It is a disease related to a decrease in the activity exerted by insulin, a hormone produced by the beta cells of the islets of Langerhans in the pancreas. More specifically, this decrease in activity can be traced back to a decreased availability of the same insulin, to a non-optimal use of the hormone by the body or to a combination of these conditions.
There are different types of diabetes, among which we find:
- Type 1 diabetes, characterized by a lack of insulin secretion by the beta cells of the pancreas. This occurs due to the destruction of these cells on an autoimmune basis. Type 1 diabetes generally occurs in childhood or adolescence, but can also occur in adulthood. Type 1 diabetes is estimated to affect approximately 3-5% of individuals suffering from this metabolic disease.
- Type 2 diabetes, attributable to a reduced sensitivity to insulin by organs and tissues (liver, muscles and adipose tissue) and / or to a reduced secretion of the same by the beta cells of the pancreas. Type 2 diabetes it tends to manifest itself in adulthood and the risk of developing it increases in the presence of some factors such as obesity and a sedentary lifestyle, but also familiarity seems to play a fundamental role in its appearance.However, sometimes type 2 diabetes is also diagnosed in children and adolescents.
In both forms of diabetes, however, lifestyle is an essential step in managing the disease. The diet must be taken care of and it is equally important to associate regular physical activity. However, if on the one hand physical activity is a fundamental part, on the other hand, for a diabetic patient this issue can be a source of doubts and questions, especially for those who would like to practice a real sporting activity, even for high intensity. In this context, the measurement, control and management of blood glucose require a high degree of accuracy in order to avoid the onset of dangerous conditions.
Nowadays, the management of blood glucose in diabetic patients who practice or would like to practice motor activity even at high intensity can be simpler than it was in the past thanks to new technologies and innovative devices such as those made by Theras Group, a company Italian company also involved in proposing technological solutions for the management of diabetes, such as the waterproof insulin pump without tubes or catheters and the continuous blood glucose monitoring system (CGM - Continuous Glucose Monitoring).
or not"Doctor Guardasole explains to us."For example, until some time ago, for subjects with type 2 diabetes undergoing therapy with somewhat obsolete drugs, carrying out sports activities could be a problem, since there was a risk that blood sugar would drop too much in the course of activities. Fortunately, now most drugs for the treatment of type 2 diabetes have a very low risk of inducing hypoglycemia. In this sense, therefore, drugs certainly help in the management and programming of a motor activity, both understood as a simple walk that like a slightly more intense "type activity"'.
The situation changes when we talk about patients with type 1 diabetes, as the specialist explains: "Type 1 diabetics, of course, are insulin-treated. Insulin is a potent hypoglycemic drug and the management of the disease during physical activity is more complex. Diabetologists must therefore work a lot on the patient's therapeutic education to try to avoid the onset of a hypoglycemia during motor activity, or later, since it can sometimes arise even after the end of the activity. In this sense, technology is providing, providing and will provide the main tool to be able to manage motor activity in safety'.
When we talk about new technologies in the field of diabetes management, what exactly are we referring to?
'We refer to those technologies that allow continuous and immediate monitoring of blood glucose that allows you to establish, moment by moment, the trend of this parameter", explains Dr. Guardasole who then goes into the specific illustrating the difference between CGM (Continuous Glucose Monitoring) and flash technology (Flash Glucose Monitoring - Flash Glucose Monitoring):"The flash technology allows a blood glucose measurement that can be continuous, but requires the intervention of the patient who must request that the value be measured, it is therefore a technology that works "on demand". On the contrary, CGM devices work in "real time" with a continuous control of the glycemic parameter and - through applications on the smartphone or specific devices - they are able to emit an alarm in the event that there are dangerous changes in blood glucose. CGM devices can only be prescribed to people with type 1 diabetes, while flash technology can be prescribed to all diabetic patients, including type 2 patients who wish to participate in sports'.
'Said this"Dr. Guardasole continues"both of these technologies, even if with different characteristics, are extremely useful precisely because they are capable of providing the blood glucose measurement at a precise moment, exactly as if the measurement were made with a fingertip. In addition, there is the presence of a history, as all data is downloaded and stored". The benefits of these new technologies, however, do not end there, as these tools also show"trend arrows that become a fundamental therapeutic education tool in the person with diabetes". Doctor Guardasole explains to us, in fact, that together with the blood sugar value, these instruments show arrows capable of indicating whether the blood sugar is rising, stable or falling and how fast this is happening: in the first two cases, the patient will be able to start sporting activity, while in the last case he will have to intervene with an adequate behavior to manage the situation.All this was unthinkable before the advent of these technologies"continues the Doctor"the data obtained with the classic glucometer was represented by a dry number and it was not possible to obtain information about the trend of glycaemia in the immediate future. Now, however, thanks to specific algorithms, we have the possibility to predict how the glycemic parameter will evolve in the next half hour. This is clearly very important, since it gives us the opportunity to be more precise in the intervention, as long as we have explained well to the patient. how it should behave'.
The advantage of the use of these technologies therefore consists in the possibility of understanding the evolution of glycaemia in order to allow the person to understand how to act accordingly, whether to start sports or not?
'Exactly", Doctor Guardasole replies,"but this only if the device that continuously measures blood glucose is given to a person who does not have an insulin pump", a device that allows the continuous infusion of this drug.
In the event that the patient is equipped with both a device for continuous glucose monitoring (CGM) and an insulin pump, in fact, the advantages increase. Dr. Guardasole explains that "pump and CGM communicate with each other and - thanks to the new algorithms developed and on the basis of preset parameters - are able to determine when it is necessary to increase or decrease the insulin infused in order to maintain blood sugar in a precise range'.
In other words, can the combination of insulin pump and continuous blood glucose meter allow the patient to take no action?
'The new systems are moving in this direction, since it has been realized that the need for the diabetic person to have to decide at every moment what to do and how to do it could be a cause of stress and anxiety."explains Dr. Guardasole who, however, specifies"each patient is different and it is also necessary to frame him from a psychological point of view: for example, there is the person who feels the need to have everything under control for which a technology that allows to minimize the actions for the control glycemic level is not properly indicated, or again, there is the individual who sees these technologies as a great help but who may find the alarms generated in the event of a blood sugar alteration intrusive and who could therefore choose to deactivate them with all the risks involved So the point is this: finding the right technology for the right person'.
What difficulties can be encountered in "approaching" the use of new technologies?
'The first difficulty is faced by the healthcare professional who must continually update himself on news. Furthermore, in order to explain to the patient how this new technology works, the physician must first understand it himself"says Dr. Guardasole who continues reiterating"The other difficulty consists in understanding the patient's needs, the discussion is much broader than one might imagine. One might think that technology solves everything, but there are patients, for example, who do not like CGMs or insulin pumps because they have not yet been able to accept the diagnosis of an unfortunately chronic disease such as diabetes. In these patients, the devices are seen as something invasive that constantly reminds them that they have a disease that they do not want to accept. On the other hand, the patient does not may think that the use of technology can make him forget that he has diabetes. The diabetologist must be clear and explain how new technologies work, what can be obtained from their use and how the patient must use them and behave, only in this way can achieve success in disease management'.
Dr. Guardasole therefore makes us understand that although new technologies may prove useful, it is necessary for the patient to be highly aware and for the diabetologist to provide him not only with all the information to correctly use the technological devices, but also all the skills necessary to understand how to manage the vast majority of events and situations that may arise in everyday life and when practicing sports.
How important is the role of the diabetologist and the patient's education in the use of new technologies?
Dr. Guardasole explains that "the doctor-patient relationship remains fundamental because it is the basis on which everything else is then built and this aspect cannot be replaced by technology. Technology is an aid that can be extremely useful, but cannot ignore the relationship between the specialist and the diabetic patient'.
Would you like to give any useful advice to diabetic patients who would like to play sports?
'Absolutely yes"the specialist tells us"Given that sport, from a therapeutic point of view, has the same and superior effects as the drug and that it brings benefits to three hundred and sixty degrees, I advise the diabetic patient who wants to practice sports to immediately communicate it to the diabetologist who follows him, since he will be able to provide him with the right advice on the type of activity to be done in relation to his clinical picture. Diabetic patients who want to play sports can also join various associations to learn about and practice physical activity together with other people who share the same type of problem. Therefore, sport is something that can be done and must be done. It must be done safely, having fun and to do this it is sufficient to talk to your diabetologist who will be happy to be able to give indications on how to practice activities, since in any case he will obtain a huge improvement in the clinical result."concludes Dr. Guardasole.
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