Exercise

Benefits of sports for diabetics

There are obvious social benefits to exercise and sports participation: peer relationships developed and enhanced by shared experiences, enhanced self-esteem and confidence from mastery of a skill, learning about teamwork, character, courage etc.

In addition, some studies suggest health benefits for athletes with type 1 diabetes.

Aerobic circuit training could help adolescents improve glucose regulation, muscle strength, lipid profiles, and cardio-respiratory endurance. Research shows that adults with type 1 diabetes safely reduced cardiovascular risk factors such as abdominal fat content, blood pressure, and adverse lipid levels by exercising 135 min/wk.

The development of type 2 diabetes can be significantly delayed by exercise and by maintaining an active lifestyle. We should anticipate increasing numbers of athletes with diabetes to be involved at all levels of participation and competition because the incidence of both types of diabetes is increasing.

Athletes should however avoid lifting excessively heavy weights, which could increase intra-vascular pressure. Maintaining good metabolic control is also important. Other studies however, suggest that the changes in type 1 diabetes are not that substantial or lasting.

How do sports benefit diabetics

1. Sports Increase Insulin Sensitivity: The exercising diabetics may experience increased glucose uptake at a given insulin concentration. Exercise does not promote more production of insulin, but it increases insulin sensitivity by enhancing receptor site biding. This effect can persist for several hours, up to 24 hours in some individuals. Due to it, non-insulin dependent diabetics may be able to reduce doses of medication (oral hypoglycemic medications or insulin). Reducing insulin levels, the diabetic become more protect from atherosclerotic damages.

2. A Better Control of Blood Glucose: When a diabetic starts with an exercise program or one is an athlete, he is already aware that he should pay closer attention to his diet and monitor his blood glucose more frequently. This is a more effective key to control and reduce complications of diabetes.

3. Reduction of Others Cardiovascular Risk Factors: Diabetes is already a risk for coronary disease and heart attack, and the reduction of other risks plays an important role in diabetics’ life. Studies show that diabetics have 7 times more risks of coronary atherosclerotic disease than non-diabetics.

4. Reducation in blood pressure: The reduction of blood pressure is another benefit from exercise. Loss of weight and decreased stress, which are the consequences of sports/exercise are recognized as safe factors for diabetics.

Sports for diabetics

The great risk of sports for diabetics occurs when blood glucose level is not very well controlled and monitored or when complications of disease are already present.

The diabetics should be very well informed to how take their medications and his diet according with what kind of sports are to be done. Only with a strict control the diabetic can avoid hypo or hyperglycemia, which can be fatal.

Diabetics with peripheral neuropathy or microangiopathy must avoid exercise that may traumatize the feet. The shoes and socks must be very comfortable and, if possible, jogging and jumping exercises should be avoid (preference to swimming and bicycling). Strenuous exercises have to be avoided by patients with proliferate retinopathy in order to do not increase blood pressure. Swimming is recommendable, but never alone or without a strict control of blood glucose to avoid a fatal hypoglycemia.

Potential risks for an active diabetic:

1. Hypoglycemia in patients using hypoglycemic drugs or insulin
2. Worsen the hyperglycemia
3. Cardiovascular diseases (infarct, arrhythmias, sudden death, orthostatic hypotension after exercises.)
4. Micro vascular diseases like retinal hemorrhage or elevation of proteinuria.
5. Degenerative articular disease.
6. Orthostatic injury due to neuropathy.

High-Risk Sports

Any sport involves a risk of injury. This risk is likely to be magnified by inattention or loss of coordination, such as during an episode of hypoglycemia. In extremely risky sports and activities, the risks are much higher.

For example, rock and mountain climbing may expose participants to a lethal danger of falling if their concentration lapses, so a climber with diabetes would have to ensure that hypoglycemia were not going to happen. Skydiving requires continuous focus of attention as well.

Scuba (under water) diving is another potentially high-risk activity; thus, its suitability for individuals with diabetes has been studied. For example, military diving is not allowed in Great Britain for people with type 1 diabetes, and in the United States they cannot join the military at all. Sport scuba diving may be safe with adequate preparation and a skilled partner who can handle trouble with diabetes during the dive.

Assessment of Exercising Diabetics

Checking of blood glucose level before, during, and after the sports/exercise is very important for a safe participation in sports. A metabolic control of ketones must be done too before the beginning of exercise; if ketosis has begun before exercise, ketone production will continue to rise dangerously.

1. Recent levels of glycohemoglobin must be satisfactory
2. Frequent monitoring of blood glucose (3 times /day)
3. Recognize the early signs of hypoglycemia
4. A candy or sugar tablet must always be carried with diabetics during exercise
5. A strategy for insulin dose, before and after exercise
6. Any kind of identification, warning for a diabetic person, must be present during exercise

Strategy for Exercising Diabetics Control

Before sports:

1. If blood glucose was lower than 130 mg/dL, diabetics should take two carbohydrate exchange (@60 kcal is one carbohydrate exchange) for 35 /45 min of mild exercise and three for intense exercise
2. If blood glucose was between 130 and 180 mg/dL, diabetics should take only one carbohydrate exchange for a mild exercise and two for an intense one.
3. If blood glucose was between 180 and 240 mg/dL, diabetics should not take any carbohydrate exchange for a mild exercise, but if exercise will be intense or long (more than 30 min.) diabetics should make another glucose test during exercise and follow the criteria shown above.
4. If blood glucose was 250mg/dL or higher, the exercise must be cancelled. A urinary ketones test should be done and a new insulin dose can be necessary.

During sports

If an intense sports activity or long exercise is to be done, a blood glucose avaliation must be done during exercise for an effective carbohydrate replacement.

After sports

Diabetics have to do a blood glucose test, especially if the exercise wasn’t usual . It is important because adaptations in diabetic body are able to occur and the strategy for a safe exercise can be changed, depending on this pos-exercise test, for a higher or lower carbohydrate replacement.

The exact control of diet and insulin dose for a perfect adaptation to an exercise will depend on each person, the kind of exercise, and the strict control of blood glucose and urinary ketones.

A common finding in active diabetics, particularly athletes, is a rise of blood glucose after exercise. The catecholamines secretion can be so intense during exercise that liver’s release of glucose exceeds the rate of utilization by muscle. It could be paradoxical, but diabetic athletes should be attempt to it and should adapt his program according to it.