Monday, September 7, 2009

Diabetes and Exercise

Diabetes affects more than 20 million Americans and a staggering 6 million Americans go undiagnosed. Many sufferers are diagnosed with Diabetes Mellitus meaning, "Sweet Honey Flowing."
There are two types of Diabetes Mellitus, type one and type two. Type one is due to an autoimmune response that destroys the pancreatic beta cells. This stops the production of insulin, and creates hypoglycemia (low blood sugar). Because these individuals cannot produce their own insulin they must rely on an external source to supply the much needed hormone. Type one Diabetes only effects 5-10 percent of all diabetics. It is also characterized as a disease that effects individuals in their younger years, once labeled "juvenile diabetes."
Type two is the most prevalent in society today, and this article will focus it's attention on exercise for the type two diabetic. (There is a "prescription" for type one, as well) In 80 percent of the cases the individual is considered to be obese. Obesity is defined as a waist circumference of 100 cm men (approx. 40"), and 85 cm for women (approx. 35".) Other measurements that define obesity are body fat reading that are greater than 25% for men, and 30% for women. (ACSM) (It is interesting to note that 58% of Americans want to loose weight, and only 21% are trying.) Type two diabetes is best impacted by diet modification, exercise and oral medications. Only 40 percent of type two diabetic require insulin injections. It seems lifestyle modification is key.
Many believe that because they do not eat sugar that the are not at risk for diabetes. This is not necessarily true. Diabetes is a disorder that is developed due to a condition referred to as insulin resistance. With insulin resistance there is glucose available in the blood stream from the food you eat, but this glucose is denied access into the cells/muscle tissue to produce energy. The insulin receptors on the cell do not let the glucose in- they are insulin resistant. The sugar builds in the blood steam until it reaches a levels where it damages small vessels, usually the eyes, kidneys and other smaller vessels. Factors that increase the risk of type two diabetes are obesity, older age, family history, and physical inactivity. (American Diabetes Association 1994)
Physical inactivity is an essential part in the prevention, and management of diabetes. An effective exercise program contains various components, such as periodized cardiovascular training, comprehensive resistance training (or strength training), personalized flexibility training, balance and proprioceptive/movement based training, core training, and nutrition. While this may look a little overwhelming, think of it as a goal. Something to be achieved a little at a time. The best and easiest way to start is by walking, and revamping the diet. The emphasis should be on reducing excess weight, lowering cholesterol, lowering triglycerides, and eliminating processed foods (white flour, white sugar, processed meats, and processed foods containing trans-fats ( such as bakery items)). This can be done in baby steps, remember it is a process.
A walking program is a great way to get moving, and instigate positive change. It is something that can be done every day, and it is something that can be done progressively, meaning you can add small easy, achievable challenges to a walking program. The suggested guidelines for cardiovascular training for an individual with type two diabetes is a program consisting of five to seven days a week of activity using the larger muscles groups (ie walking, jogging, bike riding, low/non-impact movement (even dancing!!)- optimally the individual would use a variety of modalities to cross train the muscle groups) for 40- 60 minutes per day. Remember, this is the goal. (While it may be intimidating at first, remember- this is what you are building up to!! Smaller sessions are accumulative, also.)
The intensity level should be rather easy to start, progressing to a faster pace, or even a slight incline, where the exerciser becomes somewhat breathless. If the person is using a heart rate monitor (highly encouraged, you can "see" how hard you are working, and you can "see" how you progress.) you would be working at 50-60% of your maximal heart rate to begin with, working your way gradually to 60-70% of your maximal heart rate. High intensity intervals are not recommended, as there is a risk of further elevation of blood glucose (Gordon, 1995: Hornsby, 1995) Remember, these guidelines can also be goals to aspire to! Small steps are often the best placed ones.
In addition to cardiovascular activity the ACSM (American College of Sport Medicine) and the ADA (American Diabetes Association) recommends activities to build muscle, as well as burn calories. Cardiovascular activity is a great way to burn calories. Strength training, or resistance training, is a great way to build up skeletal muscle to help overcome the problem of insulin resistance. The ADA suggests strength training three times per week, targeting all muscle groups. They suggest a progression up to 3 sets of 8-10 repetitions, using a weight that cannot be lifted more than 8-10 times.(Diabetes Care June 2006) Once again, this is a progression. It is not recommended to work out to exhaustion. Also, limit isometric contractions to lessen exercise induced blood pressure elevations. (ACE Clinical Exercise Manual Exercise Training for Special Populations, Larry Verity, PhD, F.A.C.S.M.)
In conjunction with the strength training protocol, a proper flexibility program should be implemented. Such a program would address chronic postural issues, and muscular imbalances. Paying careful attention to not stretch muscles that do not need to be stretched. A proper flexibility program can be done at home on a daily basis and can actually be used to aid in stress management.
Other considerations for exercising diabetics related to blood glucose variations. One such condition is called "hyperglycemia.' This condition usually arrises when the blood glucose levels are not being well controlled. Poor control would indicate glucose levels of 250mg/dl, and higher, prior to exercise, in which the exercise session would be postponed. It is suggested that you should see your physical if the situation does not improve.
Another glucose relate problem to watch for in an exercising diabetic program is hypoglycemia, or low blood sugar. In this case the individual would experience dizziness, instability, nervousness, confusion, and even possibly loose consciousness. A good way to reduce the risk of experiencing hypoglycemia would be exercising mid-morning, after a balanced breakfast. It is suggested that exercise does not take place for at least one hour before the exercise session, and preferably not injected into an area of the body that will be used in the exercises. It is essential to monitor blood glucose, self-blood monitoring, before any activity. Exercise should be performed when the reading is between 100-250 mg/dl. If the level is lower, a carbohydrate snack should be consumed.
Other recommendations for exercising type two diabetics are:
1) Check with your physician before starting any type of an exercise program. Make sure that there are no additional considerations. ( ie hypertension or small vessel diseases.)
2)Keep a daily log which indicated time of day, blood glucose level, type of activity, intensity of activity, snack requirements (if any), and any other details that may be revalent.
3) Always self-blood monitor!!
4)Plan your exercise sessions. This should help determine if a snack will be required.
5)Always exercise with a partner. This is your support system in the event of hypoglycemia, or other complications. You should work with a partner until it is clear what the glucose response will be for that particular activity.
6) Always wear Diabetes I.D.
7)Always wear good shoes to minimize foot irritation. They should not be too loose, or too tight. To prevent foot irritation use Vaseline on the feet, and wear the socks inside out.
8) Modify calories intake accordingly on days of exercise, and following physical activity. Self-blood monitoring can help you modify your intake of calories, if needed. Insulin requiring diabetics can prevent latent post exercise hypoglycemia by monitoring their blood sugar levels carefully. Other factors are to be considered before starting an exercise program. Always check with your physician before starting any program.
Diabetes does not have to be life sentence. With proper control, healthful eating and an enjoyable exercise program life can be full of wonderful experiences! Grasp onto life, find things you love do do that are new challenges, and do them! The human body is so remarkable, fire it up to your true potential, and start living!!

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