Sheri R. Colberg

Step by Step / Updated 10-15-2020

Many people who are stuck at home for one reason or another think they can't work on staying fit, but the truth is that you can get a stronger core and stay fitter without leaving home. You'd be amazed at how easy it is to get fit. Your body core — the muscles around your trunk and pelvis — is particularly important to keep strong so that you can go about your normal daily activities and prevent falls and injuries, particularly as you age. Having a strong body core makes you better able to handle your daily life, even if that's just doing grocery shopping or playing a round of golf. Core exercises are an important part of a well-rounded fitness program, and they're easy to do at home on your own. To get started on your body core workout, you don't need to purchase anything. (Some of the advanced variations do call for equipment like a gym ball or dumbbells.) Include all 10 of these easy core exercises in your workouts, doing at least one set of 15 repetitions of each one to start (for all that are done as reps). Work up to doing two to three sets of each per workout, or even more repetitions if you can. For best results, do these exercises at least two or three nonconsecutive days per week; muscles need a day or two off to fully recover and get stronger. Just don't do them right before you do another physical activity (because a fatigued core increases your risk of injury).

Step by Step / Updated 10-15-2020

When you're trying to keep fit and manage your Diabetes, you can do many different static stretches to flex your joints. Here are a few simple ones to get you started.

Article / Updated 11-05-2018

Some people have symptoms of diabetes or prediabetes before they're diagnosed, but many more never have any or realize that any symptoms they're having are related to diabetes. You need to recognize diabetes symptoms, both the classic and the subtle ones, to ensure that you get the necessary tests. Annual checkups— particularly when you're getting older — that measure your fasting blood glucose are important. That's only one way to diagnose it, and testing only fasting levels misses some people who experience spikes in their blood glucose after eating, although their morning levels are just fine. How to recognize diabetes symptoms The more classic symptoms of hyperglycemia, or elevated blood glucose levels, include increased thirst, excessive urination, unusual fatigue, blurred vision, unexplained hunger, rapid weight loss, and slow-healing cuts and infections. These symptoms are common in youth who develop type 1 diabetes rapidly. However, diabetes can have subtle symptoms and may go undetected for some time, particularly in adults who develop it slowly. If you or a loved one has complained recently about excessive thirst, frequent urination, or excessive hunger, schedule an appointment with your doctor or health care provider to check for diabetes. These symptoms aren't always indicative of diabetes. Sometimes elevated glucose levels can occur temporarily due to illness or medication use. Tests for diabetes and prediabetes Three main clinical methods are currently approved for diagnosing diabetes or prediabetes: fasting plasma glucose, oral glucose tolerance, and the A1C test (glycated hemoglobin). Any test that appears to indicate that you have either of these conditions should be repeated a second time (on another day) before your diagnosis is officially confirmed. Though this test isn't a usual official method, diabetes can sometimes be diagnosed when someone experiences the classic symptoms of hyperglycemia and has a random plasma glucose value of 200 mg/dL or higher. Fasting plasma glucose This simple blood test measures your blood glucose levels after an overnight fast of at least eight hours. It determines the amount of glucose in plasma, which is the clear part of the blood with all the red blood cells removed. The fasting value is reported (in the United States) in mg/dL, which is simply a measure of the amount of glucose (in milligrams, or mg) in a set amount of plasma (100 milliliters, which equals 1 deciliter, or dL). Outside of the United States or in research papers, it's reported as mmol/L (millimoles per liter, or sometimes mM). Note: To convert from mg/dL to mmol/L, divide the value in mg/dL by 18. The fasting plasma levels used for diagnosis are Normal: 70 to 99 mg/dL (3.9 to 5.5 mmol/L) Prediabetes: 100 to 125 mg/dL (5.6 to 6.9 mmol/L) Diabetes: 126 mg/dL (7.0 mmol/L) or above Prediabetes is diagnosed when your fasting glucose levels are elevated above normal (also known as impaired fasting glucose, or IFG). Diabetes is diagnosed when your fasting plasma glucose exceeds the prediabetes range. Being on the lower end of the normal range in the morning is always better, and you should take steps to lower it if it rises over time toward the high end of normal. Oral glucose tolerance An alternate testing method is the oral glucose tolerance test (OGTT), which involves drinking 75 grams of glucose and having your blood glucose monitored for two to three hours afterward. This approach tests your body's ability to respond to a large influx of sugar. If your blood glucose goes up or stays up too high for long from this oral sugar load, you're said to have impaired glucose tolerance (IGT). This test is used to diagnose diabetes, prediabetes, and gestational diabetes. Make sure to have your fasting blood glucose levels tested annually, and an A1C test (discussed in the following section) as well if you can swing it. A1C test (glycated hemoglobin) A third approved method to diagnose diabetes is to test your A1C (previously called glycated hemoglobin or hemoglobin A1C). The A1C indicates your average blood glucose over the past two or three months. Basically, the higher your blood glucose has been, the more glucose will be "stuck" to the hemoglobin part of red blood cells, and those blood cells live about 120 days. This simple blood test can also be used to diagnose prediabetes because it averages in post-meal spikes in your blood glucose that a fasting value may not detect. Finding out your risk for developing diabetes is important because complications can occur when your A1C test is still in the normal range (at the high end). How to interpret your diabetes test results The following table illustrates how the results of these tests are used to diagnose diabetes and prediabetes. Tests for Diabetes and Prediabetes Diabetes Diagnosis Fasting Plasma Glucose Oral Glucose Tolerance Test (OGTT) A1C Symptoms Type 1 ≥ 126 mg/dL (7.0 mM) 2-hour value: ≥ 200 mg/dL (11.1 mM) 6.5% or higher Classic symptoms of hyperglycemia or a random plasma glucose ≥ 200 mg/dL (11.1 mM) Type 2 ≥ 126 mg/dL (7.0 mM) 2-hour value: ≥ 200 mg/dL (11.1 mM) 6.5% or higher Classic symptoms of hyperglycemia or a random plasma glucose ≥ 200 mg/dL (11.1 mM) Gestational ≥ 92 mg/dL (5.1 mM) 1-hour value: ≥ 180 mg/dL (10.0 mM) or 2-hour value: ≥ 153 mg/dL (8.5 mM) Prediabetes 100–125 mg/dL (5.6–6.9 mM) 2-hour value: 140–199 mg/dL (7.8–11.0 mM) 5.7–6.4% Your test results can be confusing because you may not get diagnosed with diabetes with one test, but meet the criteria for another. To be considered as having diabetes, you only have to meet the criteria for one test. But then how your diabetes is managed may vary based on which category you met. For instance, if you just have elevated fasting levels but your A1C is okay, your doctor may put you on a medication that will lower your morning blood glucose. If your blood glucose shoots up after meals (as indicated by an oral glucose test), you may need a medication that makes your pancreas release more insulin when you eat but not at other times of day. Talk to your doctor or health care provider about your diagnosis and the best course of action to follow based on your test results. Test for gestational diabetes Gestational diabetes is typically tested for and diagnosed between 24 and 28 weeks of pregnancy with an oral glucose tolerance test. Managing it may involve using insulin or other medications, along with diet changes and regular exercise. All pregnant women should be screened for this condition no later than 28 weeks and possibly even earlier if it was diagnosed during previous pregnancies. Type 2 diabetes misdiagnosis Given the current diagnosis methods for diabetes, determining which kind of diabetes a person has can sometimes be difficult. In addition, diabetes can sometimes have other causes, such as pancreatic cancer or other rare conditions. Having excess body fat used to lead to an almost guaranteed diagnosis of type 2 diabetes, but that is no longer the case because people who develop type 1 are often overweight and can develop an insulin-resistant state related to weight gain, dietary choices, and physical inactivity. As many as 20 percent of adults who develop type 1 later in life may initially be misdiagnosed with type 2 due to their older age and slower onset. Being misdiagnosed because of your adult age is common, and you may initially respond well to oral diabetes medications (which further confuses the diagnosis). But you're not likely to be as insulin resistant as someone who has type 2 diabetes. If you're an extremely athletic adult (age 25 or older) and you were diagnosed with type 2 over the age of 18 while regularly active and at normal or near-normal body weight, you likely have a slow-onset form of type 1 diabetes instead. You can get antibody tests done to help make the diagnosis between type 1 and type 2. Knowing which you have can help because starting insulin therapy (rather than diabetes pills) early may help preserve your remaining beta cells for a little longer.

Article / Updated 02-21-2018

What's your risk for getting diabetes? It has gone up substantially in the past few decades. In fact, anyone born in the United States from the year 2000 forward has a one-in-three chance of developing diabetes during his or her lifetime, and the incidence is closer to 50 percent if you're part of a minority group (like African Americans, Hispanics, or Native Americans). More than 29 million Americans — close to 10 percent of the population — are estimated to already have diabetes, and this number is growing rapidly. Over a quarter of them don't even know they have it. Add in prediabetes, and the number goes up to over 100 million Americans, or one person out of every three. Everyone knows someone who has diabetes, so why worry about it? Because high blood glucose levels can be deadly. Having poorly managed diabetes can rob years from your life, and the shorter time you do have may be lived in much poorer health. Ignorance isn't bliss; ignoring diabetes and not attempting to prevent or manage its possible health consequences isn't the way to go if you want to live long and well. Worldwide, this disease causes more than 3.2 million deaths per year, or 6 deaths every minute. Many more deaths are likely related to health problems caused by diabetes that are attributed to some other direct cause, such as a heart attack or a stroke, even though diabetes lead to those events. Unfortunately, poorly managed blood glucose can cause problems with almost every part of your body, including your heart, blood vessels, brain, kidneys, nerves, muscles, and bones. It can even lead to impotence and hearing loss. Okay, so far this section has been depressing. Here's some good news: Most diabetes-related health problems are preventable. You simply need to get more physically active and follow a more healthful diet. If your health care provider prescribes medications, taking those may also help prevent future health issues. The combination of these improved lifestyle choices helps lower your blood glucose and prevent systemic inflammation that leads to heart disease, nerve damage, and other health complications when not thwarted. Well-managed diabetes can be the cause of nothing — that is, no health problems.

Article / Updated 02-21-2018

Keeping fit with Diabetes is more important to living well than you can possibly know. In fact, it's likely the most critical behavior you can adopt to impact how well your insulin works in your body. Insulin resistance is linked to multiple health problems, including type 2 diabetes, high blood pressure, reduced blood flow, inflammation, heart disease, and many more. A lack of physical activity is linked directly to defects in the action of insulin primarily at the level of your muscle and fat cells. Looking at what impacts how insulin works The two main body tissues that are sensitive to the effects of insulin are your muscle cells and adipose, or fat, tissue. Obesity is associated with an accumulation of stored fat inside both muscle and adipose cells. Muscle is an important storage site for excess glucose and carbohydrates. But when your muscles get filled with excess fat or carbohydrates, they become less sensitive to insulin, and your pancreas must release more insulin to have the same effect (or if you need insulin, you'll need to take higher doses). A third tissue also responsive to and affected by insulin is your liver. This organ is responsible for making sure you have enough glucose in your blood at all times. It can both store and release glucose to keep levels constant. In some people with diabetes, the liver becomes insulin resistant and releases too much glucose, especially overnight when they go for long periods without eating. Gaining a lot of excess fat within your abdomen (called visceral fat) and within the liver itself can contribute to an insulin resistance there. Interestingly, your fat cells usually remain largely responsive to insulin even when your muscle cells become resistant, and much of your excess blood glucose can be converted into storage fat. When the carbohydrates you eat end up spiking your blood glucose, the rise causes the release of more insulin and ultimately more fat storage in fat cells and likely your liver. Being active helps reverse insulin resistance in your liver and reduces the amount of metabolically bad, visceral fat stored inside your abdomen. Revving up your insulin action Think of your muscles as a glucose tank, a place to store the carbohydrates that you eat and don't need to use right away, as shown in Figure 2-1. When you exercise regularly, you use up glycogen stored in the muscles and have room to put carbohydrates back in after you eat. If the glycogen stores are already full because you've consumed too many carbohydrates or exercised too little, your muscles can't store more carbohydrates after you eat, and you're insulin resistant. This state is reversible with exercise. To raise your insulin sensitivity, keep your muscle glucose tank as big as possible (by doing resistance and other training regularly) and partway empty (by being active on a daily basis, or at least every other day). Physical activity isn't the only factor that can improve your insulin action, however, and most of them you have some control over. Addressing these factors can raise your body's insulin action and consequently reverse prediabetes or improve diabetes management. Factors that can boost insulin action in your muscles include the following: Regular aerobic, resistance, interval, and other types of exercise Tighter blood glucose management Increase in overall muscle mass Loss of body fat, particularly visceral fat and extra fat stored in the liver Intake of more dietary fiber, less manufactured trans fat, and fewer highly refined foods Daily consumption of a healthy breakfast Lower daily caffeine intake Reduced levels of circulating free fatty acids (fat in blood) Reduction in mental stressors (depression, anxiety, stress, and so on) Better control of physical stressors (illness, infection, exhaustion, and so on) Adequate sleep (seven to eight hours a night for most adults) Effective treatment of sleep apnea Use of insulin-sensitizing medications Reduction in low-level, systemic inflammation Decrease in circulating levels of cortisol Increased testosterone levels in men If you're trying to improve your insulin action (or lose weight) and your body releases a large amount of insulin in response to the carbohydrates you eat, you may benefit from eating a food plan that is moderate in carbohydrate. Talk to a registered dietitian or nutritionist about the best plan for you.

Article / Updated 02-20-2018

Diabetes comes in many forms — type 1, type 2, and gestational are the most common forms — as well as being tied to the related condition prediabetes. The following discussion gives you a glimpse into these conditions. Type 1 diabetes About 5 to 10 percent of people have type 1 diabetes, which equates to around 1.25 million American children and adults. Prior to having this name, type 1 diabetes used to be called insulin-dependent diabetes, which is accurate because you have to take insulin if you have this type. But that name got confusing and was dropped because many people with type 2 diabetes use insulin as well. Early on, type 1 was called juvenile onset diabetes because three-quarters of all cases are diagnosed in youth under 18. You can develop type 1 diabetes at any age, though, and most people living with type 1 are adults who inject or pump insulin daily to survive. Because adults also get type 1 diabetes, this term was inaccurate and misunderstood and was, therefore, abandoned decades ago. Type 1 diabetes results from a relative insulin deficiency, which occurs after the body's own immune system destroys the beta cells of the pancreas that make insulin. Although the trigger for this autoimmune response is unclear, it's likely due to a combination of a genetic predisposition and environmental factors. Some causes under investigation include exposure to certain viruses, early introduction of cow's milk or other proteins in the diet of infants, and lack of vitamin D. How rapidly type 1 diabetes develops is quite variable; it's rapid in some individuals (mainly infants and children) and slow in others (mainly adults). In either case, the symptoms of elevated blood glucose first appear when only about 10 percent of the insulin-making capacity of the pancreas remains. Type 2 diabetes About 90 to 95 percent of cases of diabetes are type 2 diabetes, which used to be called non-insulin-dependent diabetes and adult onset diabetes. Most people diagnosed with type 2 are adults, but it has become more common among teenagers with the current obesity epidemic and prevalence of sedentary lifestyles. It's largely related to lifestyle habits that promote insulin resistance and other bodily changes that lead to high blood glucose levels. Type 2 diabetes primarily results from an inability of insulin to work well enough to lower blood glucose to normal levels, a state of insulin resistance. However, most people with type 2 diabetes suffer from some degree of beta cell burnout, which leads to a diminishing release of insulin over time and rising blood glucose levels. The beta cells in the pancreas that make insulin lose some or all of their ability to produce insulin when exposed to high levels of blood glucose over time. If you develop type 2 diabetes, you likely have insulin resistance, paired with insulin secretion that is maximal but insufficient. In other words, your body can't make enough insulin to fully overcome your body's resistance to it. Many consider type 2 diabetes a less severe condition than type 1, but type 2 is more complex in its origin. With this type, you likely have an underlying genetic susceptibility that, when exposed to a variety of social, behavioral, and/or environmental factors, unleashes a latent tendency for diabetes. In other words, diabetes genes are triggered by combined environmental and lifestyle factors, such as inactivity, poor eating habits, weight gain, exposure to pollutants, vitamin and mineral deficiencies, and more. Although having a family history of type 2 increases your risk, the recent, unprecedented increase in type 2 diabetes cases suggests that a bigger cause is a combination of factors that increase insulin resistance, such as a sedentary lifestyle and a poor diet. Many people who get this type of diabetes don't have any relatives with it. Having a parent, sibling, or other close relative who has it increases your risk of developing it, though. Particularly when you're first diagnosed with type 2 diabetes, you may be able to manage your blood glucose levels effectively or even reverse your diabetes by making lifestyle changes, such as exercising regularly and eating a better diet. Gestational diabetes Women can develop gestational diabetes during pregnancy if their blood glucose levels rise too high, which is most likely to happen during the second or third trimester. Pregnancy hormones make the mother more insulin resistant — to spare glucose for the developing fetus — but her blood glucose can rise as a result. Managing blood glucose during pregnancy is important because elevated levels aren't good for the mother or the baby. Unborn babies make their own insulin during the third trimester and can get too large (over 9 pounds) from gaining extra fat when exposed to high levels of glucose, making the birth process difficult for the mother and the child. Babies can also have other health problems if the mother's glucose levels aren't managed well enough. If you have ever given birth to a baby weighing 9 pounds or more, then you likely had gestational diabetes during your pregnancy (whether diagnosed or not). You often can manage blood glucose levels during pregnancy with physical activity and dietary changes (particularly limiting carbohydrate intake). Regular exercise is recommended for all women during pregnancy, but it's even more important if you have or are at high risk for developing gestational diabetes. Some women must take diabetes medications that are acceptable during pregnancy to manage their blood glucose levels. Although gestational diabetes usually disappears after the baby is born, it increases the mother's risk for developing type 2 diabetes later in life. Prediabetes Prediabetes is basically a relative state of insulin resistance. About 40 percent of adults between 40 and 74 years old who were screened in 2000 were diagnosed with prediabetes. In 2014, 86 million Americans age 20 and older had prediabetes, up from only 79 million in 2011. That is a huge number of people affected by this condition. Even though blood glucose levels aren't in a diabetic range yet with prediabetes, having prediabetes puts you at high risk for progressing to type 2 diabetes at some point in your lifetime. What's more, you can develop some of the complications usually associated with diabetes, like nerve damage in your feet, heart disease, and stroke, while only having prediabetes. You can reverse prediabetes with improvements to your lifestyle. The same changes that help manage type 2 diabetes — regular exercise, a more healthful diet, and fat weight loss — can help eliminate prediabetes and prevent its progression into full-blown diabetes.

Article / Updated 02-20-2018

Regardless of which type of diabetes you have, you can become resistant to the effects of the hormone insulin, even if you have to pump or inject it instead of making your own. That fact makes insulin resistance relevant to everyone with diabetes of any type or prediabetes. Think of insulin resistance with a lock and key analogy. In your body, glucose in the blood is trying to get through the door to your muscle and fat cells. To get inside the cells, the glucose must have a key to open the door. Insulin is the key that goes into the lock (or insulin receptors, in this case) to make it open. If you have the key (insulin), but the keyhole on the lock is blocked or the key won't turn when it goes in, then glucose can't enter, and you have insulin resistance — lots of insulin available but not working well. When the keys and the keyholes are functioning well together, the doors open, and glucose enters the cells and lowers the levels in the blood.

Article / Updated 02-20-2018

The human body has to manage its own blood glucose, which it does quite effectively in most people most of the time. You have to have enough glucose in your blood; it's required for your brain and your nerves to function properly. The amount in blood is regulated by a hormone called insulin. This article explains how these two components work. Think of glucose and insulin as the actor and the director in a performance. The insulin (director) tells the glucose (actor) where to go and what to do to get the best showing out of it. It takes the two coordinating their roles to get the show done. Glucose is the actor When people talk about "blood sugar," they mean blood glucose, the primary sugar in your bloodstream that fuels the brain, nerves, muscles, and other cells around the body. Having too little in your blood can kill you. Unfortunately, so can having too much, especially over the long haul. Normally, your body digests the food you eat and breaks it down into more easily absorbed molecules, of which glucose is one. It's a simple sugar that comes mostly from the carbohydrates you eat. Blood glucose can come from different sources, but you get it mostly from your food and drinks (although your liver makes some, too). Foods rich in carbohydrates (such as grains, milk, fruit and fruit juice, starchy vegetables, most desserts, and sugary drinks) are released as glucose in your bloodstream after your body digests them. Blood glucose levels normally increase slightly after eating, even if you don't have diabetes. Your brain, nervous system, and active muscles use some of that glucose right away, although all cells in the body use glucose at some point. When everything is working right, the body stores away the rest for later. When your blood glucose levels are higher (such as after a meal), extra glucose usually gets packed away and stored in the liver and muscles as glycogen. When your blood glucose is low, glucagon (a hormone made by the pancreas) is released and signals the liver to let out some of its stored glycogen as blood glucose. When you're active, your muscles also use some of the glycogen stored in them as fuel, but the glucose coming from muscle glycogen stores stays in the muscle and doesn't raise your blood glucose. Using up the glycogen in your muscles by exercising gives your body a place to easily store more carbohydrates after you eat the next time, reducing the amount of excess glucose flowing around in your blood, potentially causing inflammation and damage. Insulin is the director When your body is working normally, your blood glucose goes up after you eat a meal, and your pancreas senses this increase and releases a hormone called insulin to help lower it. Insulin works by binding to its receptors on cells in muscle and fat, the primary places where the body can store glucose for later use. Two separate, but related, aspects of diabetes are associated with your body's insulin. One is how effectively insulin works. If you have type 2 diabetes or prediabetes, insulin may be abundant, but it doesn't work well to lower blood glucose — that is, you have insulin resistance. People with other types of diabetes can become insulin resistant as well. The second is the amount of insulin that is available. Persons with type 1 diabetes make little or no insulin; people with prediabetes and type 2 diabetes have an inadequate amount of insulin produced to meet their needs. Insulin is a hormone made by the pancreas that, when released into the bloodstream, works to allow blood glucose to enter your cells that are insulin sensitive, primarily muscle, fat, and liver cells. Some of it gets used as a fuel by those cells, but the rest is stored in these tissues for later use. During rest, insulin works to make sure that glucose leaves the blood and goes into the cells, which keeps your blood glucose from going too high or staying that way after eating. Unfortunately, excess blood glucose that can't enter cells for any reason can cause damage to your body over time. The other aspect is how much insulin the pancreas produces. You can be deficient in insulin, meaning that you simply don't make much. People with various types of diabetes can also have this issue. In that case, they may need to take medications to stimulate the pancreas to produce more, take insulin to supplement their supply, or use other medications that lower blood glucose other ways. In either case, your blood glucose may rise too high at various times, such as after you eat, when you're stressed out, if you're ill, and when you exercise vigorously. Regardless of whether you have insulin that doesn't work well or too little of it overall, exercise can help your body use insulin more effectively. Weight loss can also help. Being more sensitive to the insulin you do have means that less insulin can lower blood glucose more. In people who have insulin resistance, improving the action of insulin may even reverse the course of their disease. When overweight people with type 2 diabetes lose just 7 percent of their body weight, their insulin action increases by 57 percent. Even if you don't have diabetes, you may still be insulin resistant. Being overweight, staying sedentary, and eating a poor diet can all lead to insulin resistance, in which case your body will need more insulin to get the job done. If you're insulin resistant, you can take steps to improve your insulin action that will benefit your overall health.

Cheat Sheet / Updated 12-12-2017

If you have diabetes, keeping fit is one of the most important things you can do for your health and your blood glucose management. It sometimes requires you to take precautions to exercise safely and effectively. For best results, do some resistance training along with other activities.

Article / Updated 12-12-2017

Doing resistance training of any type is critical if you have diabetes (or even if you don't have it and want to age well). It allows you to stay strong and independent, along with giving you a place to store the carbohydrates that you eat (that is, in muscles). Here are a few tips to keep in mind as you start resistance training: Do 2 to 3 sets of 10 to 15 reps per exercise. Start with a goal of one to two workouts per week of six to eight exercises. Eventually work up slowly to three days per week and 10 to 12 exercises. Don't resistance train the same muscle groups more often than every other day. Gradually increase resistance or weight over time. Do exercises with slow, controlled movements. Extend and use the full range of motion around each joint you're working. Breathe out throughout the exercise, preferably during exertion, and always avoid holding your breath. Stop exercise if you experience dizziness, unusual shortness of breath, chest discomfort, palpitations, or joint pain.