• 29Sep

    A Diabetics Guide To Health, Fitness and Wellbeing

    I thought it was time that I updated a blog I posted over 2 years ago 


    WARNING This blog is long and you may need time to read it. If you would like to read it at your leisure then download the pdf here


    Other than obesity diabetes mellitus is the biggest diagnosed condition seen by GPs today. There has been plenty of news over the last couple of years including an announcement that £4m is being given to research to find a vaccine for type I diabetes. And a link between lack of sleep and diabetes although lack of sleep can be linked to a number of other health issues. For the purpose of this blog, we will focus on type I and type II diabetes only.




    Diabetes Mellitus


    So what is Diabetes Mellitus?


    It is characterised by an altered utilisation of glucose by the body tissues due to insufficient activity or insufficient levels of the hormone insulin.Insulin has its greatest effects on the liver, adipose tissue, and muscular tissue.


    Insulin mediates the entrance of glucose into the cells in the liver for glucose synthesis, in the adipose tissue for glycerol synthesis and in the muscle for energy production and/or glucose synthesis.


    There are risks associated with diabetes. Diabetics not only suffer from the direct metabolic effects of inadequately controlled glucose metabolic such as diabetic coma and occasional accidental insulin overdosing, but they also suffer knock-on consequences:


    • Microvascular disease is also associated with high levels of circulatory glucose resulting in eye disease (retinopathy), renal disease (nephropathy) and peripheral vascular disease of fingers and toes.

    • Diabetics have a poor serum lipoprotein i.e. LDL/HDL ratio. Free Fatty Acid (FFA) metabolism is dependent on efficient carbohydrate catabolism and therefore, in diabetes, higher levels of free circulatory fats are found together with their deleterious cardiovascular consequences, i.e., atherosclerosis…
    • Damage to nerves, especially in the extremities (peripheral neuropathy). Your feet and vision will need to be checked before diabetics start an exercise prescription as they may not feel blisters developing.
    As you can see the diabetic has a lot to risk from poor control and the easier the control of the condition, the better is the long-term prospect for management and quality of life.


    Types of diabetes

    Type 1:

    Insulin Dependent Diabetes Mellitus (IDDM) affects about 10% of people, mainly 25 years old or under. It is infrequent within family history and the appearance of symptoms is rapid. They will always use insulin and their body fatness is lean.




    Type 2:

    Non-Insulin Dependent Diabetes Mellitus (NIDDM) used to be called “adult-onset diabetes” because of diabetes risk and occurrence increase after the age of 40. More and more young people are now diagnosed with this condition. At least 2% of 20 – 39year olds have type 2 diabetes; over 200,000 new cases are diagnosed each year. Thus, type 2 diabetes is something people should be aware of at any age.


    In both cases, uncontrolled blood sugar levels can eventually lead to glycation of proteins in the body (the proteins get “gummed up” with sugar and fail to function properly), to organ damage and eventually organ failure. Among people with diabetes, the risk of premature death is about twice that of people without diabetes of similar age. High blood sugar levels eventually degenerate the eyes, leading to something called diabetic retinopathy; diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years old. At least 65% of people with diabetes die from some form of cardiovascular disease.






    Potential complications associated with diabetes include:

  • Growth impairment
  • Ketoacidosis
  • Greater infant mortality (gestational diabetes)
  • Eye disease
  • Kidney disease
  • Non-functional intestines
  • Nervous system disorders
  • Amputations
  • Stroke
  • Cardiovascular diseases
  • High blood pressure
  • What are the symptoms of diabetes?

    Hypoglycemia (low) 

  • Pallor
  • Excessive sweating
  • Shakes
  • Falling
  • Dizziness
  • Faintness
  • Double vision
  • “Drunk” appearance
  • Slurred speech
  • Confused
  • Hunger
  • Weakness
  • Irritability
  • Headache
  • Tingling
  • Nausea
  • Hyperglycemia (high)

  • Excessive thirst
  • Excessive urination
  • Drowsiness
  • Sweet smell on breath
  • Excessive hunger
  • Weight loss
  • Weakness


    • Urinary ketones




    If you have any or all of the symptoms in one particular category (high or low) please contact your local GP or medical practitioner so that tests can do as quickly as possible. The therapy for Diabetes Mellitus is aimed at the normalisation of blood glucose through a combination of diet, medication, and exercise.





    Physical activity/exercise is good for diabetics but caution must be taken. You should not take part in exercise unless your diabetes is treated and stable. I strongly recommend that there is regular monitoring of blood glucose levels.




  • If your pre-exercise blood glucose level is <4.4 mmol/l you should have a small snack containing 15 – 30g of carbohydrates then wait for 10 – 15 minutes before retaking blood glucose. If the post-snack level of blood glucose is within the ideal range, you can commence the exercise session.
  • The ideal pre-exercise glucose level is 6 – 10 mmol/l.
  • If your pre-exercise level is >13.8 mmol/l with urinary ketones you should not do any exercise until levels are within the 6 – 10 mmol/l range. Review your diabetic control mechanisms (with your GP or medical practitioner if necessary) to ensure a reduction in your pre-exercise blood glucose level (to within the ideal range) prior to the next exercise session. Remember during this period you should try to live a healthier lifestyle and do normal daily activities.



    As a youth, one of my sporting heroes was Gary Mabbutt. He was captain of Tottenham Hotspurs and became the first diabetic to play for England. One of my client heroes was also diabetic but she didn’t let it hold her back in achieving her goal to play for England Deaf Ladies and Great Britain Deaf Ladies football teams. They both monitored their levels prior to exercise and I am sure that there are others in the sports world regularly check their levels before exercising or entering the field of battle.




    Specific considerations for type 1 (IDDM)

  • Monitor blood glucose levels regularly: Before during and after exercise for the first 3 exercise sessions.
  • Bring carbohydrate snacks (your choice) to boost blood glucose levels when necessary.
  • Avoid exercise in the late evening – there must be at least 3 hours of recovery before you sleep.
  • You may need to reduce insulin levels (with professional advice).
  • Use non-exercising sites for injection.
  • Avoid exercising for one hour, those muscles which may have had short-acting insulin injected.
  • Exercise at the same time of day. This will help regulate blood sugar levels.



    Specific consideration for Type 2 (NIDDM)

  • Monitor blood glucose levels regularly (if possible): Before, during and after exercise for at least the 1st 3 exercise sessions.
  • Extra carbohydrate is often not necessary, but you must bring snacks.
  • Exercise at the same time of the day.
  • Many simple behaviours and lifestyle modifications can reduce the risk of developing diabetes, including
  • Maintain a healthy body fat percentage (under 15% for men and under 22% for women)
  • Space meals evenly
  • Avoid or minimise alcohol intake (fewer than 5 drinks per week)
  • Eat one to two servings of vegetables with nearly every meal.
  • Eat at least 25 grams of fibre per day from a variety of food sources
  • Eat lean protein at most (if not all) meals (about 20 – 30g per meal for women and 40 – 60g for men
  • Avoid trans-fat consumption (aim for) trans-fat per day)
  • Exercise at least 3 – 5 hours per week, using a combination of resistance exercise and aerobic exercise
  • Minimise refined and high-sugar carbohydrates
  • Eat/supplement with foods containing omega-3 fats, including fish oil supplements Be careful of professionals who make blanket statements about “low-carb” or “low-fat” diets being best for all diabetics. These claims are unsubstantiated. Many different strategies have been shown to work as long as they adhere to the general principles above.



    Exercise Guidelines





    Before starting an exercise programme please consult your doctor so that they can help monitor your condition. Remember to refer to pre-exercise blood glucose levels. Do not exercise within 3 hours of intended sleep. Do not exercise if you have a physical illness or infection.



    The goal is to improve muscular conditioning, therefore, increasing insulin/glucose sensitivity; reduce body fat (type 2); lower CHD profile; Increase quality of life; increase cardiovascular conditioning; improving balance and coordination (type 1).


    Start with large muscle activities (partial weight bearing or non-weight bearing exercises) such as walking or cycling (loosen or remove foot straps). This can be progressed to the using of X-training, rowing, stepping and running. A further progression can be made to group-based aerobics, swimming, and water aerobics.



    Aerobic (Cardio)

    Aim for 20 – 60 mins per session 4 – 7 days per week (at the same time of day) at an intensity that is fairly light building up to somewhat hard.


    Start with machine weights and then progress to free weights. 1 – 3 sets (or circuits) of 10 – 12 reps progressing to a higher level if interested in sports/performance.



    Aim for 2 – 3 days per week (same time of day) but not on consecutive days.


    For your FREE guide to Machine Based Weights click here






    • The following vitamins and minerals should either be eaten or taken, remember to stay within your blood sugar levels. If you need a specific meal plan then please contact a registered dietician with experience working with people who have a similar condition to you. We do have a selection of low-carb recipes for you to try here


    Foods rich in thiamine include

    • Asparagus
    • Lettuce
    • Mushrooms
    • Spinach
    • Sunflower seeds

    • Tuna

    • Peas
    • Tomatoes
    • Eggplant
    • Brussels sprouts
    • Lentils
    • Whole grains





    Foods rich in riboflavin include

  • Mushrooms
  • Asparagus
  • Lettuce
  • Spinach and other leafy vegetables
  • Eggs
  • Yogurt
  • Almonds
  • Salmon
  • Halibut
  • Whole grains



    VITAMIN B6 (PYRIDOXINE) (hypoglycaemia)

    Foods rich in pyridoxine include

  • Potatoes
  • Bananas
  • Beans
  • Oats
  • Seeds
  • Spinach
  • Trout
  • Avocado
  • Tuna
  • Salmon
  • Peanut butter
  • Walnuts
  • Hazelnuts


    Foods rich in folic acid include

  • Beans
  • Citrus fruits
  • Whole grains
  • Green leafy vegetables
  • Beets
  • Cauliflower
  • Lettuce
  • Asparagus
  • Note that “folate” is found in foods while “folic acid” is a synthetic supplement.




    VITAMIN B12 (COBALAMIN) (if taking metformin)

    Foods rich in cobalamin include

  • Trout
  • Salmon
  • Beef
  • Yogurt
  • Tuna
  • Eggs
  • Clams
  • Crab
  • Rockfish
  • Fermented foods
  • B12 fortified foods.
  • Click here for your FREE low-carb recipe pack





    Foods rich in chloride include

  • Whole grains
  • Whole fruits
  • Vegetables
  • Lean meats
  • Legumes
  • Nuts/seeds.
  • In addition, foods with salt as a flavour enhancer provide higher amounts of chloride. However, these foods, such as crisps, boxed pasta, soup, pretzels, deli meats, pickles etc. aren’t recommended. A majority of the sodium and chloride in the diet comes from salt. A lower salt intake is associated with diets that emphasise unprocessed foods




    Foods rich in chromium include

  • Broccoli
  • Potatoes
  • Whole grains
  • Meat
  • Apples
  • Green beans
  • Bananas
  • Onions
  • Tomatoes
  • Lettuce.
  • Diets with higher amounts of sugar can elevate chromium excretion in the urine, leading to an increased chromium requirement. In addition, ingesting vitamin C with chromium can enhance uptake.




    POTASSIUM (Hyperglycaemia)

    Foods rich in potassium include

  • Swiss chard
  • Lima beans
  • Yams
  • Squash
  • Potatoes
  • Prunes
  • Raisins
  • Bananas
  • Artichokes
  • Spinach
  • Tomato juice
  • Molasses
  • Tomatoes
  • Sunflower seeds
  • Organ meats
  • Almonds
  • Avocado
  • Soybeans
  • Pinto bean
  • Lentils
  • Papaya.

    Consuming foods high in potassium may balance out of the intake of sodium-rich foods, which may help regulate blood pressure




    Foods rich in sodium include

  • Whole grains
  • Whole fruits
  • Vegetables
  • Lean meats
  • Legumes
  • In addition, foods with salt as a flavour enhancer provide higher amounts of sodium. However, these foods, such as crisps, boxed pasta, soup, pretzels, deli meats, pickles, etc. aren’t recommended. Note: a majority of the sodium and chloride in the diet comes from salt. Consuming a diet based around whole, unprocessed foods usually results in a lower sodium intake










    Reviews.com recognized that medical alert systems can be key for a diabetic senior contacting help if an accident occurs in the home. We created a comprehensive guide featuring factors to consider to help families and seniors choose the right medical alert system to fit their needs.


    You can see the guide here


    Don't forget to check in with Diabetes UK and American Diabetes Association for the latest information.