–35 3000–3500 5 500 40–45 4000–4500
Week 10 5 500 35–45 3500–4500 5 500 45–55 4500–5500
Week 11 5 500 45–55 4500–5500 5 500 55–65 5500–6500
Week 12+ 5 500 Maintain or continue to increase 5 500 Maintain or continue to
until you reach your goals! increase
Remember that the rate at which you increase your walking may be faster than or not as fast as the plan suggests.
What’s important is that you take it one day at a time and build up your walking stamina at a pace that’s comfortable for you.
Source: I hate to exercise, 2nd edition, by Charlotte Hayes - American Diabetes Association

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 10. Role of yoga in diabetes
There is inadequate data to prove the benefits of yoga in diabetes
management. Hence, yoga can be considered as an add-on to
recommended diabetes regimen.

Yoga may benefit diabetes by:

• Lowering fasting and postprandial
blood glucose levels and
maintaining good glycaemic status
for long periods of time
• Decreasing the drug requirement
• Decreasing the incidence of acute
complications like infection and
ketosis
• Decreasing the levels of free fatty acids, decreasing body fat percentage
and increasing the lean body mass
• Decreasing body weight (waist-hip ratio)
• Increasing the number of insulin receptors, thereby improving insulin
sensitivity and declining insulin resistance
• Beneficial effect on the co-morbid conditions like hypertension and
dyslipidaemia
• Meditation relieves stress, depression and anxiety, and improves
patient’s attitude and self-control12

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 11. Maintenance of exercise programme

Apart from developing a safe exercise programme considering

precautions, the following factors will ensure adherence:

• q

• n
e
m

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 12. Summary

• Regular exercise is a key determinant of glycaemic control

• Exercise not only helps to improve diabetes but also enhances quality of
life

• Weight training increases insulin sensitivity, strengthens muscles,

reduces obesity and cardiovascular risk

• Special precautions should be taken in diabetes patients with associated

co-morbidities

• Yoga is emerging as an important adjunct therapy in diabetes with

numerous health benefits

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 13. References

1. Thent ZC, Das S, Henry LJ. Role of exercise in the management of diabetes
mellitus: the global scenario. PLoS ONE 2013;8(11):e80436.
2. Horton ES. Role and management of exercise in diabetes mellitus. Diabetes
Care. 1988;11(2):201–211.
3. Physical activity is important. American Diabetes Association. April 09,
2015 . [Internet] Accessed on: July 19, 2015 . Available at: http:// www.
diabetes.org/food-and fitness/fitness/ physical-activity-is-important.html?
referrer=https://www. google.co.in/
4. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes.
Diabetes Care. 2010;33:e147–e167.
5. AADE. Practical diabetes mellitus. Pradeep Talwalkar.
6. Johnston BD. Benefits of Exercise. Merck Manual. 2015. [Internet] Accessed
on: July 19, 2015. Available at: http://www.merckmanuals.com/home
/fundamentals/exerciseandfitness/benefitsofexercise
7. Physical Activity/Exercise and Diabetes. American Diabetes Association.
Diabetes Care. 2004;27(1):S58–S62.
8. IDF education module 2011. International Diabetes Federation. Module 2-3 –
Physical activity.
9. American Diabetes Association. 5. Facilitating Behavior Change and Well-
being to Improve Health Outcomes: Standards of Medical Care in
Diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S53-S72.
10. Sigal RJ, Kenny GP, Wasserman, et al. Physical activity/ exercise and type 2
diabetes. Diabetes Care. 2006;29(6):1433–38.
11. Walking-a great place to start! American Diabetes Association. May 19,
2015 . [Internet] Accessed on: July 19, 2015. Available at:
http://www.diabetes.org/food-and-fitness/fitness/types-of-activity/walking-a-
great-place-to-start.html?referrer= https://www.google.co.in/
12. Sahay BK. Role of yoga in diabetes. JAPI. 2007;55:121–26.

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EXERCISE IN DIABETES
Role plays Module 8

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 14. Role play
Scenario 1: Vir is 21 year old boy with type 1 diabetes mellitus. His blood
glucose levels are not under control for the past few months. He wanted to
start gyming as he had heard exercise will help in controlling his blood
glucose levels. He has come to visit a diabetes educator

D.E.: Hello, how may I help you?

Vir: Hi, my blood glucose levels are not under control. They are always in
200 and 300 range. I want to start exercise to bring my blood glucose levels
under control. I have heard exercise helps in controlling blood glucose
levels.

D.E.: Yes, exercise plays a very important role in controlling blood glucose
levels. But you should not exercise if your blood glucose levels are above
250mg%.

Vir: Oh, why?

D.E.: This is because above 250mg%, ketosis has started and the body
is under stress. Exercising at this level will further increase the stress on
the body.

Vir: So what should be done?

D.E.: Firstly consult your doctor and a qualified dietician/nutritionist. Get

your blood glucose levels in control and then you can start working out.

Always check your blood glucose levels before workout. If it is <120mg%

before activity, have a fruit or a small snack (equivalent to 15g
carbohydrates).

If it is >240mg%, do not exercise. Have plenty of salty fluids like salted

lemon water, salted soups. Bring down the blood glucose levels and then
exercise. If it is above 180mg% you should not do any intensive activity.

Vir: Okay! Thank you so much.

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Scenario 2: Mr Rajesh is 40 year old man with diabetes and an ejection
fraction of 35%. He got very enthusiastic about his workouts and started
running which resulted in angina. His wife is very worried and has come to
the D.E

D.E.: Hello, please have a seat. How may I help you?

Mrs Renu: My husband has diabetes and an ejection fraction of 35%. He

gets very enthusiastic about his workouts and started running one day
inspite of the doctors warning him to go easy on workouts. This resulted in
angina and we had to hospitalize him immediately. He has put on a lot of
weight as has stopped working out completely and eats a lot of fried and
unhealthy food. Please explain to him the gravity of the situation.

D.E.: Mr Rajesh, it is good that you enjoy working out, however in your case
you need to go slow or else like you have experienced in the past you may
face that discomfort again and can also put your life at risk. Eat a healthy
balanced diet and start with a gradual walk. Stop when you feel tired. You
can start with a twenty minute low pace walk and gradually increase it to
40-45 minutes without increasing the speed. Make sure you sleep well and
manage stress better

Mr Rajesh: Thank you so much. I will follow what you say and come and
meet you next month to check my progress.

Mrs Renu: Thank you so much. I am feeling very relived after meeting you

Scenario 3: Mr. Kunal is 42 year old man with type 2 diabetes mellitus on
insulin for the past 1 year. He has started going to the gym to be fit and
active. Despite of doing regular exercise it comes high post exercise.
Hence, has come to visit a diabetes educator

D.E.: Hi, how may I help you?

Mr. Kunal: Hello, I am having diabetes for the past 7 years. I was put on
insulin one year ago. I have recently started exercising to control by blood
glucose levels. Whenever I check post exercise it is always high.

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D.E.: It is good that you have started exercising. What time do you go to the
gym and what time do you eat post exercise?

Mr. Kunal: I go to the gym at 6 in the evening. I do cardio and weight training
both till 7pm. I check my post exercise around 7.10-7.15pm and then
immediately have egg whites as I am very hungry.

D.E.: You should always check your blood glucose levels atleast 30mins
post exercise.

Scenario 4 : Master Ravi is a 13 year old boy with Type 1 diabetes. He goes
in hypoglycemia while playing down in the evening with his friends. His
post lunch blood glucose levels when checked are under control. His mom
(Ms. Dolly) is worried and has come to meet a diabetes educator.

D.E.: Hello, please have a seat. How may I help you?

Ms. Dolly: My son is having type 1 diabetes mellitus. He always goes in

hypoglycemia – 50 or 60mg% while playing with his friends in the evening.
I have checked his post lunch blood glucose levels, it is always under
control.

D.E.: Do you check his blood glucose levels before play?

Ms. Dolly: No I don’t. I only check post lunch.

D.E.: Always check blood glucose levels before play or any activity. If it is
<120mg%, then give him a fruit or any light snack (equivalent to 15g
carbohydrate). Check 30mins after completing the activity.

Ms. Dolly: Recently during the day also he is going in hypoglycemia atleast
3-4 times a week.

D.E.: If this is the case, then you can speak to the doctor and reduce his
basal dose of insulin or make sure you are giving him adequate
carbohydrates for his insulin.

Ms. Dolly: Okay! Thank you.

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Scenario 5 : Mr. Ryan is 45 year old man having type 2 diabetes mellitus for
the past 20 years. He was diagnosed with hypertension He also has a
history of retinopathy. He has been doing intense functional training. His
recent routine checkup showed microalbuminuria – 946.8 and albumin to
creatinine ratio 701.3. His wife (Ms. Setu) is worried and has come to visit a
diabetes educator

D.E.: Hello, how may I help you?

Ms. Setu: My husband is having type 2 diabetes mellitus and hypertension.

He also has a history of retinopathy. His recent routine checkup showed
microalbuminuria – 946.8 and albumin to creatinine ratio 701.3.

D.E.: He is following a healthy meal plan? Any physical activity he is doing?

Ms. Setu: He is not following a proper diet. He has been doing intense
functional training.

D.E.: He should not do resistance training as he is having hypertension and

history of retinopathy. Hypertension affects the kidney function and
microalbuminuria worsens the kidney function. He should take care of his
health at this moment as intense activity can damage the kidney and
worsen retinopathy. He can try alternate activities such as swimming or just
walking but nothing which is weight bearing.

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