What You’ll Learn:
• How to Start and Stick to an Exercise Plan that is Diabetes-Friendly
• What Exercise Does For Us
• Why Is It Important To Do Something About Diabetes
• The 7 Steps of Diabetes Fitness Plan
• Don’t Believe These 9 Exercise Myths
• Breaking News That Matter to Diabetics
How to Start and Stick to an Exercise Plan that is Diabetes-Friendly
Let us therefore start with this: Listen to Sheri R. Colberg, PhD, FACSM who presented the main essential things about exercise and diabetes.
Introduction
This is the problem. Most of us have good intentions. The proof? Every year we make a New Year’s Resolution to lose weight. We sign up for gym classes. We buy gadgets to see us through our resolution. Do all these work? No, because before we know it, we find excuses not to go through it. We say it’s too hard; we don’t have time and so on and so on.
I think the problem is our mental set-up. We think of exercise as something that makes us sweaty. We think of it as something we have to walk or run every day for an hour or something but it does not have to be that way. Exercise can be fun. Go walking and stop to admire some of the birds you see flying around or find some activity you enjoy.
Swimming, line dancing, the list is endless. You just have to incorporate the activity in your day and make it a habit. For much too long, experts said eating much sugar does not exactly cause diabetes but now research has shown that increased sugar consumption is linked to diabetes. That is why it is important for us to understand this all important link to diabetes rates.
Glucose monitoring or not, exercise will always make you feel better both physically and emotionally. Before the advent of the glucose meter, it was the only way the diabetics can feel a sense of control over the blood sugar levels. Now that we have all the information we need, exercise is still a part of our life. But first we have to understand the basic truths on exercise and diabetes.
1. Mistakes made on the blood glucose can be eliminated by exercise. You see, exercise is like an extra dose of insulin because it gets the glucose out of the blood into the muscles. This happens when you are active because insulin is needed to get the glucose into the muscles. So when you eat a little bit more, exercise can erase this mistake.
2. Mind you, exercise does not make the blood glucose go down immediately. In fact, it can raise the blood glucose temporarily but in 2 or 3 hours, that exercise can bring it right down. That is why some have recommended not taking too much insulin to correct this. And if you don’t take insulin, give your blood glucose time to go down by doing slow-type exercise like walking.
3. Another thing to remember about exercise is what it does to your muscle mass. It holds it intact which is essential as a depot to store the carbs you consume. If you are not active, the carbs can fill up the muscles for you exceed the capacity to hold more so the blood glucose goes up. So exercise regularly to keep your muscle storage capability as large as possible.
4. Exercise has a natural antioxidant that prevents one from getting diseases. It is the best medicine really and keeps one looking younger.
5. Exercise also keeps our emotional stress under control and keeps us from developing depression.
6. Exercise comes in different forms from just standing more often than sitting down, walking and just keeps on moving along. There is really no excuse not to exercise.
What Exercise Does For Us
Just think of all the benefits you get out of exercise. Heck, we do not even have to call it exercise. Let’s call it “Our Fun Thing To Do Today”. We could lift weights or run; both are good as they will make the different parts of the body stronger. Running will make our heart muscles stronger while lifting weights will build muscles that help with better sugar control. Let us do both but not on the same day, you silly. Run one day and lift weights the next day.
A research study has shown that those who did both types of “fun things to do” have better sugar control after nine months. The cardio workout will get your heart rate at 60-80% of your maximum rate. So consult your doctor to see what is safe. Your health care team will let you know the safe heart rate for you to work up to.
When lifting weights, we have to make sure we do it right or risk getting injured. Don’t just start lifting weights without proper instruction. Start slowly especially if you have not done it before. Lifting weight has been found effective in blood sugar control. Why? Because it increases the metabolic rate. Besides the increased muscle mass makes one’s baseline metabolism higher.
A word of caution here. Test the blood sugars more often when beginning an exercise plan. You want to make sure you don’t get hypoglycemia. You may have to adjust your medication or have snacks more frequently. Above all be patient. Rome was not built in one day. The blood sugar control may come later so don’t be discouraged.
Here’s what an expert, Dr. Colberg said, "Exercise when your insulin levels are lowest or cut back on it beforehand to avoid exercise lows." She also says, "The amount of insulin in your system during and after has a big effect. Exercise increases insulin action for 2-72 hours"
With the essential knowledge gained from above, we are ready for more information on how to be fit and live well with diabetes. With the diabetes epidemic going strong, now is the right time to deal with weight loss that is essential to control the condition. We try to diet but fail miserably at it but what we may not know is that the latest research has shown we do not have to lose a lot to stay healthy. Only exercise of 90 minutes a week lowers insulin resistance.
So don’t make the mistake of focusing only on weight loss. Some expectation is not realistic to the point we get discouraged and stop our effort on trying to control diabetes. Who would not be so discouraged? Well, don’t fret because here’s a book that will give us the real deal: I can’t put all the details here but just sign up and I will give you the link. It is not the whole book but most of it. If you like the full version, you can buy it at Amazon right here:
The book is easy to read and covers diabetes control, what it means to be physically and emotionally fit, how to prevent and reverse diabetes. You will learn how to be healthy despite diabetes and being overweight along with the strategies on nutrition and physical exercise to achieve optimal health. As well. you will gain insight on the role of supplements and medications to treat diabetes along with tips to motivate you to achieve your goal. There is no other book like this.
Whether you have type 1 with the body cells producing insulin is destroyed (autoimmunity) or type 2 defined or described as insulin resistance. This is diagnosed by a fasting BG level of 126 milligrams per deciliter (mg/dl) or 7.00 mmol/l) or above. You will be advised to lose weight and so will have a difficult time to control the diabetes. What if I tell you, you don’t have to lose that much weight to prevent, reverse and control the condition? The answer is in this book.
Why Is It Important To Do Something About Diabetes
This is really something to worry about although don’t get me wrong. I don’t want you to worry about it. What I really hope is for you to do something about it. Why? Because not doing so will not only lower your quality of life by approximately 20 years but also rob you of around 12 years of your life. If we don’t do something about it, diabetes can lead to amputation, loss of sight and mobility, chronic pain, kidney and heart diseases.
I don’t mean to scare you but we really have to face this head on so we can avoid the statistics because time and time again, it has been proven we can live a long and healthy life with diabetes. After you have read this book and implemented the recommendations, you will be more motivated because you will understand that losing a lot of weight will not cure the condition because one can live well with diabetes despite being overweight.
Now just get up, stretch and walk for awhile before reading the 7 steps. In fact the suggestion is to do the stretching and walking in between the steps. You will become more fit. The seven steps are just a recap but if you want some details you can either buy the book here:
The 7 Steps of Diabetes Fitness Plan
Step 1- Learn the basics and choose the lifestyle that helps most.
To control diabetes and prediabetes, eat healthy and move more. Improve insulin sensitivity by increasing fitness that is best suited for you despite how much you weigh. Keep the blood sugar within the target range that has been recommended by the doctor. This is quite challenging because there are many factors that can affect the BG.
The factors that can affect the blood sugar reading are food you consume, the physical activity you undertake, illness, alcohol, menstruation and menopause, stress, and the medication you take. This goes to show that the genes alone cannot be blamed for the diabetes because lifestyle choices are significant and carry a lot of weight.
Step 2 - There are a lot of ways of moving more.
Regardless of your present physical condition, there are variety of ways to move more that can be beneficial for diabetes and your health. If you’ve not been active for most of your life consult with your doctor first before undergoing exercises of higher intensity. The easiest way is to add more steps in your everyday activities. Every bit of movement whether planned or not is good. Just plainly standing and talking can help with the weight and diabetes.
Being physically active can prevent the onset of most complications. You can do any regular physical activity safely and efficiently. Whether it is accompanied by weight loss or not, exercise can help the body use insulin more efficiently. We can therefore truly say that exercise is the best medicine for diabetes and any other ailments that bother you.
Later on you graduate to cardio, flexibility, toning and strength exercises that will provide more health benefits. There are non-weight bearing exercises too like bicycling, swimming and other aquatic activities; exercises on the chair can be done by most everyone. Thanks to diabetes for giving us the reason to do all these exercises to be physically fit.
The extra body fat is not the only cause of the BG meandering. In fact even small body reduction of 10 to 15 pounds can make one enjoy the health benefits of having normal weight. And the only thing that can help you keep off whatever weight loss you have gained is exercise. It is the only truly effective way to lose the abdominal fat. You see you can still be physically fit even when you’re overweight.
What To Do for Step 2
1. Consult with your doctor as to the best time of the day to exercise as this has to be coordinated with your meals and medication.
2. Know your numbers by asking your doctor the suitable blood sugar level for you before you start exercising.
3. Check your BG and stay hydrated by drinking water and other liquid while exercising as the blood sugar level will be affected by dehydration.
4. Be ready for any eventuality by always having a glucose tablet or small snack just in case your blood glucose goes down too low. Wear a diabetes identification bracelet.
Step 3 - Move more and use a variety of exercises to get the most benefits.
You can do aerobic exercises of different intensities, stretching, and resistance training body core exercises and then rest on every 7th day. You can either have planned or unplanned activities you can do every day. Unplanned activities can be in the form of yard work, taking extra steps, going up and down the stairs without the use of elevators and escalators.
Other unplanned activities can be as simple as taking the dog for a walk, playing with the kids, indulging in recreational activities, doing housework or going shopping. Planned activities for over 30 minutes for up to 5 days a week can be swimming, walking briskly, jogging, bicycling or using machines for aerobic conditioning.
Both resistance and flexibility exercises can be done for 2 or 3 days a week. Flexibility exercises can stretch the main muscle groups for 10-30 seconds. Irregular activities like watching TV, using the computer and some other inactive pursuits can also be part of the physical fitness plan. Every activity helps.
What To Do for Step 3
1. Do warm-ups before you begin a more intense exercise so that your blood will get pumping thus getting your body ready to exercise. Example of this are just walking and marching in place. Likewise do a cool down after an intense exercise for about 5 to 10 minutes to reduce muscle fatigue, stiffness and tenderness.
2. Improve your aerobic fitness level just by adding 6 minutes of intense exercise per week to your fitness plan. Include short periods of faster walking to whatever exercise you’re doing.
3. Doing approximately three hours a week of exercise does more than two hours a week regardless of intensity. It looks like length of exercise is more important than intensity.
4. Talk test the intensity of your exercise. Being not able to talk while doing an exercise means you’re working too hard which may cause injury and may discourage you to do any workout.
5. Make your exercise more progressive by adding some weight or resistance if you can do more after 2 or 3 sets of repetitions.
6. Don’t hold your breath when doing resistance exercises as this will make your blood pressure rise to the point it may lead to heart attack and stroke.
Step 4 - Consume a healthy diet which works hand and hand with exercise.
Eat high fiber, low-GI foods that are natural and of different colors in small portions. This will help control the body weight and diabetes. Healthy eating is a cornerstone of healthy living — with or without diabetes. But if you have diabetes, you need to know how foods affect your blood sugar levels. It's not only the type of food you eat but also how much you eat and the combinations of food types you eat.
What To Do for Step 4
1. It is more important to know the effects of certain foods on the blood sugar level than just learning the composition of the foods and limiting the consumption of those foods.
2. The Glycemic Index will help in the meal planning.
3. Avoid consuming sugar and other refined carbohydrates as they have a negative effect on the blood sugar. Doing so can help lessen or even reverse the symptoms of diabetes.
4. Consume the recommended daily adult fiber intake of 25 to 40 grams of fiber like beans and dry peas, leafy green vegetables, nuts and seeds, dry fruits, whole fruits and whole grain foods.
5. Limit intake of caffeine as they may lower the insulin action.
6. Try to avoid eating at fast-food restaurants.
7. Find out more about carbohydrate counting and portion sizes.
8. Eat well-balanced meals and match them up with the medications.
9. Stop drinking beverages sweetened with sugar.
Step 5 - Strive to be emotionally healthy as this is as important.
In fact emotional healthy is just as important as physical health in diabetes control and in preventing dementia, depression and unhealthy eating. Being physically active will help win over all these. It is easy to get emotionally disturbed from the challenges of having diabetes. Even carrying extra weight would affect one’s emotional health.
Speaking of weight, we have been told to diet but the trouble is even if we stick to the diet, we don’t really lose much weight and this leads to frustration and an unhealthy way of eating. Mind you being overweight is not the main cause of disordered way of eating but getting so preoccupied with the idea can lead to losing touch with other things we can do to control diabetes.
Anyway if frequent attempts of dieting lead to disordered eating, this can be treated. But why wait and be bothered by frequent dieting when you can practice moderation without entirely giving up your favorite food? That way your blood sugar will thank you for your effort. Our treatment should not just focus on losing weight.
Besides, getting obsessed with losing weight will just give one a negative self-image. We can improve our self-esteem just by exercising even with the mildest forms of exercise like walking. Getting physically fit will lead to emotional health. You see, exercise releases brain endorphins which in turn helps improve the mood and lowers anxious feelings. In addition, exercise lowers the risk to develop Alzheimer’s disease and dementia.
For example, it is not a good idea to totally avoid your favorite food. This is not the best way to make changes on your way to healthy eating. Instead, give yourself permission to enjoy small amount of your favorite food once in a while and take time eating it so you can have a longer time enjoying it. Eat more slowly and you will feel full sooner thus will be eating less.
Foods certainly affect our mental capability and emotions. Each time something wrong occurs, we respond by grabbing a comfort food. Some eat because they are bored, sad, depressed or other emotional reasons. In addition, the diabetes police keep telling us what we are doing wrong.
No wonder approximately half of the people with diabetes suffer from depression. The prolonged stress may just cause the blood sugar to rise. Being in a lot of extra pressure will do it. If you are still bothered by this, get help on the negative relationship with food so that you can focus on your diabetes control.
What To Do for Step 5
1. Check your stress level and assess it on a scale of 1 to 5 when you do your blood sugar. You might be able to see a pattern. Sometimes you don’t even have to do this. You know how you feel.
2. When you learn how the stress level affects the blood sugar, gain control through relaxation, avoidance of things that stress you and exercise.
3. Get help if you feel you are not feeling any better. A psychiatrist, psychologist or a clinical social worker can help you.
Step 6 - Use medications and nutritional supplements wisely.
Next to eating a healthy diet and moving more, medications and supplements form the third cornerstone in managing diabetes efficiently. It is not your fault if the natural approach of changing the lifestyle has not worked but continue doing them as they are most important facets of keeping healthy.
Medications and insulin are meant to lower the blood sugar level but taking them may make you gain weight and increase your risk for hypoglycemia when you exercise but you can make adjustment by lowering the dose and keeping physically active and eating a diet with low-GI foods.
Nutritional supplements like Vitamin D and magnesium and cinnamon may help because they are known to have antidiabetic effects but try to take them naturally from the foods you eat. And don’t believe all the hype you hear about so and so supplement has some magic power as there has not been a conclusive scientific on the benefits.
Remember that the medications and insulin are effective depending on the size of the dose and the timing of it as well. In addition, other medications that you take for other conditions may also affect your blood sugar level. So monitor the effect of the dose, the physical activity and make adjustment with the help of your health care team.
What To Do for Step 6
1. Store the medications and insulin properly. Make sure they are not past the expiration date when you take them and therefore may not be effective then. I never leave them in the car as it gets too hot. These medications, especially insulin are sensitive to excessive change in temperature.
2. Be careful with new medications. Monitor the response of your body to the medication as it may interact negatively with all other factors.
3. Report to your health care team any change you observe like if your blood sugar level drops like a rock or if it remains constantly high. The timing and dosage may have to be adjusted.
Step 7 - Try different strategies to stay motivated in making healthy choices.
These healthy choices should last all your life. This is an important step as motivation will keep us going with the resolve to take care of ourselves. Without this, we may just give up so easily. Exercise everyday instead of getting into diet after diet that does not work. For one thing dieting can lead to a decreased metabolic rate especially if you are consuming less than 1000 calories.
Remind yourself everyday that exercise is good for you and get to know more diabetes knowledge so you can continue with lifestyle changes. Don’t make excuses like your joints are painful and so can’t exercise. I am telling you from experience that exercise helps me lose my pain which is just unbelievable. Really you get more energy when you move more.
Also make it more convenient. In my case, I make it easy for me to exercise. I just incorporate it into my schedule and I make it easy for me to start. I don’t have to get ready for it; I just exercise right in my pajamas. I don’t have to change or go to a gym. Every part of my house is my gym.
I have a back-up plan when I am travelling for then I will not be able to do my yoga or taichi but I can still do aerobic exercises by walking around the airport and doing stretches. This way, I keep being active all day long. And when I am busy at work, I keep moving by walking up and down the stairs instead of taking the elevator.
If you do not have time to exercise, just take it one day at a time. You can multitask with exercise. For instance, while I am doing my prayers, I run around the house. You can also exercise while you are reading a magazine or book or even the insurance policy, watching TV, listening to music or story on tape and even while talking on the phone. Just don’t do it with Facetime.
Or you can make it fun by checking out what activities are going on in your community. We go line dancing, golfing and ballroom dancing for instance which we do not want to miss because we love them so much. You see when your physical activity is fun and varied, it is no problem sticking to it. There are even equipments you can use in some recreational centers.
If you do not want to exercise alone, get a friend to do it with you. You can then motivate each other to keep on going. At the end of each week, check how you made out with your fitness program and if you find you did not miss a day, reward yourself with a sticker or two and put them on a calendar. Keep one calendar especially for this. Or go out for lunch in the weekend.
Starting out with intense exercises is not wise as you may get frustrated and then give up. Start slowly but surely. Then if something goes wrong and you stop your exercise regimen, get back to it one step at a time until you get back to where you fell off the wagon. Illness, vacation time and responsibilities can wreck havoc to your exercise schedule. It is not a dishonor to get off the exercise wagon, but it is a disgrace not to get back to it.
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Don’t Believe These 9 Exercise Myths
There are all kinds of advice they tell us and sometimes we fall for them. Not anymore for here are the lies they tell us. After reading them, make sure you take action and permanently delete them from your life. Keep exercising!
1. Weights will make you look bulked up.
We sometimes think we will develop all kinds of muscles but actually we will just look more fit. It will take more lifting of weights for us, to look like Arnold Schwarzenegger. Let us not be afraid of lifting weights because this part of exercise can be a good and welcome portion of our fitness plan.
2. The readings on the gym cardio machines are accurate.
We can’t trust those readings. If the display says we have burned 300 calories after thirty minutes on the treadmill, those readings are not accurate. Even if we input the necessary data like age, gender and weight, those readings cannot be construed as true. So be on the lookout for these readings and trust more on things you have to do.
3. Consuming protein drinks and supplements is enough to build muscles.
The healthy foods we eat contain proteins that we need for muscle building. We do not have to buy supplements and protein drinks to build muscles.
4. Check the weighing scale to assess your success at losing weight.
Watching the weight scale could just give us a reason to stop exercising and eating healthy food, right? Wrong! You see when we start exercising, we may even gain a bit of weight. Why? Because as we start exercising and gain some muscle and lose fat, the heavier of the two which is the muscle will show more weight on the scale. So don’t let that weight gain stop you from doing your fitness plan. You are on the right track if you keep on exercising.
5. The only way to benefit from exercise is to do it every day.
This is not true at all and is probably the reason why most of us stop our exercise regime. Just remember that every exercise you do has some benefit. Don’t stop your fitness program just because you miss exercising on certain days.
6. Fix problem areas by toning and tightening some trouble spots.
This is how we get attracted to buy all those products that promise to flatten the stomach and fix other trouble spots of the body. Truth be told, we cannot pick and choose which part of the body we want to lose fat from. They may help but for us to lose weight and tone the muscles, we need an exercise routine that focuses on all parts of the body.
7. I exercise so I can eat anything I want.
This is not true at all. Just because we exercise we are given the license to eat unhealthy meals. Remember that whatever we consume we have to burn or else those extra calories will appear as gained weight.
8. No pain, no gain.
Exercising does not have to be painful. There are all kinds of exercises. Choose one that fits your lifestyle. In my case, I go line dancing twice a week to lose weight. Now if only I could stop going to buffets, I could lose more weight. If you have a way to do that, let me know, okay? Just write your suggestions in the comment box below.
9. Stay hydrated with sport drinks.
Research has shown that all you need is to drink water while exercising and after it as well. Sport drinks can contain a lot of calories which may mean you will be consuming more calories than you are burning while exercising.
Breaking News That Matter to Diabetics
1. Is It Okay for Diabetics to Drink Protein Shakes?
It is fine for the diabetics to have protein shakes but in moderation. Read the label to see the total grams of carbohydrate for each serving to see how you can fit it in your diet plan. Remember that the carb budget for a man is 60-75 grams for each meal while for a woman it is 45-60 grams/meal.
Check also the total grams of protein which makes the blood sugar rise more slowly while the carbohydrate does it more quickly. Just monitor the rise of the blood sugar level around 4 to 6 hours after a meal when consuming food with high protein content. It is also a good idea to remember at this point that a balanced diet from a variety of food is advisable.
2. How Is This Possible: Environmental Destruction Caused by Diabetes Treatment.
US waterways are now containing drugs that include diabetic drugs. The most common drug found in Lake Michigan is metformin, a diabetes drug. The trouble is the fish hormonal system may be altered. The contamination of the water has made those who live on rural areas to drink more soda pop which contribute to increase diabetes and obesity rates.
3. Two Cases That Affect the Diabetics to Be Decided by the Supreme Court
On deck is the Obama’s Affordable Care Act where the issue of whether the tax credits to millions of Americans will be deemed illegal. I don’t know why helping people afford health insurance will be deemed illegal. The tax credit will not cover the whole premium, I don’t think. It will just be a small percentage of the person’s income and that is after they will probably lower eligibility by putting in place some factors as the income and the social benefits.
The other issue the Supreme Court will decide is how the Americans with Disabilities Act will be covered when the police come in contact with people with disabilities. This is important as people with disabilities include people with diabetes. How are they going to deal with this? With compassion, duh! Why do we make a mountain out of a molehill, huh!
Conclusion
There you have more information on diabetes and exercise. Please no matter what happens, continue exercising as this will be most helpful. Mind you, you have to check with your doctor so that any condition that may be worsened by exercise is not present. And do not be concerned too much about weight loss.
Your Turn
What do you think of all of these? Did you learn something new? Do you have any information on this issue to contribute? What strategies do you use so you can keep on exercising? What’s your view on this? Did you learn something new? Share it with your friends! Love to hear your thoughts. Leave us a comment below and we’ll know.
By Roger Guzman, M.D. and Evelyn Guzman
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Refresh The Diabetic Foot
Blood Sugar Control All About It - Part Two
Disclaimer: This is not a medical advice column. We are PWDs or long time interested on learning as much as we can and freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not both MDs, RNs, NPs, PAs, CDEs. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
Some people asked me about this.
References
1. Diabetes and Exercise: Highlights of Our Recent Twitter Chat http://www.diabeticconnect.com/diabetes-information-articles/general/1606-diabetes-and-exercise-dcde-twitter-chat-summary?utm_source=Newsletter&utm_medium=Email&utm_campaign=DCE_20150302
1. 6 Things You Should Know About Exercising with Diabetes. http://www.diabeticconnect.com/diabetes-information-articles/general/1588-6-things-you-should-know-about-exercising-with-diabetes
2. Frugal Fitness: 7 Tips to Work Out on a Budget 3 Equipment-Free Exercises to Combat Diabetes Need Exercise Ideas? Try Sweatbetes Videos
3. http://www.shericolberg.com/diabetes-fitness-plan.asp The 7 Step Diabetes Fitness Plan Living Well and Being Fit with Diabetes, No Matter Your Weight Marlowe & Company, 2006
4. 9 Exercise Myths You Need to Forget http://www.diabeticconnect.com/diabetes-slideshows/237-9-exercise-myths-we-need-to-forget?utm_source=Newsletter&utm_medium=Email&utm_campaign=DCE_20150302&utm_term=1head#10
5. How to Start a Diabetes-Friendly Exercise Plan http://www.diabeticconnect.com/diabetes-information-articles/diet-and-exercise/getting-started/306-how-to-start-a-diabetes-friendly-exercise-plan?utm_source=Newsletter&utm_medium=Email&utm_campaign=DCE_20150302
6. http://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-management/art-20047963
7. http://www.dabeticconnect.com/diabetes-news/general/5210-ask-the-expert-are-those-protein-shakes-ok-for-diabetics?utm_source=Newsletter&utm_medium=Email&utm_campaign=DCE_2
Overtreatment of Diabetes Now Causing Environmental Destruction http://articles.mercola.com/sites/articles/archive/2015/03/04/overtreatment-diabetes.aspx?e_cid=20150304Z1_DNL_NB_art_2&utm_source=dnl&utm_medium=email&utm_content=art2&utm_campaign=20150304Z1_DNL_NB&et_cid=DM68918&et_rid=86379117
4 8. http://www.dlife.com/diabetes-food-and-fitness/diabetes_and_exercise/the_7_step_diabetes_fitness_plan
