Nerve damage to the feet can stop you from recognizing injury, and as a result you can develop calluses, foot ulcers, or even a Charcot's foot (see Chapter 3). If you have significant peripheral neuropathy, you should avoid pounding the pavement and try non-weight-bearing exercises such as swimming, rowing, and cycling instead. When you buy athletic footwear, choose shoes with cushioned midsoles and socks that wick away moisture.
Autonomic neuropathy can dull the classic warning signs of hypoglycemia (palpitations, sweating, and shaking), and this may prevent you from recognizing exercise-induced hypoglycemia. Similarly, if you have hypoglycemic unawareness due to recurrent hypoglycemic episodes, you should monitor your blood glucose more frequently during and after exercise.
Autonomic neuropathy can also cause problems with blood pressure regulation, and you can get light-headed with exercise. Dehydration can worsen the problem, so it is important to drink adequate fluids. The heart rate is often increased even at rest, and this means that you cannot rely on taking your pulse rate to monitor your exercise level. It may be best to judge the intensity of your exercise on your perception: if you think the exercise is somewhat hard, this is equivalent to moderate exercise (see the Borg perceived exertion scale in the "Aerobic Exercise" section earlier in this chapter).
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