What is Diabetes?
Diabetes is a chronic condition that affects the way the body processes blood sugar known as glucose. The primary types of diabetes are Type 1 and Type 2. Type 1 diabetes (5%–10% of cases) is an autoimmune disease which results from cellular-mediated autoimmune destruction of the pancreatic b-cells, producing insulin deficiency. In other words, the pancreas produces little to no insulin due to genetic causes. Type 2 diabetes (90%–95% of cases) results from a progressive loss of insulin secretion, meaning your pancreas is not producing enough insulin or the insulin you are producing is not working effectively. Type 2 Diabetes is a progressive condition and can be managed with regular physical activity, a healthy eating plan, and regular health checks.
How can exercise help?
Exercise is important for the health and well-being of people with Type 1 diabetes. Benefits include increase insulin sensitivity and glucose uptake, meaning your muscles and insulin levels are working more effectively. Additional benefits include improvements in cardiorespiratory fitness, vascular function, lipid profile, blood pressure and BMI.
Exercise can help reduce the incidence of Type 2 diabetes by almost 60% in people at risk. Studies show that exercise can help prevent or delay Type 2 diabetes, improve management of blood glucose, decrease the proportion of body fat, decrease the risk of heart disease, and increase heart and lung fitness in people with Type 2 diabetes. Furthermore, exercise leads to improved mental health and quality of life.
Exercise recommendations for people with Diabetes?
Current recommendations for people with diabetes is to accumulate at least 150 min/week of moderate-intensity aerobic and resistance exercise and to have no more than two consecutive days without physical activity. However, if you haven’t previously completed much exercise then start low and slow – you don’t want to start off too hard, if you are not used to the exercise you will be sore the next day and this will not make exercising a fun experience! Over time, you can slowly increase the intensity of the exercise.
Type of exercise: What you enjoy doing – water aerobics, walking, golfing, dancing
Intensity of exercise: Moderate – This means you should still be able to talk as you exercise without becoming breathless.
Frequency of exercise: Aim for 30 mins 5 days per week – 150min/week
The total amount of exercise should include a combination of aerobic and resistance training. Aerobic exercise (e.g. walking or running) increases heart and lung fitness, while resistance training (e.g. lifting weights) can maintain and increase muscle and bone strength. Importantly, combining both aerobic and resistance training has recently shown to be more beneficial on blood glucose levels in people with diabetes.
It is recommended that all individuals with Type 1 diabetes, and those with Type 2 diabetes who are taking insulin and/or sulphonylureas, always check their glucose level two to three times prior to exercise to establish the direction of change in glucose. In addition, it is recommended that these individuals with Type 1 diabetes also check their glucose level every 30 min during exercise and again after exercise to establish a pattern and understand the effects of exercise on their blood glucose. This helps prevent hypoglycaemia (low blood sugar). Additional glucose testing may be required when significantly changing the exercise program.
For people with Type 1 diabetes, hypoglycaemia during and for up to 24 h following exercise are usually the main risks. Symptoms include confusion, heart palpitations, shakiness and anxiety.
In relation to hypoglycaemia, exercise should be avoided:
- If blood glucose has been < 2.9 mmol/L or if a hypoglycaemic event that required assistance from another person to treat the event within the previous 24 hr.
- If glucose is between 2.9 and 3.9 mmol/L, exercise should not commence until the hypoglycaemia is treated.
- If starting glucose was 2.9–3.9 mmol/L, exercise should be avoided if alone, or the type of exercise is potentially unsafe (e.g. swimming, skiing, surfing, rock climbing etc.)
For people with Type 2 diabetes taking insulin and/or sulfonylurea medication, hypoglycaemia during exercise, or for up to 12 h after exercise, is the main risk.
In relation to hypoglycaemia, exercise should be avoided:
- If a person has had a hypoglycaemic event that required assistance from another person to treat the event within the previous 24 h,
- If feeling unwell or glucose is < 4.0 mmol/L and the intended exercise is being done alone or is potentially unsafe scenarios.
Initial hypoglycaemia treatment involves consuming one serve (15 g) of fast-acting carbohydrate and re-checking glucose after 15 min. Another serve of fast-acting carbohydrate should be administered each 15 min if glucose remains < 4.0 mmol/L. After initial treatment, monitoring is advised for clinical features of hypoglycaemia such as abnormal sweating, trembling, anxiety, hunger, weakness, dizziness, inability to think straight and tingling sensations in the mouth and/or fingers.
How Physio For You can help
Our team at Physio For You is made up of physiotherapists and exercise physiologists. Their university training and their experience allows them to create effective and targeted exercise programs for diabetes patients. The therapist takes into account your medical history, personal health, fitness goals, exercise ability and any other relevant information. This results in faster outcomes, effective management for the symptoms of diabetes as well as a healthier lifestyle.
You may consult a physiotherapist or accredited exercise physiologist either directly or by referral from your medical practitioner. Most private health insurance funds offer rebates for physiotherapy/exercise physiology treatment. Physio For You offers on-the-spot HICAPS claiming.
Some patients are eligible for Medicare rebates for physiotherapy/exercise physiology from their GP, contact us for more information.
If you have any questions regarding Diabetes please contact our clinic on (02) 4392 1547.