Q&A | Jacqueline Shahar on Diabetes and Exercise

Exercise facility at Joslin Diabetes Center

Jacqueline Shahar, M.Ed., R.C.E.P., C.D.E.

Thursday, July 29, 2010

“Diabetes is a complex disease and there’s a lot you can do with exercise to manage it,” says Jacqueline Shahar, who is a Clinical Exercise Physiologist, a Certified Diabetes Educator and the manager of the exercise physiology department at Joslin.

She recently sat down to answer eight questions about Joslin’s exercise programs and about how best to engage in physical activity with diabetes.

What is your role at Joslin?

My role is to make sure that all of our patients receive an individualized exercise program that will help them with their diabetes control. We are trying to get all of our patients to be active because we know the benefits of exercise and physical activity. We consult with adults and kids with type 1 and type 2 diabetes who are not active and need to get motivated and overcome barriers to physical activity, and with others who are very athletic and need to manage their blood glucose while performing in sports events.

We send a message that exercise is another great medication for diabetes that is not costly and does not have side effects.

Do all Joslin patients see you?

Exercise training is part of JoslinCare philosophy, in which patients will meet with a whole team of caregivers that include an exercise physiologist. Exercise consultation for diabetes patients is covered by insurance and requires a co-pay only.

What surprises your patients the most?

When patients see up to a 100-point drop in blood glucose, even just with 10 or 15 minutes of exercise! They’re so amazed: “Wow, it’s actually working!” That’s kind of motivation to continue and do more and more exercise. Knowing the effect of exercise on blood glucose, it’s actually not too hard to do a little bit of exercise! It’s not too difficult to fit it in and get great results.

Is it common for diabetes clinics to have gyms, like Joslin?

No. We are really fortunate that we have a place here that we can teach our patients how to exercise.

Is research about exercise changing your work?

Yes. Resistance training used to be on the side, mostly done by athletes and very healthy people. However, research is finding that resistance training is for everyone. Resistance bands are a great tool for all patients, especially those who are not comfortable going to a gym. We teach patients exercises that they can even do at home in front of the TV, using resistance bands.

What is the importance of resistance training?

Take this example: If the only exercise people are getting is walking, they will eventually reach a plateau where they don’t see any more results. Resistance training challenges muscles to work more, burn more glucose and stored fat. It’s an essential component in improving glucose control and promoting weight loss.

You also emphasize interval training—how does that work?

When we perform aerobic exercises, like walking and biking, part of the approach is really to change the pace of your exercise and incorporate bursts of high-intensity work with moderate-intensity work. So you may be walking for two minutes at a fast pace and then be jogging for one minute. Changing the speed and the intensity of the exercise every minute will challenge your muscles to burn more calories. We’ve seen a lot of good results with interval training to supercharge fitness, boost metabolism and improve diabetes control.

What do you tell people with diabetes about the risk of low blood glucose levels?

Active muscles burn glucose during and after exercise, and they need to replenish themselves after exercise. This process lasts 24-48 hours after the activity and it increases the risk for low blood glucose. We explain the risks of low blood glucose both during and after the activity. Patients need to be aware of the right steps in managing it. To prevent low blood glucose, they should check their blood glucose before, during and after  exercise. Those who take specific oral medications or insulin should plan in advance to cut down on their insulin dose or oral meds on days that they exercise, in order to avoid low blood glucose.

Exercise facility at Joslin Diabetes Center