People with type 2 diabetes know that exercise and a well-balanced diet are crucial to well-being. But a new study of more than 23,000 patients showed that less than 40 percent of people with diabetes get enough exercise—and those who could benefit most are the least likely to get up and go (Diabetes Care, 2007, vol. 30, no. 2). With proper nutrition, you can stick to an optimal fitness regimen even as you manage life with diabetes.

Everyday fuel
Type 2 diabetes requires a balanced diet that pays particular attention to the quality and quantity of carbohydrates, the primary culprit affecting blood glucose levels.

Carbohydrates break down into glucose, the body's main energy source. When the pancreas receives a signal that glucose is roaming the bloodstream, it releases the hormone insulin, which allows glucose to enter cells. For diabetics, a snag occurs either in insulin's production or utilization. When carb stores are too low, blood glucose drops, causing weakness, fatigue, and disorientation; but too many carbs spike blood glucose. With exercise added to the mix, balance is key to avoiding "see-saw syndrome"—glucose fluctuations that may lead to complications, including kidney and heart disease.

"Carbohydrates are not the enemy; in fact, they are the body's preferred energy source," says Gary Scheiner, MS, CDE, author of The Ultimate Guide to Accurate Carb Counting (Marlowe and Company, 2006). "The enemy is having too many carbs all at once. If we overload the body's ability to process those carbs, that's when high blood sugars develop."

Shoot for unrefined carbohydrates to comprise 50 percent to 60 percent of your diet. "Be careful not to cut carbs too much," says Scheiner. "Having insufficient carbohydrates means that some of the protein you eat will convert into blood sugar, which can cause high blood glucose the same way as ingesting too many carbs."

For active people with diabetes, daily protein intake should be 15 percent to 20 percent of total calories consumed. While about 60 percent of protein converts into glucose, it works much slower than carbohydrates, helping to stabilize blood sugar. Be attentive to the types of fat in your protein choices, and eat good-fat foods, such as salmon, olive oil, almonds, and avocados, in moderation—no more than 25 percent to 30 percent of your daily calorie intake.

As for fiber, look for foods with a low glycemic-index rating (check out www.glycemicindex.com), which will cause a much slower rise in blood sugar.

Feed your workout
For an exercise session longer than 90 minutes, check blood glucose (bg) before starting; if low, fuel up with 15 grams of healthy carbs. Wait 15 minutes, then check bg again; if still low, take in another 15 grams. For one-hour sessions, check bg before and after, making appropriate adjustments.

—J.J.A.

Get going and keep going
When planning a workout, provide abundant and balanced fuel to keep your blood sugar on an even keel. Breakfast or an afternoon snack might include a 1-ounce wedge of cheese with a whole-grain cracker; a cup of really good yogurt; a small whole-wheat pita with 1/4 cup hummus, chopped tomatoes, and lettuce; or an 8-ounce glass of soy milk.

It's also critical to carry along snacks to keep your engine running efficiently. For long-distance activities pack a small, balanced meal, such as whole-grain bread with nut butter, all-fruit spread, and sliced banana; flaxseed crackers spread with hummus and sprinkled with toasted pine nuts; or a handful of dried fruit and nuts.

Stay hydrated Loss of fluids and electrolytes through sweating may lead to dehydration, which can starve cells and raise blood glucose. Drink at least 4 ounces of water or a sports drink every half hour during exercise. Ideal drinks include sparkling water or springwater with a splash of citrus juice, or herbal iced tea with fresh mint.


Writer Judith Jones Ambrosini has lived with type 1 diabetes since 1961.