Diabetes and Exercise



Diabetes and Exercise

Diabetes is a lifelong disease for which there is not yet a cure. There are several forms of diabetes, including:

• Type 1 diabetes, often called juvenile or insulin-dependent diabetes

• Type 2 diabetes, often called adult or non insulin dependant diabete

• Gestational diabetes, which occurs during pregnancy.

Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas produces too little insulin to regulate blood sugar levels appropriately.

Type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age—even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly.

Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.

For all types of diabetes, the metabolism of carbohydrates (including sugars such as glucose), proteins and fats is altered. In type 1 diabetes, the beta cells of the pancreas produce little or no insulin, the hormone that allows glucose to enter body cells. Once glucose enters a cell, it is used as fuel. Without adequate insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy despite high levels in the bloodstream, leading to increased hunger.

In addition, the high levels of glucose in the blood causes the patient to urinate more, which in turn causes excessive thirst. Within 5 to 10 years after diagnosis, the insulin-producing beta cells of the pancreas are completely destroyed, and no more insulin is produced. Type 1 diabetes can occur at any age, but it usually starts in people younger than 30. Symptoms are usually severe and occur rapidly.

The exact cause of type 1 diabetes is not known. Type 1 diabetes accounts for 3% of all new cases of diabetes each year. There is 1 new case per every 7,000 children per year. New cases are less common among adults older than 20.

Signs and Symptoms of Diabetes

• Increased thirst : The increase in thirst does not include drinking excessive amounts of fluid on a boiling hot summers day. It refers to an increase in the consumption of liquids over a prolonged period.

• Increased Urination: If you find that you are going to the toilet more often than before and it is not related to a history of a weak bladder.

• Weight loss despite increased appetite:

This weight loss is applicable if it is not related to any physical activity which would result in a weight loss.

• Nausea : Nausea is one of the more common symptoms of diabetes

• Vomiting : As discussed above.

• Abdominal pain : This abdominal pain is not to be mistaken for menstruation pains, spastic colons, or ulcers.

• Fatigue: Fatigue is a feeling of weariness, tiredness, or lack of energy

• Absence of Menstruation: The absence of menstruation means no menstrual flow.

Treatment

Once diagnosed, the immediate goals of treatment are to treat diabetic ketoacidosis (this is a complication of diabetes) and high blood glucose levels. Diabetic ketoacidosis is quite simply caused by the build up of by-products of fat-breakdown.this occurs when glucose is not available as a fuel for the body and fat is then broken down instead.. People with diabetes lack enough insulin, a hormone the body uses to process glucose (a simple sugar) for energy. When glucose is not available, body fat is broken down instead. The by-products of fat metabolism are ketones. When fat is metabolized, ketones build up in the blood and "spill" over into the urine. A condition called ketoacidosis develops when the blood becomes more acidic than body tissuesBecause of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalization.

The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs.

These goals are accomplished through education, insulin use, meal planning and weight control, EXERCISE, foot care, and careful self-testing of blood glucose levels.

INSULIN

Insulin lowers blood sugar by allowing it to leave the blood stream and enter muscle cells. Everyone needs insulin. As a Type 1 diabetic you cannot produce your own insulin, and you must take insulin every day.

Insulin is injected under the skin using a syringe, or in some cases, an infusion pump delivers the insulin continuously. It is not available in an oral form.

Insulin preparations differ in how fast they start to work and how long they last. The health care professional reviews blood glucose levels to determine the appropriate type of insulin the person should use. More than one type of insulin may be mixed together in an injection to achieve the best control of blood glucose.

The injections are needed, in general, from 1 to 4 times a day. People are taught how to give insulin injections by their health care provider or a diabetes nurse educator. Initially, a child's injections may be given by a parent or other adult. By age 14, most children can be expected (but should not be required) to give their own injections.

DIET

Meal planning for type 1 diabetes requires consistency to allow food and insulin to work together to reglulate blood glucose levels. If meals and insulin are out of balance, extreme variations in blood glucose can occur.

Consultation with a registered dietitian or nutrition counselor is an invaluable tool for meal planning and dietary control for diabetics.

Effects of Exercise Training

Please consult with your GP or specialist before commencing any exercise programme.

Although exerise is considered by many to be one of the cornerstones of diabetes care, it is not considered a component of treatment in Type 1 diabetes to lower blood glucose. Those with Type 1 diabetes are encouraged to exercise to gain other benefits as dicussed below, but blood glucose must be in reasonable control (250mg/dl, no ketones) (ACSM, Exercise Management for Persons with Chronic Diseases and Disabilities, 2nd Edition 2003) if the individual is to exersise safely. However, benefits of exercise for Type 2 diabetics include :

• Improved insulin sensitivity / lower medication requirement: Exercise training results in improved insulin sensitivity, and for many with diabetes this could result ina reduction in the dose of insulin or medication.

• Reduction in body fat: Research has shown that weight loss increases insulin sensitivity, and may allow those with diabetes to reduce the amount of insulin or oral hypoglycemic agents needed.

• Cardiovascular bebefits: regular exercise decreases the risk of cardiovascular disease.

• Stress reduction: stress can disrupt diabetes control by increasing counter-regulatory hormones, ketones, free fatty acids, and urine output, making stress reduction an important part of diabetes care.

• Prevention of type 2 diabetes: Epidemiological studies show that exercise may play a role in preventing Type 2 diabetes. People suffering from Impaired Glucose Tolerance (IGT), gestational diabetes, or a family history Type 2 diabetes may especially benefit from a regular aerobic exercise program.

Nearly everyone that suffers with diabetes may derive some benefit from an exercise program, although not all benefits will necessarily be realized by each person with diabetes. Careful monitoring of blood glucose and attention to balancinf food intake and medication are necessary for the person to participate safely in an exercise program.

Diabetes: Exercise Programming

|Modes |Goals |Intensity/ Frequency/ Duration |Time to Goal |

|Aerobic | | | |

|Large muscle activities |Increase aerobic capacity |50-90% peak HR |4-6 months |

| |Increase time to exhaustion |50-80% VO2 peak** | |

| |Increase work capacity |Monitor RPE*** | |

| |Improve BP* response to Exercise |4-7 dys / week | |

| |Reduce cardiovascular risk factors |20-60 min/session | |

|Strength | | | |

|Free Weights |Increase maximal no. of repetitions |Low resistance, high repitition for |4-6 months |

|Weight Machines |Improve performance for patients interested |most clients | |

|Isokinetic Machines |in competition |High resistance OK for athletes with | |

| | |well controlled diabetes | |

|Anaerobic | | | |

|High- intensity intervals |Only for athletes good diabetic control |Same as healthy athletes | |

|Flexibilty | | | |

|Stretching / Yoga |Maintain / Increase range of motion |2-3 sessions / week may suffice |4-6 months |

|Neuromuscular | | | |

|Yoga |Improve balance |2-3 sessions may suffice | |

| |Improve co-ordination | | |

|Functional | | | |

|Activity Specific Exercise |Increase vocational potential |Individualized to each client | |

| |Increase in self-confidence | | |

*BP: blood pressure

**Lower intensity activity may be advisable if complications are present and / or diabetes is of long duration. The majority of people with Type 2 diabetes will benefit from low-moderate-intensity physical activity of 40-70% VO2 max

***RPE: rate of perceived exertion

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