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Description

• Diabetes Mellitus or sugar diabetes is a condition where the body cannot process glucose, the sugar that the body uses as a source of energy. Glucose or sugar levels rise in the blood while glucose or sugar levels within the individual cells of the body cells fall. Insufficient insulin or the body's resistance to insulin triggers diabetes.
• Insulin is a protein hormone that controls the concentration of glucose in the blood.
• Insulin is produced and stored in the pancreas.
• Insulin aids glucose transport from the blood into the body's cells as glycogen, which is used a fuel for energy.

Three types of diabetes mellitus.

• Type 1 diabetes or insulin dependent diabetes is also known as childhood onset diabetes. The pancreas cannot make insulin. Type one diabetics account for 5 to 10% of all diabetics.
• Type 2 diabetes occurs when the body develops resistance to insulin. The body cannot use the insulin than the pancreas can supply. Type 2 diabetics account for 90 to 95% of all diabetics.
• Gestational diabetes occurs in pregnant women who are not diabetic but have high glucose levels. Gestational diabetes is usually discovered late in pregnancy, around week 28. Approximately 4% of pregnant women develop gestational diabetes.

Exercise Health Benefits

• People with diabetes are more likely to develop some of the following conditions: Cardiovascular Disease, Heart Disease, Cerebrovascular Disease and Stroke, Peripheral Vascular Disease, Diabetic Neuropathy, Diabetic Foot Problems, Diabetic Eye Disease, Kidney Disease.
• Exercise helps the body:
• decrease body fat
• reduce the risk of developing cardiovascular disease
• helps the body improve insulin sensitivity and use glucose without extra insulin.
• People with type 1 diabetes who exercise require less insulin and reduce their risk for cardiovascular disease.
• People with type 2 diabetes can often control and keep their blood sugar levels within normal limits through exercise. The exercise must be maintained in order to maintain blood sugar control.
• People who exercise are less likely to develop type 2 diabetes than those who do not exercise. More than 70% of persons with Type II diabetes are obese at the time of onset.
• Moderately overweight individuals are 5 times more likely to have diabetes and the risk increases with the degree of obesity.
• Pregnant women who develop gestational diabetes can minimize the risk to themselves and their unborn children through diet and exercise. Many women who had gestational diabetes can develop type 2 diabetes after the pregnancy. Diet and exercise can prevent the onset of type 2 diabetes.

Types of Exercises and Programs

Type 1 Diabetes

• Exercise goals for people with type 1 diabetes are to reduce the risk of cardiovascular disease and to improve overall fitness.
• Aerobic activity can be done for one half hour to one hour per day with an initial intensity of 40% to 60% target heart rate adjusted for age as a starting point. Low impact or no impact aerobic activities can include dancing, walking, swimming and bicycling. As the body adapts to the activity, intensity levels can be increased to increase the fitness progression. A conservative starting point for aerobic activities is a 10 to 20 minute session at an effort scale of 5. Add 3 to 5 minutes per week until a one-hour duration is reached with an effort scale of 5 to 7.
• Resistance or strength training activities can be done two or three times a week. Lower weights combined with higher numbers of repetitions are a safe starting point.
• A conservative stretching program would include hamstring stretches, calf stretches, chest, back, shoulder, arm and stretches. These stretches are done before and after the aerobic and before and after the strength-training program.

Type 2 Diabetes

• Exercise goals for people with type 2 diabetes are to burn calories. Most people who develop type 2 diabetes are obese or over weight. Burning calories improves the body's sensitivity to insulin and reduce the amount of fat the body is carrying.
• Exercise can induce low blood sugar levels or hypoglycemia. And exercise can occasionally increase blood sugar levels.
• Aerobic activities can be done one hour every day with an initial light to moderate intensity of 40% to 60% target heart rate adjusted for age is a starting point. As the body adapts to the activity, intensity levels can be increased to increase the fitness progression. A conservative starting point for aerobic activities is a 10 to 20 minute session at an effort scale of 5. Add 3 to 5 minutes per week until a one-hour duration is reached with an effort scale of 5 to 7.

Safety Issues

Type 1 and 2 Diabetes

• Exercise can induce low blood sugar levels or even occasionally increase blood sugar levels. People with diabetes must carefully develop and coordinate any diet and exercise program as insulin requirements can change during and after exercise. Glucose levels and insulin levels must be carefully managed.
• Diabetics with proliferative or low to moderate non-proliferative retinopathy or damage to the retina of the eye must avoid jarring or rapid head motion and any activity that raises the body's blood pressure or induces a hypertensive response. Lifting very heavy weights can raise the body's blood pressure.
• Diabetics with peripheral neuropathy or damage to the nerves in the legs, feet or hands must protect soft tissues and joints from injury. The body no longer has the sensation or the pain cues it needs to protect itself from damage.
• Diabetics with autonomic neuropathy or lack of sensation in the body's autonomic nervous system may have a limited ability for high intensity exercise due to a decreased maximum heart rate. Their body may no longer be able to feel the sensations associated with hypoglycemia or low blood sugar.
• Diabetics with coronary artery disease would ensure that exercise intensities stay below their angina thresholds. Exercise intensity and duration chosen to bring on mild claudication or leg pain, which will improve walking distances.
• Diabetics are more vulnerable to dehydration and postural hypotension - lightheadedness if abruptly stopping an activity or quickly standing up from sitting or lying down.
• Diabetics are prone to poor circulation and sensation in their feet. Wounds in the arms and the legs and the feet take longer to heal or can develop complications.
• Diabetics need to consider the following conditions in their feet before exercising:
  • Sensation and pulse
  • Cuts, sores, bruises, blisters, bunions, or other problems
  • Special shoes - if required
  • Diabetics must consult a doctor for foot care information who will advise if a foot specialist is required.
• Exercise is not recommended when any of the following factors are present:
  • Active retinal hemorrhage or bleeding inside the eye
  • After recent retinopathy therapy such laser treatment
  • If illness or infection is present
  • Blood glucose levels are high or >250 to 300 mg per dl of blood and ketones are present. Lower the blood glucose before the exercise.
  • Blood glucose is 80 to 100 mg per dl of blood. Low blood sugar levels or hypoglycemia risk is great. Eat a carbohydrate and raise the blood glucose level before the exercise.

Related News or Promising New Research

The Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes study in the 30 January 2003 issue of The New England Journal of Medicine reports that a healthy diet and exercise plan, adopted in combination with a program of vitamins, aspirin and medication, can reduce by up to 50% complications such as heart disease, kidney failure, nerve damage and blindness.

The plan includes:

• A diet of at least six servings of vegetables
• One serving of omega-3 rich fish a week
• No more than 30 per cent of total calories from fat
• At least 30 minutes of light to moderate exercise, three to five times a week
• Quitting smoking
• Consuming the equivalent of a half-aspirin daily
• Consuming 400 micrograms of folic acid daily
• Consuming 100 micrograms of chromium picolate daily
• Taking a drug to lower blood pressure or cholesterol, depending on need.

Rates of death from cardiovascular disease, kidney failure and blindness resulting from diabetes-induced blood vessel problems were reduced by 50%. 70% per cent of the combination therapy participants achieved "low-risk" cholesterol levels, 60% of the participants reached ideal triglycerides or blood sugar levels. More than 50% controlled of their blood pressure.

References

http://www.coloradohealthsite.org/diabetes/facts_risk.html

http://www.regranex.com/living/living_index.htm

http://www.hollandandbarrett.com/healthnotes/Concern/Diabetes.htm

http://www.diabetes.org/main/type1/complications/default.jsp

Durstine, J. Larry.ASCM's Exercise Management for Persons with Chronic Diseases and Disabilities. Champaign Illinois: Human Kinetics. 1997.

Shankar MD, Kamala. Exercise Prescription. Philadelphia: Hanley & Belfus, Inc. 1999.

Swain, David P. PhD. Brian C. Leutholdtz PhD. Exercise Prescription - A Case Study Approach to the ACSM Guidelines. Champaign Illinois USA: Human Kinetics Publications. 2002.