(Part-2) Diabetic patients are often advised to exercise because it can reduce the likelihood of suffering from the complications of diabetes. Unfortunately, exercise can also reveal, or worsen some complications, and screening should therefore, be undertaken before diabetic people either start, or increase their level of exercise.
The screening process should identify any complications of the disease that could be revealed or worsened by exercise and also assess the individual’s current level of control over their diabetes.
A pre- exercise programme should typically consists of:
· A ‘glycosylated haemoglobin’ (HBA1C) blood test to assess how well the person has controlled their blood glucose over the previous few months;
· Examination of the cardiovascular system, including measurement of blood pressure and assessment of pulses in the arms and legs, and a test to check blood lipid profile;
· Examination of the eyes to identify any problems caused by diabetes;
· Examination of the nervous system of the upper and lower limbs to identify any loss of feeling or weakness due to nerve damage;
· A check for diabetic foot ulcers;
· Blood and urine tests to check kidney function.
Diabetic people are at increased risk of ischaemic heart disease, but may not experience the chest pain normally associated with it, because of nerve damage caused by diabetes. The latest published advice suggests that an exercise stress test should be performed if the patient:
· Will be undergoing vigorous activity (heart rate over 60% of maximum);
· Has had Type 2 Diabetes for over 10 years or Type 1 Diabetes for over 15 years;
· Is over 35 years old;
· Has risk factors for coronary artery disease (eg high blood pressure, high cholesterol);
· Has any of the cardiovascular, eye, kidney or nerve complications of diabetes.