DIABETES: PHYSICAL ACTIVITY AND DIABETES MELLITUS - SPORT-AND-HEALTH

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Physical activity and diabetes mellitus

Diabetes: why physical activity is important

"Diabetes

Physical exercise, especially if aerobic, is an integral part of the treatment plan for Diabetes Mellitus.
The first historical observation on the subject dates back to the first half of the 19th century and is present in the book "Memoires d" un diabetique "in which the author, doctor and diabetic, reported that after a large meal he used to run along the external boulevards of Paris and felt great benefit on his body.
The first scientific observation dates back to 1926 (only 5 years after the discovery of insulin), the year in which Lawrence, an English doctor and diabetic, published in the British Medical Journal an article in which he demonstrated on himself that an injection of 10 units of Ready insulin produced a much greater and faster lowering of blood glucose if followed by physical exercise rather than if one remained at rest.
Due to the synergistic action of muscular work and insulin, physical exercise was considered a "pillar" of diabetes therapy (Joslin Clinic, 1959).

The physical activity recommended for diabetic patients is always an aerobic type. In the absence of complications, it is useful and recommended to use a resistance training program.

Which sports to choose?

The organization of a typical training session generally includes:

A WARM-UP PHASE: 5-10 minutes of low-intensity aerobic activity to prepare the heart, skeletal muscle and lungs for a progressive increase in exercise.
Then another 5-10 minutes of gentle muscle stretching.
A CENTRAL PHASE CHARACTERIZED BY THE "SCHEDULED PHYSICAL ACTIVITY
COOL DOWN AT THE END OF THE SESSION: 5-10 minutes to gradually bring the heart rate back to basal levels.

IN GENERAL, SPORTS THAT REQUIRE SHORT AND INTENSE EFFORTS (eg fast running on a short distance of 100-200 m), those that require maximum speed or numerous sprints and weight lifting, CAN CREATE PROBLEMS.

In addition, sports that involve frequent jerks and sudden movements of the head (boxing, motor sports) should be avoided.

On the contrary, if the sport is progressive and lasts several hours, the diabetic can adapt his metabolism with the appropriate precautions.

RECOMMENDED SPORTS AUTHORIZED SPORTS SPORTS NOT RECOMMENDED

Fast running

Light running (jogging)

I swim

Skiing (cross-country or downhill)

Tennis

Golf

Football

Basketball

Volleyball

Cycling

Handball

Boating

Canoe

Athletics

Artistic gymnastics

Classic dance

Boxing

Free wrestling or Greco-Roman

Mountain climbing

Parachuting

Extreme skiing

Underwater sports

Motor sports

Sports and diabetes: precautions

Use of special ventilated or silica and gel insoles and polyester or cotton-polyester socks to keep the foot dry and minimize trauma

Identification bracelet visible during exercise

Adequate hydration before exercise, during and after.

High-resistance exercises with weights can be accepted in young people, but not in elderly people or those with long-term diabetes.

Training programs that use light weight and high repetition weights can be used to maintain or build strength in most people with diabetes.

Benefits of regular physical activity

A GOOD METABOLIC CONTROL IS AN ESSENTIAL CONDITION FOR PREVENTING THE COMPLICATIONS OF DIABETES.

A medium-low intensity exercise 3-4 times a week for at least 30-60 minutes leads to the general improvement of the metabolic control parameters:

increased sensitivity to insulin
prevention of cardiovascular diseases
induces a less atherogenic lipid profile
reduces VLDL triglyceride levels
increases "good" HDL cholesterol
reduces "bad" LDL cholesterol
reduces blood pressure levels significantly in patients with hyperinsulinemia
promotes weight loss
HELPS PREVENT TYPE 2 DIABETES BY IMPROVING INSULIN SENSITIVITY AND GLYCEMIC CONTROL THANKS TO:
increased blood flow to insulin sensitive tissues
greater proportion of type I muscle fibers that are more sensitive to insulin action than type II fibers
reduction of total fat and in particular of the "insulin-resistant" abdominal fat
increase in the post-receptor action of insulin (increase in glut4 in the muscle and its translocation to the cell surface)

PHYSICAL EXERCISE IS PARTICULARLY ADVANTAGEOUS IN SUBJECTS WITH Mild to Moderate DIABETES, IE WITH FASTING GLUCOSE LESS THAN 200 mg / dL

Recommendations for proper exercise

Evaluation of the presence of complications (diabetologist)

Evaluation of the presence of silent ischemic disease (cardiologist)

Exercise electrocardiogram in patients over 35 years of age

Evaluation of therapy with oral hypoglycemic agents and / or insulin

Evaluation of therapy with hypertensive drugs

Additional precautions and recommendations

DURING PHYSICAL EXERCISE IN PHYSIOLOGICAL CONDITIONS THERE IS A LOWER IN INSULIN LEVELS, SO THE DOSE OF INSULIN REQUIRED AT REST MAY BE EXCESSIVE DURING THE EXERCISE DETERMINING:

REDUCED HEPATIC PRODUCTION OF GLUCOSE + INCREASED UTILIZATION OF GLUCOSE = HYPOGLYCEMIA.

Exercise increases insulin action for several hours after exercise resulting in a prolonged risk of hypoglycemia.

In addition, subcutaneous insulin absorption can be increased by exercise if the injection is made in an area involved in muscle activity.

SO IT IS FUNDAMENTAL TO MONITOR YOUR GLUCOSE BEFORE AND AFTER EXERCISE

identify when it is necessary to reduce the insulin dose;

study the glycemic response to different exercise conditions.

THE RISK OF HYPOGLYCEMIA IS "HIGHER" WHEN EXERCISE IN THE POST-PRANDIAL PERIOD (requires a reduction in the dose of insulin or ingestion of carbohydrates).

The risk of hypoglycemia is lower when exercising away from meals when insulin levels are low.

Physical activity in the afternoon or evening can lead to nocturnal hypoglycemia.

If possible, schedule physical activity away from insulin injections.

Avoid exercise during the peak of insulin action.

Reduce the insulin dose when exercise is scheduled.

Administer insulin to areas not involved in muscle activity.