ALCOHOL BEVERAGES

Most people with diabetes can drink alcohol safely if they drink in moderation (one or two drinks occasionally), because in higher quantities alcohol can cause health problems:

• Alcohol has calories without the vitamins, minerals, and other nutrients that are essential for maintaining good health. A doctor can discuss whether it's safe for an individual with diabetes to drink. People who are trying to lose weight need to account for the calories in alcohol in diet planning. A dietitian also can provide information about the sugar and alcohol content of various alcoholic drinks.
• Alcohol on an empty stomach can cause low blood glucose or hypoglycemia. Hypoglycemia is a particular risk in people who use oral medications or insulin for diabetes. It can cause shaking, dizziness, and collapse. People who don't know someone has diabetes may mistake these symptoms for drunkenness and neglect to seek medical help.
• Oral diabetes medications--tolbutamide and chlorpropamide--can cause dizziness, flushing, and nausea when combined with alcohol. A doctor can advise patients on the safety of drinking when taking these and other diabetes medications.
• Frequent, heavy drinking can cause liver damage over time. Because the liver stores and releases glucose, blood glucose levels may be more difficult to control in a person with liver damage from alcohol.
• Frequent heavy drinking also can raise the levels of fats in blood, increasing the risk of heart disease.
  

EXERCISE

Exercise has many benefits, and for someone with diabetes regular exercise combined with a good diet can help control diabetes. Exercise not only burns calories, which can help with weight reduction, but it also can improve the body's response to the hormone insulin. As a result, following a regular exercise program can make oral diabetes medications and insulin more effective and can help control blood glucose levels.

Exercise also reduces some risk factors for heart disease. For example, exercise can lower fat and cholesterol levels in bloods which increase heart disease risk. It also can lower blood pressure and increase production of a cholesterol, called HDL, that protects against heart disease.

However, infrequent, strenuous exercise can strain muscles and the circulatory system and can increase the risk of a heart attack during exercise. A doctor can decide how much exercise is safe for an individual. The doctor will consider how well controlled a person's diabetes is, the condition of the heart and circulatory system, and whether complications require that the person avoid certain types of activity.

Walking is great exercise, especially for an inactive person, and it's easy to do. A person can start off walking for 15 or 20 minutes, three or four times a week, and gradually increase the speed or distance of the walks. The purpose of a good exercise program is to find an enjoyable activity and do it regularly. Doing strenuous exercise for six months and then stopping isn't as effective. People taking oral drugs or insulin need to remember that strenuous exercise can cause dangerously low blood glucose and they should carry a food or drink high in sugar for medical emergencies. Signs of hypoglycemia include hunger, nervousness, shakiness, weakness, sweating, headache, and blurred vision. As a precaution, a person with diabetes should wear an identification bracelet or necklace to alert a stranger that the wearer has diabetes and may need special medical help in an emergency.

A doctor may advise someone with high blood pressure or other complications to avoid exercises that raise blood pressure. For example, lifting heavy objects and exercises that strain the upper body raise blood pressure.

People with diabetes who have lost sensitivity in their feet also can enjoy exercise. They should choose shoes carefully and check their feet regularly for breaks in skin that could lead to infection. Swimming or bicycling can be easier on the feet than running.

Points to Remember

Exercise has three major benefits; it burns calories, improves the body's response to insulin, and reduces risk factors for heart disease.

An exercise program should be started slowly and with the advice of a doctor.