31 Aug Managing diabetes in a pandemic: the role of exercise and stress

There’s no denying this pandemic has been tough for a lot of us. But for those living with a chronic illness like diabetes, the added stress can have a variety of additional implications. In this blog, we take a look at how exercise can help to mitigate the impact of stress on type 2 diabetes management.

The COVID-19 pandemic sweeping the world has not only taken its toll on the global economy, but also our health. In statistics released by the Australian Bureau of Statistics, around 20% of the Australian population reported their health had declined as a result of the pandemic. And it’s not just our physical health that’s suffering, it’s our mental health as well. In August 2021, Lifeline reported the largest number of calls to their helpline in history.

We’re all feeling the stress of this pandemic. And for those with a chronic condition, the negative  impact of stress can be even greater.

What is Type 2 Diabetes?

Type 2 Diabetes is a condition that affects a vast proportion of the world. In Australia, diabetes contributed to 11% of deaths (16,700) in 2018, with 4.9% of the population (1.2 million) living with the condition.

Diabetes is a condition that impacts the ability to regulate blood sugar levels. In people living with type 2 diabetes, there’s increase in insulin resistance that results in an inability of insulin to play it’s role within the body.

When we eat a meal, carbohydrates are broken down into glucose molecules which in ideal circumstances enter the muscle cells with the assistance of insulin. In healthy circumstances a large proportion of the carbohydrates we eat are stored in the muscle as glycogen. With type 2 diabetes, there’s an inability to get these glucose molecules into the muscle, so blood sugars rise. This increases the risk of related complications like tissue injury to nerves, blood vessels and vital organs such as the eyes, kidneys or heart and its blood vessels. Energy that is unused can accumulate as adipose tissue which increases the risk of metabolic disease and associated co-morbidities.

The link between stress and glucose

When stressed, our bodies release glucose to provide energy for our bodies to ‘fight’. When I say that I’m referring to the sympathetic nervous system and our bodies ‘fight or flight’ mechanism. It’s an adaptive response to escape a potentially dangerous situation. In the short term this can help us survive potential threats, however longer term, this isn’t so great for our health!

Here’s why…

In this situation adrenaline is released causing the liver to secrete glucose, spiking an increase in insulin and reduction in glucagon levels within the blood. Cortisol, the so called ‘fat storing’ hormone also increased its concentration in the blood. This cortisol release combined with increased glucose levels are definitely something we don’t want chronic exposure to.

Exercise can help to manage stress

Regular exercise is a great way to reduce stress levels. It plays a vital role in your mental health, boosts your mood and can improve your sleep quality (which is a crucial part of stress management).

Sadly, those living with type 2 diabetes often experience additional barriers to being active.

One study looking at women over 65 years of age living with diabetes identified pain as a primary barrier to their participation in structured exercise. Another study and found 58.15% of individuals with diabetes experience some form of musculoskeletal disorder.

Musculoskeletal pain, insulin resistance and the stress of living in a pandemic are a perfect storm for those living with type 2 diabetes. So, it’s particularly important for these individuals to take steps to manage their stress and physical wellbeing during a time like this.

How much exercise should you do?

Do your best to meet the physical activity guidelines for diabetes management. For adults, that means being active on most, preferably all, days every week.

You should aim to accumulate 150 to 300 minutes of moderate intensity physical activity each week. That’s about half an hour a day. If you can’t meet these guidelines, then do what you can. Every little bit counts!

Regardless of how much physical activity you’re able to do throughout the day, regularly breaking up periods of prolonged sitting every 20-30 minutes (or wherever possible) will have significant impact on your ability to manage your blood sugar readings. Even just two minutes of low to moderate intensity walking every 20 minutes can help! Research shows that it can help to mitigate the impacts of a meal on blood sugar levels lowering them by around 24-29%.

Is high intensity exercise safe?

You may identify that your glucose levels are elevated after strenuous bouts of exercise. Resistance training or other structured exercise performed at high intensities requiring substantial physical exertion can cause a transient rise blood glucose levels. This is a normal response and is generally caused by the release of adrenaline in response to this type of exercise.

It’s important to monitor your blood glucose levels before, during and after to see how your body reacts. This will help you to avoid hypoglycaemia (lows) and hyperglycemia (highs). Don’t let this dishearten your efforts towards becoming more physically active! In fact, even low and moderate intensity exercise will still help you to reap the rewards of improved insulin sensitivity.

Remember, if you’re experiencing illness or infection, a stress response is provoked in the body. This causes hormones like adrenaline and cortisol work against the action of insulin, increasing blood glucose levels. In these circumstances gentle low intensity exercise is okay, provided that ketones in the blood are under 1.5mmol/L and you’re feeling well. Avoid high intensity forms of exercise such as sprints or other anaerobic activity like heavy lifting.

Need some extra advice?

If you’re living with type 2 diabetes and need some advice on exercising safely, an Accredited Exercise Physiologist can help. They are university-qualified health professionals who understand the complex relationship between exercise, insulin and blood glucose. They will help to provide you with individualised advice to ensure you’re exercising in a way that’s right for you. To find a qualified professional near you, click here.

Written by Hayden Kelly. Hayden is an Accredited Exercise Physiologist who works for Diabetes NSW & ACT.