It's a message you hear everywhere: Exercise is one of the most important things you can do to control your diabetes. It's also a catch-22: Controlling diabetes can be so exhausting that some days just leaving the house feels like climbing a mountain.
Why is lack of energy such a big issue? One big cause is an imbalance in blood sugar. "If your blood sugar is out of control in either direction—too high or too low—you can feel tired and drained," says Aaron Vinik, M.D., Ph.D., research director at the Strelitz Diabetes Center at Eastern Virginia Medical School in Norfolk.
Other health factors, such as high blood pressure and excess weight, can also make you feel as if there's a giant hole in the tank of your energy reserves. But you can find the energy you need to exercise—you just need to know where to look.
Start small. Stop watching extreme workouts on TV weight-loss shows and thinking that's what you should aspire to. "That will turn you right away from exercising," says Camille Eroy-Reveles, M.P.H., a fitness instructor and exercise consultant in New York City. "Do what you can, right at this moment. If that means five minutes of walking, then that's what you can do. You have to start somewhere."
Give yourself permission to stop. Sometimes the best way to get started is to start small. "If you're feeling horrible, tell yourself that you're just going to walk for a few minutes. After that, if you're still feeling horrible, you can quit," says Eroy-Reveles. "Exercise is going to be hard for the first few days. Give yourself two weeks for it to feel better. You can do anything for two weeks!"
Time it right. For a couple of days, pay close attention to your energy levels and try to figure out what time of day you have the most energy. Is it first thing in the morning or later in the afternoon? What time of day do you usually feel most productive? That's often the best time to schedule your exercise.
Track blood sugar. Uncontrolled blood sugar can cause a lot of fatigue with diabetes. Keeping your blood sugar levels on target is key, and the best way to monitor that is to test regularly with your meter.
Play detective. Blood sugar numbers aren't the only pertinent data to record. "Keep a journal, and on the days when you're really fatigued and experiencing pain, look at what you've been doing," says Julie Silver, M.D., a rehabilitation physician and assistant professor at Harvard Medical School. For three days, write down what you're doing every half hour, and rate your pain and fatigue level on a 0–5 scale (0 = feeling great; 5 = a lot of pain and fatigue). Then review the data. "On bad days, did you use coffee as a pick-me-up, skip a meal or drink alcohol? On days when you felt really good, what did you do?" Silver asks. Identifying your fatigue triggers can help you eliminate them and restore your energy.
Consider insulin. If you've had type 2 diabetes for a while and fatigue is a major issue, talk to your doctor about adding insulin to your therapy toolbox. It's not a treatment of last resort, Vinik says. He recommends early, aggressive use of insulin as the boost some people need to get up and get moving.
Call it fun. Whatever you do to move more, don't call it exercise, suggests Vinik: "That sounds like a punishment, a prescription. Choose something that's fun for you."
Before any strenuous physical activity, be sure to talk to your doctor.