What To Ask Your Doctor

Before starting an exercise program, the American Diabetes Association (ADA) recommends a detailed medical evaluation with appropriate diagnostic tests.

The medical screening should include a search for signs and symptoms of disease focusing on the heart and blood vessels, eyes, kidneys, and nervous system, as well as your HgbA1c.

A stress test (treadmill, bike, or medicine) may also be helpful to assess the cardiovascular system if an exercise program of moderate-to-high intensity is of interest and there is high risk for underlying heart disease. The ADA advocates a graded stress test when one of the following criteria is present:

• Age > 35 years
• Type 2 diabetes of > 10 years duration
• Type 1 diabetes of > 15 years duration
• Presence of any additional risk factor for coronary artery disease (smoking, high cholesterol, high blood pressure, obesity, stress)
• Presence of microvascular disease (Proliferative retinopathy-eye disease, nephropathy-kidney disease: including microalbuminuria)
• Peripheral vascular disease
• Autonomic neuropathy

Because diabetes is a chronic disease that can be progressive, follow-up evaluations are necessary. The regularity of these meetings with your doctor depends on many things, including your blood glucose control and any other complications.

Your doctor will also check for heart disease.
This is needed because heart disease may have no symptoms. This exam will include:

• A blood pressure check
• Listening to your heart and lungs
• Feeling the pulses in your neck, arms, legs and feet. This checks for blood flow problems. He may also do a Doppler test to measure the degree of blood flow (or lack of).
• An EKG (electrocardiogram, an easy, painless test that measures heart rate and rhythms)
• An exercise treadmill or bike test if you:
• Have or may have heart disease.
• Are over the age of 35. (If you are younger, this still needs to be done if you have had type 2 diabetes for more than 10 years or type 1 diabetes more than 15 years).
• Are at high risk for heart disease. You are at high risk if you have high cholesterol, high blood pressure or poor blood flow. You are also high risk if you smoke or have a family history of heart disease.
• Your doctor will also check to see if you have autonomic nerve disease, due to the affect it may have on your heart rate and blood pressure. This also increases the risk of a silent heart attack.

A final part of this visit includes advice on safe exercise.
Your doctor will want to make sure you can manage your blood sugar levels during and after exercise. You will be given an outline of how often, how much and how hard you should exercise. Lastly, your doctor can explain if you need to avoid any types of exercise.

Be sure to have this complete exam before you embark on an exercise program. This is key to the start of a safe exercise program.

Here is an outline of what your doctor and health care team will do to clear you for an exercise program.

First, they will get to know your diabetes. They will want to know:

• Your insulin or pill schedule.
• Your current diet and exercise program.
• If you are having problems with your blood sugars, like patterns of low or high blood sugars. If you are not able to recognize low blood sugar symptoms. Show your doctor your logbook.

Tell your doctor about the type of exercise you plan to do. Discuss any problems you have had in the past. For instance, do you have a history of sports injuries? Do you get dizzy, short of breath, leg pain or suffer chest pain when you exercise?

Your doctor will want to make sure you are up to date with your diabetes care.

• He or she will want to check if you have any heart, kidney, eye, or nerve problems. If you have any of these problems, you may have limits on your exercise program.
• A Hemoglobin A1c (average blood sugar test) will be ordered. This gives your doctor a good idea of your blood sugar control over the past 2-3 months.
• Lab tests will be done to check your kidney function and cholesterol levels.
• Your doctor will make sure you have had your annual dilated eye exam.
• A foot exam will be done to check for loss of feeling or other problems. You may need special shoes to protect your feet if you have any deformities and/or changes in the shape of your feet.

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