Speaking of which, always take special care with your feet. “Over time, diabetics can develop neuropathy—nerve damage that causes a pins-and-needle discomfort followed by a loss of sensation—which means you can injure your feet or get a blister and not know it,” says Colberg-Ochs. She suggests inspecting your feet daily and wearing proper footwear and socks with padded soles, or “replacing running with something where your feet aren’t at risk, such as cycling.”
Diabetics also have to be wary of microvascular problems with the eyes, kidneys and nervous system. If you have such a condition, you should avoid any activity that involves excessive jumping or increased blood pressure, or causes your head to drop lower than your heart. Another danger: “silent ischemia,” a symptomless condition in which you don’t get enough blood flow to the heart because of insulin nerve damage. To be on the safe side, check with your physician before starting or altering any exercise program.
The Proactive Diabetic
Don’t let any of this scare you. Most diabetics can still work out by choosing activities that don’t exacerbate their conditions. A study published in Diabetes Care found that subjects were able to safely reduce cardiovascular risk factors, such as abdominal-fat content and hypertension, by exercising 2.25 hours per week. And a report in Diabetes Education was enthusiastic about the positive effects of resistance training, except when retinopathy is present.
Above all, diabetics must balance workouts with proper nutrition. Hall gives himself up to eight insulin shots daily during peak training. With that much insulin, his body constantly craves carbohydrates for fuel. “At first I didn’t know the carb content of a baked potato,” says Hall. “Then I compared it with the frozen kind, which turned out to have twice as much, so I had to give myself twice as much insulin. Basically, you have to have an idea of what every food you consume is going to do to you and how your body is going to react to it. In a lot of ways, you have to be your own doctor.”
If you eat right, you should be able to cut down the amount of insulin you need, says Colberg-Ochs. Adding fiber is usually recommended, as is substituting low-fat milk for whole milk and replacing saturated fat and tropical oils with “healthy fat,” such as nuts and peanut butter. “Balance is the key,” says Colberg-Ochs. “Not too many carbs or fats or protein.”
Each athlete must find his own formula. Diabetics should measure blood sugar before, during and after their activities. Technology has made frequent testing much simpler. Hall carries a glucose monitor the size of a watch; he can determine his sugar level in just five seconds. He also has an insulin kit that can fit in his back pocket.
“Whether it’s running a half-marathon or playing pickup basketball games with your college buddies, don’t let anyone tell you that you can’t do it,” says Hall. “It all comes down to you and how well you take care of yourself.”