Article by Laura Walker
Diabetes is a complex group of diseases with varied causes.
Diabetes is a metabolic disorder. Metabolism is the cycle of the body using digested food for energy. When you eat carbohydrates, the digestive tract breaks down carbohydrates into glucose, a form of sugar that enters the bloodstream. With the help of the hormone insulin, released by the pancreas, cells throughout the body absorb glucose and use it for energy. As the blood glucose level rises after a meal, the pancreas is triggered to release insulin. Within the pancreas, clusters of cells called islets contain beta cells, which make the insulin and release it into the blood. Insulin synthesizes the storage form of gluces (glycogen) and carries across into the muscle cells and liver where it its stored and used for energy.
Diabetes develops when the body doesn’t make enough insulin or is not able to use insulin effectively, or both. As a result, glucose builds up in the blood instead of being absorbed by cells in the body. The body’s cells are then starved of energy despite high blood glucose levels.
One of the signs or symptoms of diabetes is excessive urination. The Greek word ‘diabainein’ means ‘to siphon’ or ‘to pass through’. This is how the condition Diabetes gained its name. Centuries later the word ‘mellitus’ was added due to the sweet smell and taste of the urine. Diet and exercise play an enormous part in the control of the condition diabetes mellitus. It is important however to distinguish between the two most common types of diabetes and their causes.
Type 1 diabetes is an auto-immune condition, usually diagnosed in children, but not always. It applies to people whereby the pancreas has stopped producing insulin and they are unable to control blood glucose levels, at all. Diet and lifestyle have little bearing on the cause of Type 1 diabetes condition. However, they both play a part in helping the person maintain a healthy lifestyle and a healthy weight in the same way as for all children and adults.
Type 2 diabetes formerly called adult-onset diabetes, is the most common type of diabetes. About 90 to 95 percent of people with diabetes have type 2. People can develop type 2 diabetes at any age, even during childhood, but this type of diabetes is most often associated with older age. Type 2 diabetes can be associated with excess weight, sedentary lifestyle, family history of diabetes, previous history of gestational diabetes, and certain ethnicities.
Type 2 usually begins with insulin resistance, a condition linked to excess weight in which muscle, liver, and fat cells do not use insulin properly. As a result, the body needs more insulin to help glucose enter cells to be used for energy. At first, the pancreas keeps up with the added demand by producing more insulin. But in time, the pancreas loses its ability to produce enough insulin in response to meals, and blood glucose levels rise.
Diet and lifestyle is the first form of treatment for anyone newly diagnosed with diabetes type 2. As we age so the condition progresses and tablet medication becomes the next form of treatment. Insulin injections is the final form of treatment to control the condition. As the body ages, so the condition will progress but diet and lifestyle will dictate the rate at which the condition progresses.
Newly diagnosed
People newly diagnosed with diabetes have varying reactions to the diagnosis. Some find it hard to come to terms with. It seems that yesterday you were perfectly healthy but today you have been given a long-term health condition. How did that happen? Some feel relief knowing that they have a condition that can be well managed and that they will feel better at some point
Whatever the feelings, it is certainly a turning point whereby further understanding of the condition and its effects on your body is paramount to understanding how to deal with the condition and living a full and active life.
Exercise & Type 2 Diabetes
‘Regular exercise provides substantial health benefits to people with type 2 Diabetes, including better control of their condition, and improves cardiovascular risk profile, weight loss and an improved quality of life’ (Sigal et al 2006). The evidence, which Sigal produced, tells us that Diabetes and exercise are inseparable. Exercise plays an enormous role in managing this lifelong health condition. Exercise puts people back in control of the condition and not the condition in control of the person. This has an enormous benefit in maintaining good mental health as well as physical health.
The evidence base is there for people with diabetes to exercise in order to manage the health condition but getting people to exercise needs more motivation. Dr Alison Kirk at Dundee University in 2009 found that to be successful in enabling people to exercise ‘consultation is a useful intervention in promoting physical activity in people with type 2 diabetes’. Dr Kirk also found ‘exercise interventions for older adults should also include behavioural or cognitive strategies, rather than health education, exercise prescriptions or instructions alone.’
Simply telling someone that exercise is good for them go and do it, is not effective in enabling them to manage their health condition. As the exercise professional, understanding what they have been through to get to the position of standing in front of you either in a gym or an exercise class will, help them to keep coming back and, for you to be more empathetic in your teaching.
Move your legs to move your lungs
Much of the blood glucose is stored in the muscles of the body. It was once thought that only aerobic exercise, like walking, running, swimming, cycling was the only type of exercise to control diabetes but there is now much evidence that strength training also plays as great a role in controlling the condition. (http://www.hindawi.com/journals/jar/2012/284635/) Healthy muscles burn more calories at rest, therefore utilising blood glucose also, whilst resting.
Using the big muscles in the legs will use the blood glucose well. They will also increase the heart rate, which will ultimately strengthen the heart. By moving the legs to move the heart it creates a whole body movement e.g. walking, arms need to move when walking to keep the balance. This also contributes to being physically fit. Regular exercise will slow down the rate at which diabetes will progress in the body. Regular exercise will slow down the rate at which we age. Whether with diabetes or not exercise can be beneficial to your health.
How much is enough?
When exercising its important to know how much effort is being put into the activity. A handy guide is to use a scale of 1-10 (A modified Borg scale http://www.brianmac.co.uk/borgscale.htm). Below is a version of a scale of 1-10.
10 need to stop
9 moving feel nauseous and dizzy.
8 moving intensely
7 moving breathing faster able to speak intermittently.
6 moving and breathing faster still able to speak
5 moving & noticeable breathing
4 moving with effort
3 moving
2 standing not moving
1 sitting down not moving
Your Rate of Perceived Exertion (the scale of 1-10) is your guide to how you feel during exercise. The correct position to be on your scale of 1-10 is between 4-7. Less than that and the effort is insufficient to produce health benefits. More than that and the body does not work efficiently and is too much for the individual. When you exercise a warm up and cool down is necessary. During the workout phase you must know where you are on your scale of 1-10 each time you exercise.
Exercise and diabetes
If monitoring blood glucose is something that is done on a regular basis then it must be monitored closely when starting an exercise programme and when adding more exercise into the routine. The blood glucose must sit between 5.6 to 13.9 mmol/L before exercising to ensure sufficient blood glucose to exercise. If it is lower than this consider eating a carbohydrate, toast or a sandwich, before continuing to exercise. If your blood glucose is well controlled and it is sitting at 16.7 mmol/L, or higher, consider delaying exercise until it has reached a more usual level.
Exercising with too high a blood glucose level is as dangerous as exercising with low blood glucose. If the glucose level is high you may not be able to utilise the glucose during exercise and this may increase the risk of dehydration and ketoacidosis. Monitoring blood glucose is essential on a regular basis to ensure this does not happen. If the person is feeling unwell for several days’ medical advice must be sought.
Exercising with too low blood glucose is dangerous, as it will cause you to become disorientated. It’s at this point it’s advantageous to have an orange juice at hand to increase the blood glucose immediately. However, a carbohydrate, such as a sandwich, is essential to keep it elevated and to feel better. It can take half an hour to go from feeling ok to feeling unwell with low blood glucose. Close monitoring of glucose levels is essential during exercise. If blood glucose drops and the person feels unwell, stop exercising immediately and treat the hypoglycaemia. No further exercise that day.
The body will become used to the exercise within 6-12 weeks and the body will know how to handle the exercise and diabetes. Close monitoring must go on at the start of the exercise programming to understand how your body copes with exercise.
The 5-minute rule
If at any time, you feel unsure if you want to exercise with no signs or symptoms to rely on try the 5-minute rule. Exercise for 5 mins and if you continue to feel unwell then stop. If you feel ok exercising then continue to do so.
As exercise professionals we know what to do to be active and how to prescribe the exercise. We must understand that exercise plays a small part in controlling diabetes. It’s the information, the support and the understanding that we, as exercise professionals can give builds confidence with people. This enables people with diabetes to start and continue being active as part of their lifestyle. We will then become more effective exercise professionals with greater job satisfaction.
If you are interested in studying more why not join us on our level 4 Weight Management & Diabetes course or our Level 3 Nutrition course.
Laura Walker Biography
Laura is an innovative and passionate teacher of special populations with over 20 years of experience. Her motivation lies with teaching the elderly and specifically those experiencing chronic health conditions. Laura likes to challenge individual perceptions of her clients exercise ability helping them lead full and active lives. Laura excites her audience to be healthy and has vast experience in presenting for Drummond Education, GP practices, conferences, students and women’s groups.