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Conquering Diabetes

with Michael Dansinger, MD

This blog has been retired. We appreciate all the wisdom and support Dr. Dansinger has brought to the WebMD community.


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Friday, May 20, 2011


aerobics class

Photo: Ryan McVay

This WebMD article highlights the latest scientific findings on the favorable effects of exercise for diabetes patients. The article reports what we would all expect: cardiovascular (aerobic) exercise and resistance training are both beneficial for diabetes and lower the hemoglobin A1c levels.

Structured exercise programs (I like to think of these as formal exercise programs with some degree of hands-on supervision) typically produce better results than “exercise advice”, simply because the structured exercise programs achieve greater intensity and duration and greater compliance, than when patients are left to their own devices to get the recommended exercise.

In fact, studies with “exercise advice” typically produced no improvement in the hemoglobin A1c (due to poor compliance) unless dietary improvements were also made. The best combination is always simultaneous dietary improvement plus exercise (cardio and/or resistance), and the more “structured” or “formalized” the better. In fact, while patients who achieve the standard recommended “2.5 hours per week” see greater improvements in hemoglobin A1c than those who do not meet this standard; those patients who exceed the standard get even greater improvements!

Easier said than done! Exercise is one of life’s biggest challenges. We all know it is good for us, but almost none of us get enough of it. Why is that? What keeps us from doing the things we want to do (and what makes us do things we don’t want to do)?

I think the main reason is because the subconscious mind fights against the rational mind that knows better. I believe the subconscious mind is genetically designed (through millions of years of evolution) to keep us alive in the wild natural world, where survival had typically depended on saving one’s strength and energy for the immense daily work required just to live. Until the past century or so, physical exertion was an automatic part of life, with few machines to do our work. In my view, one price we must pay (the “tax” we owe) in order to take full advantage of this modern world of technology and freedom, is the exercise necessary to keep our bodies healthy.

For the majority of us who do not automatically gravitate toward exercise, we must find a way to overcome the natural resistance caused by the subconscious mind. The subconscious mind will bombard the conscious rational mind with all kinds of excuses. The barriers are almost never truly physical. I work with chronically ill patients with diabetes every week so I have a very good understanding of the degree of debilitation that does and does not exist across the entire range of patients with diabetes. At least 90% can exercise regularly. Even patients who are missing their legs or have very weak heart or lung function can perform and benefit from exercise.

It is easy to say it can’t be done, and to find seemingly good reasons to justify the decision. Just be aware these are typically just the subconsious mind dominating over what objective science documents time and time again — that you’ll feel better and probably live longer with regular exercise no matter how healthy or unhealthy you are today. Put it this way — if you would literally die today if you failed to get 30 minutes of physical activity you would get it done, and if death would come the very day you failed to exercise you would do exactly what was necessary to avoid this fate. You are genetically designed to do so! We just don’t live in that kind of world anymore.

The trick, I believe, is to use your rational mind to anticipate and outsmart the subconscious mind’s resistance tactics. For example:

  • Put yourself in a position of being “forced” to follow through with exercise  — where someone is keeping you accountable. This can be a personal trainer, an exercise class you pay for, or an exercise partner for tennis, walking, workouts, etc.
  • Sign up for a walkathon, bikeathon, triathlon, marathon, etc.
  • Join a fitness or weight loss contest at work or at a health club.
  • Link entertainment to exercise — –save your best music, movies, etc. exclusively for exercise time.
  • Buy yourself something if you meet an ambitious exercise goal.
  • I even have some patients who have chosen to “penalize” themselves for failing to meet their exercise commitments by donating money to their LEAST favorite presidential candidate or other charity.
  • Create regular opportunities to read and re-read all the good reasons to keep yourself in shape — write your reasons down and post them and carry them.
  • Hang out with others who set a good example.

There are many other tricks you can discover. Let’s figure out how to do whatever it takes to win this battle as if our lives depend on it NOW, rather than later.

- Michael Dansinger, MD

Posted by: Michael Dansinger, MD at 10:50 am

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