As with any population, increasing physical activity has some potential risk for the patient with type-2 diabetes. Individuals who have underlying coronary heart disease, as in non-diabetic patients with heart disease, exercise may theoretically precipitate angina, myocardial infarction, arrhythmias or even sudden death. As with other patients with coronary heart disease, physical activity is contraindicated in the presence of unstable angina. High intensity aerobic exercise and isometric exercise are contraindicated in the patient with proliferative retinopathy because of an increased risk of developing retinal or vitreous hemorrhages and retinal detachment. However, moderate intensity aerobic exercise, such as walking, is an acceptable modality of treatment. Patients with peripheral neuropathy should not engage in exercise which may traumatize the insensitive foot (such as jogging). In addition, properly fitted footwear and checking of the feet for injury after exercise are recommended precautions. Data evaluating the potential problem of exercise-induced hypo-glycemia in type-2 diabetes patients taking oral agents or insulin are lacking. However, non-diabetic individuals taking oral hypoglycemic drugs developed hypoglycemia during prolonged exercise. A reasonable precaution is to monitor blood glucose frequently upon initiating a physical activity program. The positive effects of physical activity in persons with type-2 diabetes may require adjusting medications and physicians should be alert for this need when their patients begin increasing physical activity.
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