DIABETES What is Diabetes? ‘Diabetes Mellitus is a disorder of carbohydrate metabolism, characterised by hyperglycaemia as a result of total lack or impaired insulin secretion and/or action.’ This means there isn’t enough insulin to transport the glucose in the blood to the body cells that need it. The blood levels of glucose rise and the cells starve. Diabetes is increasing world wide and in all age groups. In 1997 the NHS estimated there were 124 million diabetics world wide (97% what is called type II diabetes or Non Insulin Dependent and is life style-related) and projected there would be 221 million in 2010.
2.5 million diabetics in the UK (Diabetes UK) 85-90% Type II Estimated yearly cost to the UK = £2 billion+ (British Diabetic Association)
2 types of Diabetes
Type I (insulin dependent DM; IDDM, or juvenile/early-onset diabetes) Type II (non insulin dependent DM; NIDDM, or late onset diabetes)
TYPE I (IDDM)
Develops in childhood & accounts for 10-15% of all sufferers
10-12% of cases appear to be related to genetics
Pancreas produces little or no insulin Insulin injections are critical Approx. 80% of cases are an autoimmune condition whereby the body has destroyed the cells in the pancreas responsible for producing insulin Other cases linked to viruses, cow’s milk in infancy.....
TYPE II (NIDDM)
Usually diagnosed after the age of 30 Becoming more prevalent in children as child obesity increases (youngest known type II sufferer = 5 yrs old – he was reported to be twice the weight of an average 5 yr old) Hyperglycaemia and insulin resistance characterises this condition Associated closely with obesity, especially of the upper body Management includes lifestyle, exercise and diet with only very few sufferers needing insulin injections
Physical effects
Thirst Weight loss due to fluid loss and the accellerated breakdown of fat and muscle tissue
Frequent urination
Arterial disease resulting in MI or peripheral gangrene
PHYSICAL EFFECTS
Lack of energy
Blurred vision possibly leading to blindness
Impotence due to samll vessel damage
Reduced life expectancy
Skin infections / feet problems possibly leading to amputation
Motivation for exercise
It improves fitness and well-being and encourages a healthy lifestyle Improves the action of insulin (can decrease insulin requirement by 50% in type I and in type II eliminate the need all together) and enhanced glucose control Reduced chance of developing complications such as vascular deterioration Slow twitch muscles give the best results for insulin sensitivity so aerobic exercise should be encouraged All usual benefits still apply!
TRAINING TIPS CV
Glucose control –initial priority 3-7 days, 20-40 mins (10-15 mins initially) Exercise should be performed daily and at the same time to allow planning of diet/medication to accommodate exercise Low/moderate intensity Low impact Extended warm up and cool down Monitor blood glucose levels Base progressions on duration and frequency initially, as opposed to intensity Swimming, cycling and walking are all good exercise choices for diabetics Exercise intensity for older adults 50-60% of max VO² or target heart range Exercise intensity for younger children 60-85% of max VO² or target heart range Those who have a propensity to suffer from hypoglycaemia often do better exercising in the morning (minimising the effects of post exercise hypoglycaemia)
Resistance
Glucose control – initial priority 2-3 days per week 1-3 sets, 10-20 reps People with retinal complications beware of blood pressure Extended warm up and cool down Monitor blood glucose levels
CAUTIONS
Delay exercise if blood glucose is found to be elevated (may be an indication of illness/stress) Do not exercise if unwell Ensure feet are free from injury and suitable footwear is worn. Diabetics with peripheral neuropathy can damage feet without being aware of the injury which can cause ulcers Jumping and pounding exercise (high impact aerobics, jogging etc) should be avoided in diabetics who suffer from peripheral neuropathy or vascular disease due to the increased
risk of complications and injury to the legs and feet. Also should be avoided if proliferative retinopathy is suspected or diagnosed due to potential to damage eyes Avoid exercise that encourages excessive holding breath, particularly if the person has vascular disease (damage to small vessels and eyes) Be aware of concurrent disease states Ensure you have carbohydrate snacks and or insulin to hand while exercising Avoid injecting insulin into muscles that are about to be worked hard (may reduce insulin effectiveness) Avoid exercise within 40 minutes of a short acting insulin injection and 2 ½ hours after an intermediate acting insulin injection (may affect action of insulin)
SUMMARY 1. 2. 3. 4.
See Metabolic Diseases – A Guide Type II diabetes most common Exercise and lifestyle change critical Behaviour change and normal challenges associated with ‘getting people active’ apply
METABOLIC DISEASES – A GUIDE TYPE II DIABETES The body’s preferred and immediate source of energy is glucose (derived from the metabolism of carbohydrate). The body uses glucose for energy production in every cell in the body, in fact the brain can ONLY use glucose. Glucose is transported to the body’s cells via insulin, which is secreted by the pancreas. Diabetes Mellitus is a disorder of carbohydrate metabolism, characterised by hyperglycaemia (too much glucose in the blood) as a result of total lack or impaired insulin secretion (by the pancreas) and/or impaired action on the cells. This means that there isn’t enough insulin to transport the glucose in the blood to the body cells that need it. The blood levels of glucose rise and the cells starve. There are 2 classifications of Diabetes. The prolific growth of type 2 Diabetes termed Adult Onset Diabetes demands attention under the heading metabolic diseases.
FACTS AND STATISTICS Diabetes is increasing worldwide and in all age groups. In 1997 the NHS estimated there were 124 million diabetics worldwide (97% type 2) and projected there would be 221 million in 2010. Diabetes UK estimate there are currently 2 million plus diabetics in the UK and as many as 750,000 undiagnosed. The British Diabetic Association estimate the annual cost in the UK at over £2 billion (this does not count the cost of primary care).
WHO IS AT RISK? Type 2 diabetes is usually diagnosed after the age of 30, but sadly has been seen now in children as young as 10 years of age. Hyperglycaemia (high levels of blood glucose) and insulin resistance (the cells won’t let the insulin deliver the glucose) characterises the condition.
Type 2 diabetes is associated with obesity, especially of the upper body, (visceral/abdominal) and often presents after a period of weight gain. Impaired glucose tolerance associated with aging and de-conditioning is also closely linked with this type of diabetes. Other risk factors include family history (a parent or sibling) of diabetes and women who have had gestational diabetes (pregnancy related). The management of type 2 diabetes centres around lifestyle, exercise (increases the cells sensitivity to insulin) and diet; weight loss may see the return to normal blood glucose levels. Some people require insulin to manage symptomatic hyperglycaemia.
GESTATIONAL DIABETES Diabetes can also occur during pregnancy at a rate of 1-3%. Gestational diabetes is similar to type 2 diabetes and is due to the increased insulin demands of pregnancy and the action of hormones secreted by the placenta. Post delivery the maternal glucose/insulin ratio normally resets, but gestational diabetes is considered to be a risk factor for developing type 2 diabetes in later life. If untreated the syndrome is associated with increased foetal size, increased foetal and neonatal loss and neonatal and maternal morbidity.
PHYSICAL EFFECTS OF TYPE 2 DIABETES Diabetes may present acutely or over a period of months or years. Type 2 is typically insidious and often people complain about feeling generally unwell. A person may have type 2 diabetes for years and not know it. Typically a person may notice:
Excessive urination. Polyuria results when the blood glucose reaches the renal threshold Excessive thirst. Thirst as the result of loosing fluid and electrolytes to the above process Lack of energy Blurred vision due to glucose induced changes in refraction Skin infections Retinopathy (damage to the retina in the eye) noted during visit to the opticians Tingling and numbness in the feet due to diabetic neuropathy (damage to the free nerve endings due to increased blood glucose levels Poorly healing ulcers on feet and legs due to neuropathy and small vessel damage. In severe cases this may lead to gangrene and amputation Impotence due to small vessel damage Arterial disease resulting in MI or peripheral gangrene
SUMMARY
Type 2 diabetes is a serious disease that may lead to a reduction in life expectancy (5-10 years if diagnosed with type 2 between age 40 and 59). It is in most cases preventable and with lifestyle and behaviour modification most cases of type 2 diabetes are reversible.