Knowledge of diabetes

Symptoms of diabetes

• Drinking plenty of water
• Overeating
• Frequent urination
• Excessive fatigue
• Visual impairments ‌
• Weight loss
• Sexual disorders ‌
• Wounds and recurrent infections

What do you know about type 2 diabetes?

Type 2 diabetes, which is prevalent in 9% of diabetic people, is a chronic and progressive disease.

There are more than two million diabetic people in our country, Iran, many of whom do not know their disease and suffer from dangerous side-effects due to lack of timely diagnosis.

Dangerous side-effects of diabetes      

Kidney disease: Diabetes is the most common cause of kidney disease leading to dialysis or kidney transplantation.

Visual impairments: Diabetes can lead to serious visual impairments and even blindness.

Peripheral nerve disease: Diabetes affects the peripheral nerves, causes sensory disturbances, and results in chronic ulcers in the limbs. Infection from these wounds can lead to amputation.

Cardiovascular diseases: The most important cause of death in diabetic patients is cardiovascular problems.

Do I have diabetes or prediabetes?

If you have symptoms of diabetes.

If you do not have symptoms of diabetes.

If you are overweight at any age and have one or more of the following risk factors:

• Immobility,
• History of diabetes in the first-degree relatives,
• History of gestational diabetes or overweight baby,
• Blood pressure greater than or equal to 140/90 mmHg or those who are under treatment due to high blood pressure,
• Women with polycystic ovary syndrome,
• History of cardiovascular disease,
• Cholesterol <35 mg, HDL triglyceride >250 mg/dL, and or hemoglobin A1C ≥5.7,
• The rest of the people must perform the first test at the age of 45.

Laboratory criteria for diagnosis of prediabetes and diabetes in adults

A blood sugar ≥ 180/dl in a random blood sample in a patient with obvious symptoms of the disease indicates diabetes.

Highlights

If the results are normal, the tests should be repeated at least once every three years.

If the results are not normal or the person has a risk factor, the tests should be repeated at shorter intervals, depending on the initial results.

People with a history of prediabetes should be examined in a laboratory once a year in terms of the progression of type 2 diabetes.

Definition of hemoglobin A1C

The hemoglobin A1C test is a very common blood test that is efficient for screening diabetics and shows how well patients have been successful in controlling their diabetes. Hemoglobin is one of the proteins in the red blood cells (RBCs), which carries oxygen in the blood. Like all other proteins in the body, it combines with sugars, including glucose. This compound is stable as long as the RBCs are alive (approximately 120 days) and forms the basis of the hemoglobin A1C test. If your normal blood sugar level is higher than the normal value over the past 8 to 12 weeks, the percentage of your hemoglobin A1C that has been combined with glucose, will be higher.

Diabetes and nutrition

Food pyramid

In the food pyramid of diabetics, foods are divided into six main groups. These groups have different roles in the food pyramid. The largest group that forms the base of the pyramid relates to the starches, grains, and cereals. In other words, it should be said that the maximum amount of your daily food should be supplied through these foods. The smallest group that forms the top of the pyramid is the fats, sweets, and alcohol, reflecting that your daily intake of these materials should be as small as possible.

For each food group in the pyramid, numbers are reported that specify the minimum and maximum consumption units of each during the day. If smaller units are chosen, the body will receive about 1600 calories per day, and if larger units are chosen, daily intake will be about 2800 calories. Most women should choose smaller units, and most men should choose larger units if they are physically active. The exact amount of nutrients the body needs depends on the factors, including diabetes control status, calories, and nutrients needed by the body, lifestyle, and favorite foods. Hence, the number of necessary units must be divided between main meals and daily snacks.

However, it should be noted that the food pyramid for diabetics differs from the common food pyramid, which you may be familiar with, in terms of how foods are divided and the number of units. For example, in this pyramid, starchy vegetables are in the starch group instead of vegetables, cheese is in the meat group and its substitutes instead of milk, and these differences occur because the amount of carbohydrates in each group should be as similar as possible.

Foods in this group include cereals, cornflakes, different types of Macaroni, breads, and different types of biscuits. The energy in these foods is mostly supplied by carbohydrates and also contains small amounts of protein and sometimes fat. Cooked cereals, beans, and lentils are in this group and also in the group of meat and its substitutes due to their high protein content. Therefore, each serving of beans, peas, or lentils is taken into account as a serving of bread and cereals, and each serving of meat and substitutes.

Thus, this group must not be eliminated from the diet of diabetic people. In fact, diabetic people should choose more foods from this group for obtaining the necessary calories because the food stuffs in this group meet all the needs for nutrients, including fiber, vitamins, minerals, and macronutrients. However, these foods contain carbohydrates and increase blood sugar. Food stuffs in the three groups of bread and cereals, dairy products, and fruits must be consumed in the daily diet of a diabetic person.

One serving of bread and cereals

One serving of bread and cereals contains 80 calories, 15 g of carbohydrates, 3 g of protein, and 0-1 g of fat.

Examples of a serving of bread and cereals

Examples of a serving of bread and cereals include:

• A slice of toast
• 1/4 of baked potato
• 1/3 cup of cooked spaghetti
• 1/3 cup of cooked rice (6 tablespoons)
• A palm-sized (excluding fingers) portion of Barbari bread
• A palm-sized (excluding fingers) portion of Sangak
• Two rusks
• Two slices of 10×10 Lavash

Examples of a serving of starchy vegetables

Starchy vegetables contain more carbohydrates and calories than other vegetables. Therefore, these vegetables fall into the category of bread and cereals. A serving of starchy vegetables equals 1/2 cups of these vegetables when cooked.

Starchy vegetables include corn, broad bean, peas, potatoes, and pumpkin.

Nutritional notes

Most starchy foods are good sources of B vitamins.

Foods made with whole grains (cereals with their skins and bran) are also good sources of dietary fiber.

On average, one unit of each of the above- mentioned breads contains 1 g of dietary fiber.

On average, a unit of starchy vegetables contains 3 grams.

Cereals are good sources of protein and fiber required by the body.

On average, a unit of this group of foods contains 6 fibers.

Notes on the selection

Starchy vegetables used for cooking and preparation are considered a unit of starch (carbohydrate) and a unit of fat while counting the units.

Yazdi cake, dry sweets, vanilla wafer, pie, and so forth are reported in the list of other carbohydrates.

Different types of beans, peas, and lentils are also included in the list of meat and its substitutes. Most food units are measured after food is cooked.

Fruits

This group includes fresh, frozen, canned, and dried fruits as well as juices. They are categorized into one group because all of these calories are supplied from carbohydrates. Fruits lack fat and are low in protein. Although carbohydrate-rich foods increase blood sugar, diabetic people must not avoid fruits and juices. In fact, each person should consume at least 2 servings of fruits daily. In addition, like other food groups, fruits should be included in everyone’s diet.

A serving of fruit group

A serving of fruits consists of approximately 60 calories and 15 g of carbohydrates.

Examples of a serving of fruits include:

• A small, fresh fruit (for example, an apple or orange with the size of a tennis ball),
• 1/2 glass of fresh or canned fruit (for example, fresh and chopped pears or canned peaches),
• 1/2 glass of sugar free juice (like sugar free orange juice),
• 1/3 cup of juices that are naturally high in carbohydrates (i.e., plum juice),
• 1/4 cup of dried fruits (like raisins).

Notes on how to eat fruits

Try to consume fresh fruits instead of juices or canned fruits. Unlike fresh fruits, canned fruits and juices are high in sugar and calories and also fiber free. Dried fruits have more calories than fresh fruits. If you do not know how to serve fruit in a meal, read the nutrition label on the package.

For information on serving fresh fruits, you can also follow the above-mentioned methods mentioned in section one of the fruit group.

Vegetables

Foods in this group include vegetables that are low in calories, carbohydrates, and protein and are known as non-starchy vegetables. This group includes various forms of vegetables, such as fresh, frozen, and canned vegetables.

Non-starchy vegetables are a rich source of vitamins and minerals. Moreover, vegetables are low in calories and fat and thus are the best source of fiber. Since these vegetables have fewer carbohydrates than fruits, they are served larger.

Different types of vegetables

Vegetables are divided into five main groups:

• Green vegetables (such as lettuce, broccoli, spinach, cabbage, etc.),
• Orange vegetables (such as walnuts, carrots, squash, etc.),
• Dry cereals (such as red beans, black-eyed pea, white beans, soybeans, peas, lentils, etc.),
• Starchy vegetables (such as corn, green beans, green peas, potatoes),
• Other vegetables, including lettuce, cabbage, cucumber, eggplant, celery,bell peppers, mushrooms, onions, tomatoes, turnips, turnip, beetroot, ).

A serving of vegetables

A serving (i.e., a full glass of raw vegetables and half a glass of cooked vegetables) from the vegetables group contains 205 calories, 2 g of carbohydrates, and 5 g of protein.

Dairy products

Foods in this group include milk, yogurt, and milk-related products. These foods contain similar contents of carbohydrates and fats. In fact, it can be said that all foods that are made from milk and contain calcium fall into this group. However, foods that are made from milk but have a small content of calcium, such as cream, cream cheese, and butter, are not included in this group. Most foods in this group usually have the same amount of carbohydrates and protein, but their fat content varies depending on the type of product.

One serving of the dairy group

One serving of this group usually contains 12 g carbohydrates and 8 g protein but their fat content and calories vary. For example, a glass of skim milk contains about 90 calories and no fat, while a glass of regular milk contains about 150 calories and 8 g of fat. To obtain more information on the amount of calories and fat in dairy products, read the nutrition label on the package at the time of purchase.

Examples of a dairy serving include:

• 1 glass of milk (non-fat, 0.5%, 1%, 2%, and regular milk),
• 1 glass of soya milk(low-fat or fat free milk),
• 2/3 glass of yogurt (flavored or flavor free),
• 3/4 glass of low-fat yogurt.

Notes on how to consume dairy products

Try to consume more fat free or low-fat dairy products because this group contains very little fat and calories. Read the nutrition label on the yogurt package while buying because the packaging containers of different types of yogurt are different. They also vary in calories because some companies add other ingredients to their products, such as essential oils, artificial sweeteners, or fruits.

If you do not know how to serve dairy products in a food, read the nutrition label on the package.

If you consume products such as flavored milk, cocoa milk, and desserts such as pudding, which contain sugar, you should consider them as carbohydrates while counting the carbohydrates.

Meat and substitutes

This group includes red meat, chicken and other poultry, fish, shrimp, and other seafood, eggs, cheese, and peanut butter. This group provides the body protein. However, low-fat types should be chosen and the least amount of oil should be used to cook them. 2-3 units of the foods in the meat group and its substitutes should be consumed every day.

A serving of meat group and its substitutes

In general, it could be said that one unit of meat and its substitutes equals:

• 30 g of red meat, fish, chicken, or cheese and
• 1/2 glass of (cooked) beans, peas, and lentils.

According to the amount of fat in different types of meat, they can be divided into very low-fat, medium-fat and high-fat categories. Always try to prepare your meals using very low-fat meats or meat substitutes.

Nutritional notes

High-fat meats contain high amounts of saturated fats and cholesterol, and thus are high in calories. They have also a very significant effect on the elevation of blood cholesterol. For this reason, experts in the field recommend to use low-fat or lean meats.

Each unit of beans, peas, and lentils have 3 g of fiber. Therefore, they are appropriate sources for providing the dietary fiber required by the body.

Lunch meat, sausage, and soy contain some carbohydrates. Hence, consider these cases while counting carbohydrates.

Notes on the selection of meat

Measure the weight of the meat after cooking and separating the bones and its extra fats. 30 g of each type of meat, half a glass of lentils, peas, and beans, and two egg whites are considered one unit of meat or its substitutes.

Reduce the consumption of meat or very fatty substitutes to three servings or less during the meal.

Lentils, peas, and beans are also included in the starch group.

Peanut butter is also included in the fat group.

Attention!!!

Always try to eat grilled or boiled meat and fish instead of frying them in the oil. In order to avoid oil, use nonstick cookware for frying or roasting food.

Meat fats must be removed before cooking.

Fats and sweets

Foods in this group include butter, margarine, salad sauce, mayonnaise, liquid oils, animal fats, and nuts and are classified in one group because of the same amounts of calories and fat. Apart from nuts, the rest cases in this group contain small amounts of protein and carbohydrates. Although fats are known to be harmful to health, they are essential for the body. Our body needs a certain amount of fat daily. However, it should be known for everybody what kind and how much fat to consume.

Fats are divided into three groups based on the type of their content: monounsaturated, polyunsaturated, saturated and Trans fat. Decreased consumption of a monounsaturated and polyunsaturated fat has a positive effect on health. Consumption of saturated fats has a relationship with the heart disease and cancer. In contrast, Trans fat and saturated fats increase the risk of heart disease.

Sweets include cakes, biscuits, desserts, and so forth, which are made from sugar. Note that the consumption of food in this group, which is at the top of the pyramid, should be minimized.

One serving of the fat group

One serving of fats contains 45 calories and 5 g of fat. Examples of a serving of monounsaturated and polyunsaturated fats include:

• A teaspoon of margarine,
• A teaspoon of mayonnaise,
• A teaspoon of low-fat mayonnaise,
• A teaspoon of liquid oil (corn, canola, vegetable),
• Six almonds,
• Ten peanuts

Examples of a serving of saturated fats include:

• A teaspoon of butter,
• A teaspoon of animal fat,
• A tablespoon of cream cheese,

Note on how to consume fats

Try to consume more foods containing monounsaturated and polyunsaturated fats.

Foods such as peanut butter in small amounts are considered fat, but if consumed in large amounts, they are considered as high-fat meats. All fats are high in calories. To stay healthy, limit their intake.

Nuts and seeds (like sesame) are low in fiber, protein, and magnesium. If you are worried about high blood pressure, choose salt free fats (such as salt free peanuts) to reduce your sodium intake.

Dietary sweeteners

Dietary sweeteners are commonly used as sugar substitutes; they are many times sweeter than sugar, but they have few or no calories. These sweeteners are used in different foods and their safety has been approved by the US Food and Drug Administration (FDA). Therefore, their allowable consumption does not danger humans and also does not increase blood sugar. They will helpful in the weight loss program and reduce the risk of tooth decay. Here, different types of dietary sweeteners and their related notes will be presented.

In general, sweeteners are divided into two groups:

Nutritive sweeteners that contain carbohydrates and calories, so their consumption should be calculated so as not to lead to weight gain.

Non-nutritive sweeteners are low in calories or lack calories. They are much sweeter than regular sugar (sucrose). This sweetener is 200 to 700 times sweeter than regular sugar and has no calories. These sweeteners can replace the sweet taste of sugar or sweet energy drinks.

Alcoholic sugars

Alcoholic sugars are widely used in food products to reduce carbohydrate intake and have less effect on increasing blood sugar. These sweeteners are used alone or in combination with other sweeteners. The energy supplied by alcoholic sugars varies due to differences in their slow or incomplete digestion and absorption. Sorbitol, mannitol, and xylitol isomalt fall into this group. Excessive consumption of sorbitol and mannitol causes diarrhea due to lack of complete absorption in the intestines. This type of sweetener is generally not recommended for obese diabetics who also have high blood fats. Therefore, before consuming dietary food products, read the label on them, which reflects their ingredients.

Saccharin

As a non-nutritive sweetener, Saccharin was first discovered and used in 1879. It is 200-700 times sweeter than the regular sugar and has no calories. It is daily used in drinks, juices, processed foods, and in cooking. More than 30 human studies have shown that saccharin is safe for human consumption and thus it was removed from the list of carcinogenic foods in 2000.

Aspartame

Aspartame is a nutrient sweetener with a protein structure consisting of two amino acids, phenylalanine, and aspartic acid. This dietary sweetener was discovered in 1965 and its use was approved by the FDA in 1981. Aspartame tastes 200 times sweeter than regular sugar and is less used because of its fewer calories. Moreover, it is not heat resistant and its sweet taste changes with heat, so it is not usually used alone for cooking. This sweetener is often produced in combination with acesulfame potassium sweetener and its taste does not change with cooking.

Note: Only people with rare disease of phenylketonuria (PKU) should be careful about consuming sources containing phenylalanine, including aspartame.

Acesulfame potassium or acesulfame K

Acesulfame K is a non-nutritive sweetener made from a combination of organic acid and potassium, and was approved by the FDA in 1988 to be used in the food industry. It tastes 200 times sweeter than regular sugar and is often consumed in combination with other sweeteners.

Since the sweet taste of Ace-K does not change with heat and is heat resistance, it can be used for cooking. It is also commonly used in cold desserts, chocolates, beverages, and ingredients. Aspartame-acesulfame sweetener

This flavor is low in calories and is made from a combination of two sweeteners, aspartame and acesulfame K with a weight ratio of aspartame (64%) and acesulfame K (36%). Therefore, it contains more aspartame and thus people with PKU should be careful about its consumption. It tastes almost 300 times sweeter than regular sugar and is widely used for breakfast and food industries such as sweets, chocolates, chewing gums, desserts, diet drinks, and some oral medicines.

Sucralose

Sucralose is a non-nutritive sweetener that is 600 times sweeter than regular sugar. It is commonly used in cold desserts (such as Jellies), chewing gum, chocolates, beverages, and cooked food. It maintains its stability under temperature and its sweet taste does not change. Hence, it is used as a substitute for sugar in cooking food, sweets, and cakes.

Neotame

Neotame is a non-nutritive sweetener and is approximately 7,000 to 13,000 times sweeter than regular sugar. This sweetener is a derivative of the amino acid combination of phenylalanine and aspartic acid. Although neotam contains phenylalanine, it is very small and is released in small amounts in the body. This sweetener is also heat resistant, so it is suitable for cooking, but is rarely used in the food industry.

Advantame

Advantame is also a non-nutritive sweetener and is about 20,000 times sweeter than regular sugar. This sweetener is also heat resistant and can be used in cooking.

Stevia

Steviol glycosides (stevioside & rhabadioside) are natural constituents of stevia rebaudiana and are commonly known as stevia. The whole leaves of this plant contain compounds that do not all have a sweet taste, so the sweet extract of the leaves of the plant was extracted in 2008 to be used in the food industry.

It is a non-nutritive sweetener that is 200 to 400 times sweeter than regular sugar.

The stevia sweetener tastes sweet if used in the right amount but may taste bitter in higher amounts. However, it should be noted that raw stevia leaf and plant extracts are not generally considered safe (GRAS) and are not FDA approved to be used in food.

Exercise and diabetes

Today, the incidence of diabetes in countries throughout the world has increased with the decreased activity of people and increased obesity. With regard to the role of exercise in increasing the level of activity and weight loss, its importance in the prevention and treatment of diabetes can be realized. Most people who control their diabetes exercise regularly. In fact, exercise is one of the three main elements of diabetes treatment along with diet and medication. Exercise should be part of your daily routine.

To achieve this goal, regular exercise must be started as soon as possible at a younger age. If your child has diabetes, your regular exercise will not only increase your general health but also will be a good example for your child. Therefore, try to be with him as much as possible during sports activities and encourage him/her to do it regularly.

Related topics: Proper insulin injection

Frequently Asked Questions

Exercise and type 2 diabetes

Experts in the field have mentioned several positive effects of exercise on type 2 diabetes. New research emphasizes that the long-term regular exercise will not only improve the control of type 2 diabetes but it can even prevent diabetes in people at risk. Another important thing about the role of exercise in controlling type 2 diabetes is that it should be started as soon as possible. In fact, if more exercise is started in the early stages of diabetes and before a person needs medication, we will observe its greater effects on the improvement of diabetes control. In general, the benefits of regular exercise in type 2 diabetes include:

Better control of blood sugar: It is well known that one of the major causes of high blood sugar in type 2 diabetes is resistance to the insulin function in the body. Exercise reduces blood sugar by decreasing this resistance and increasing the effect of insulin in the body or increasing the entry of glucose into the cells, in particular, muscle cells. This effect will be manifested by declining fasting blood sugar (FBS) and the content of hemoglobin A1C, reflecting the long-term status of blood sugar over the past 2-3 months.

Fat reduction: Many studies have demonstrated the high effectiveness of regular exercise in reducing blood lipids, especially triglycerides. It also elevates good cholesterol (HDL) in the body.

Treatment of obesity and weight gain: As mentioned earlier, regular exercise in combination with a proper diet plays a very important role in weight loss, maintenance of the existing weight, and prevention of the obesity recurrence.

Principles of exercise and diabetes

In general, aerobic exercise is the best type of exercise for diabetic people. It should be noted that exercise is divided into two general types of aerobic and anaerobic. In aerobic exercise, you will exercise for at least 20-25 minutes of moderate or moderate intensity or continuous exercise. Instead, in anaerobic exercise, you do strenuous activity for a short period of time and then relax (e.g., weightlifting, bodybuilding, basketball, football, & tennis). Aerobic exercise further strengthens the heart and circulatory system, and anaerobic exercise increases the strength and volume of the body muscles.

Examples of aerobic exercise include walking, jogging or running on a conveyor, boating, jumping rope, dancing, swimming, skiing, and cycling by riding a stationary bike.

Intensity of exercise

In general, after the onset of physical activity, the heart rate begins to rise to a maximum. This value varies at different ages and is calculated as follows:

(In terms of age): 220 – age = maximum heart rate.

For example, in a 40-year-old person, the maximum heart rate is calculated as follows: 220 – 40 = 180.

If we assume a resting heart rate (RHR) of 70 beats per minute, the maximum number of beats that this person’s heart can have more than a resting state is calculated as follows: 180 – 70 = 110, which is called the maximum heart rate reserve (HRR).

In general, the intensity of aerobic exercise should be such that you reach 70-90% of your HRR, but it should increase gradually. For example, in the previous example, adjusting the intensity of sports activity is planned according to the following steps: starting the activity with 40-50% HRR, 40×110 = 44%. In fact, this person’s heart should beat 111 times per minute (44+70) at the beginning of the activity.

Gradual increase in activity intensity over several weeks to reach the target value (60-70% of HRR) 110 × 70% = 77; that is, the heart rate should be 77 times greater than the resting time after reaching the ideal level, (i.e., 147 times per minute).

As a simple rule, instead of the above calculations, according to their doctor’s diagnosis, elderly people with a long history of diabetes, who experience side effects of the autonomic nervous system (because the heart rate is not well regulated during exercise) can consider the intensity of the exercise to be appropriate for themselves, in which they are able to speak easily and without huffing and puffing while feeling warm.

Since walking is the easiest option among aerobic exercises, you can start your activity by 1.5 km walking a day and increase it to 6 km in 6 weeks. At present, it is recommended that diabetic adults perform strength training (working out with a low-intensity equipment) 2-3 times a week to increase their muscle mass.

Exercise duration

In general, to achieve the favorable effects of an aerobic exercise on the body, it should be performed continuously for at least 20 to 30 min. You can start by doing a light activity a few minutes a day and gradually add a few minutes to it each day for a few weeks to reach the ideal time. Moreover, never stop your activity suddenly, but after a gradual decrease in activity intensity, as the beginning of the exercise, repeat the stretching exercises for 5-10 min.

The number of sports activities

Regular exercise has a very important role in increasing the effect of exercise on lowering blood sugar; therefore, you should exercise at least every other day. When weight loss is the purpose of exercise, the number of sessions should be at least five times a week.

Exercise time

In general, the best time to exercise is 1-2 hours after a meal, because it not only can further control your postprandial blood sugar, but it can also decrease your blood sugar if you inject insulin (hypoglycemia). In addition, if you use insulin, you should avoid exercising during the hours when your insulin activity in your body reaches its maximum.

Exercise and side effects of diabetes

One of the most important things you should do after the onset of diabetes is to maintain vitality to participate better and more effectively in treatment programs and also increase the level of physical activity to increase the resistance and efficiency of various organs of the body. Therefore, exercise can help you a lot in this regard.

In case of the occurrence of the side effects of diabetes, you should do more exercise than before, but you must follow all the previous principles mentioned in the exercise section. In particular, always keep your doctor informed of what type of exercise you are doing. Here are some notes for people with any of the side effects of diabetes when exercising. It should be noted that water sports, in particular, swimming, are the best choice for diabetic people.

Nerve injury in the legs

Since this damage reduces the flexibility in the muscles and joints of the body, it is of high importance to perform stretching exercises, in which the muscles are stretched for 10-20 seconds. In general, a proper exercise for these people is a kind of activity that does not impose too much pressure on the legs (such as cycling and boating). They also must follow the principles of foot care when exercising.

Retina injury

Exercise is bad for your eyes when the injury is active and severe. Hence, first treat the injury (usually laser therapy). Exercise is only allowed if your doctor prescribes it; that is, after the lesion is under control. In general, when there is a retinal injury, doing sports that require strain, such as weightlifting, or sports in which the head is lower than the body or exposed to severe shocks, such as basketball and football, is harmful due to increased eye pressure and risk of intraocular bleeding.

Kidney injury

In this case, in particular, when accompanied by high blood pressure, you should avoid strenuous and professional exercise or exercise in which the hands are moved highly, but doing light or moderate aerobic exercise can be useful. Therefore, consuming enough fluids during exercise is of high importance.

Peripheral vascular injury

In case of symptoms such as pain at the back of the leg or cold feet during exercise, doing some exercises, especially intermittent walking with adequate rest in the walking distance, will result in the improvement of the symptoms.

Heart disease and high blood pressure (HBP)

In these cases, your doctor must calculate your ability to do exercise by doing an exercise test before starting any exercise activity and, accordingly, suggest an appropriate exercise for your condition. Since most diabetic people are asymptomatic, it is recommended for all people with type 1 diabetes who are over 30 years old or their diabetes has been diagnosed more than 15 years old, and also all people over the age of 40 years with type 2 diabetes, do the exercise test. In general, low or moderate intensity aerobic exercise will be useful for patients with heart diseases.