by David Garred,
Club Manager Dusit Resort Sports Club.
Twentieth century living is resulting in an increase in many, many chronic
conditions, including Diabetes, that can be helped or worse still can be
adversely affected by poorly prescribed exercise.
Recent studies have shown that one type of Diabetes is
becoming more and more common with males over the age of thirty who are
white collar workers, working over 30 - 40 hours per week.
Which is why I am going over it today: so many of us fit
into or know someone who is in this category on the Eastern Seaboard.
DIABETES is broken into two major categories:
1. Insulin Dependant Diabetes Mellitus ( IDDM ).
Often referred to as juvenile onset or Type 1 diabetes.
This form of diabetes generally has a sudden onset most likely resulting
from the body’s immune system attacking and disabling the insulin producing
beta cells of the pancreas. As a result, daily insulin injections are
usually required to control the disease.
2. Non-Insulin Dependant Diabetes Mellitus ( NIDDM ).
Also known as mature onset or Type 2 diabetes. The onset of NIDDM is more
gradual. It can result from delayed or impaired insulin secretion, reduced
insulin sensitivity of the body’s insulin responsive tissues (muscle, fat
and liver cells) or excessive output from the liver.
Of those diagnosed with diabetes, about 15% have IDDM and
the remaining 85% have NIDDM. Diabetes can be controlled reasonably well
through insulin/drug therapy, a balanced eating plan and appropriate
physical activity.
General exercise recommendations:
Frequency; 4 to 7 sessions per week for easier
regimentation of insulin and food intake. Ideally speaking, it should be
performed in the morning or late afternoon/evening to avoid hypoglycaemia
during sleep (i.e., don’t work out at 10.00 pm).
Intensity; should range between 50% and 80 % of age
predicted maximum heart rate.
Time; duration 20 to 40 minutes. Less than 20 minutes -
little or no Cardiovascular benefit. More than 40 minutes increases the risk
of Hypoglycaemia.
Type; Cardiovascular exercise using major muscle groups
is preferred for people with diabetes. Resistance training can be beneficial
within moderation and only with supervision/good instruction.
Exercise recommendations for people with NIDDM (Type 2);
Regulation of metabolism and Blood Glucose Level doesn’t differ greatly
between non-diabetic people and those with NIDDM. Exercise plays a major
role in controlling BGL in people with NIDDM. Exercise reverses the problem
that this group faces which is reduced insulin sensitivity. Exercise
significantly increases insulin sensitivity both during and for several
hours after exercise. Appropriately prescribed exercise will decrease
elevated BGL towards normal without significant risk of Hypoglycaemia when
performed with the correct dietary considerations.
** Check list for avoiding hypoglycaemia during and
post-exercise for people with IDDM;
- avoid injecting insulin into regions of working muscles
(i.e., if cycling, inject into the abdomen).
- don’t exercise until 60-90 minutes after insulin
injection or until peak insulin action time has been reached.
- if your pre-exercise BGL is above 13.9 mmol/L postpone
exercise until BGL is below this figure.
- if your pre-exercise BGL is in the normal range of 3.9
to 6.9 mmol/L you should consume 15 to 30 grams of readily absorbed
carbohydrate, or on the advice of your doctor manipulate insulin dose prior
to exercise bout. Often these strategies are combined.
- during moderate intensity exercise you should consume
15 to 30 grams of carbohydrate every 30 minutes. The use of sports drinks
containing the appropriate concentration of glucose is a practical and
comfortable way to do this.
- following exercise, hypoglycaemia can occur as a result
of repletion of depleted glycogen stores. This can take place as long as 4
to 6 hours after exercise. To avoid this you should test your BGL regularly
after exercise and eat some slowly absorbed carbohydrate as well.
- people with diabetes are predisposed to dehydration
because hyperglycaemia increases fluid requirements for urine production.
Therefore ensure adequate pre-, during and post exercise hydration occurs,
especially in a climate such as Thailand. Drink at the very least 250 mls of
water/fluid every 15-20 minutes.
Until next week, Keep Fit & Healthy.
Carpe’ diem.
