DIABETES MELLITUS. By Tracey Steenkamp Biokineticist at the Institute for Sport Research, University of Pretoria

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1 DIABETES MELLITUS By Tracey Steenkamp Biokineticist at the Institute for Sport Research, University of Pretoria What is Diabetes Diabetes Mellitus (commonly referred to as diabetes ) is a chronic medical condition. It is a group of chronic metabolic disorders characterized by hyperglycaemia resulting from a relative deficiency in insulin, through either reduced insulin secretion or reduced insulin action (or both). Insulin is a hormone necessary to carry glucose from the bloodstream into the cells where it is used for energy. If there is too little insulin, or resistance to insulin, blood glucose levels continue to rise, as glucose is not removed from the bloodstream. You are more likely to develop diabetes if you have one or more of the following risk factors: Overweight or obesity Physical inactivity Family history of diabetes Previous diabetes in pregnancy (gestational) It has been estimated that there are approximately one in ten South Africans with diabetes, however there are many adults who are unaware they are diabetic. Diabetes appears to be increasing with time. In 1995 an estimated 4% (135 million worldwide) appeared to have diabetes whereby it is expected to rise to 5.4% (300 million worldwide) in the year This results in an increasing burden on health care budgets. Diagnosis of diabetes Blood glucose concentrations must be maintained within narrow limits. This is to prevent the acute and chronic complications seen in diabetes mellitus. Diabetes is diagnosed by two consecutive elevated fasting plasma glucose readings or via a glucose tolerance test. A normal fasting blood sugar level is 5.6 mmol/l (100 mg/dl). A fasting blood sugar level of mmol/l is considered prediabetes. If the value is 7 mmol/l on two separate tests, a person is diagnosed with diabetes. Types of Diabetes There are several types of diabetes. These include Type 1 (Insulin Dependent Diabetes Mellitus), Type 2 (Non-Insulin Dependent Diabetes Mellitus) and Gestational Diabetes Mellitus.

2 Type 1 diabetes mellitus is when a persons pancreas does not produce enough insulin to regulate blood glucose levels. This results in inadequate glucose uptake into the cells for energy and an accumulation of glucose in the blood. Type 1 diabetics are required to take daily insulin injections. Type 2 diabetes mellitus is more common than Type 1 Diabetes. Type 2 diabetes is where your body is able to produce insulin however it is unable to use the insulin it produces. Some patients have inadequate insulin production. This type of diabetes is often controlled through diet and exercise alone, however in more advanced stages the use of oral medication and/or insulin is necessary. Gestational diabetes is a type of diabetes which occurs during pregnancy in women who otherwise don t have diabetes. Women typically develop gestational diabetes during the 14 th to the 28 th week of pregnancy. Women who develop gestational diabetes are at an increased risk of developing Type 2 diabetes. Symptoms and complication of diabetes Symptoms vary from individual to individual and some elderly people may not present any symptoms. People with diabetes may experience the following symptoms: Constant thirst Passing more urine than normal Tiredness Unexplained weight loss Blurred vision Tingling/Numb feet Increase in appetite These symptoms are a result of having too much glucose in the blood and not enough in the cells. Although there is no cure for diabetes, with careful monitoring and a healthy lifestyle changes, diabetics can avoid complications and enjoy a long, productive life. In uncontrolled diabetes, high levels of glucose over many years can damage many different parts of the body including: The heart and blood vessels The eyes Kidney disease and kidney failure Ulcers, infections, gangrene in the feet Neuropathy Low blood glucose It is very important to know the symptoms of low blood glucose. These include headaches, trembling, hunger, blurred vision, sweating, rapid heart rate, dizziness and irritability. 15 grams of fast-acting carbohydrates will help treat low blood glucose. This includes glucose tablets or snacks such as raisons, juices or soda s. To avoid low blood glucose, you should test and record your blood glucose levels before and after exercise. This information is useful in educating you and your doctor on how blood glucose responds to different types of exercise.

3 Treatment of Diabetes Traditionally, treatments for diabetes have centered on the use of pharmaceutical interventions. These include oral antihyperglycaemic agents and/or insulin therapy. Lifestyle modifications (which include a controlled diet and regular exercise) form an integral component of management in patients with Type 2 diabetes. Dietary advice for managing diabetes Exercise combined with a healthy diet is advisable in controlling your sugar levels and reducing the risk. Eating a healthy varied diet with small, regular meals, will help to regulate your blood sugar levels. A diet with fibre-rich starches (oats, wholewheat bread and brown rice) is preferred over refined starches. Fruit is preferred in a solid form rather than as a juice. Fat in the diet (especially saturated and trans fat) should be limited and replaced with unsaturated fats. Fish, especially naturally oily fish containing healthy omega-3 fats can improve heart health. Sugar, salt and alcohol should be limited. Alcohol can affect blood sugar levels and should therefore be consumed in moderation. Diabetes and exercise There are many health and fitness benefits associated with physical activity and endurance exercise training. Physical activity is known to prevent the occurrences of cardiac events, and reduce the incidence of strokes, hypertension, depression, and type 2 diabetes mellitus. Exercise helps keep you strong and healthy, therefore reducing the rate of mortality. It improves blood circulation, strengthens your bones, muscles and joints, helps with depression, anxiety and stress and helps you sleep better. Sedentary individuals increase the risk of developing heart disease, obesity, colon cancers, osteoporosis, stroke, high blood pressure and diabetes. Living a sedentary life also results in poor circulation. Although there are many benefits of exercise, it is important to consult with your doctor and biokineticist before starting with an exercise routine. This is especially important if you have any cardiac risk factors including diabetes. Exercise safety tips Exercise is strongly advocated for all patients with controlled diabetes. Before starting with an exercise program consult with a Biokineticist. The biokineiticist will evaluate you and design an exercise program according to your needs. Here are some exercise safety tips: Don t exercise while you have a sore throat, fever or chest cold Avoid exercising in hot, humid weather You can exercise any time of the day, however morning exercise may cause your blood glucose to drop less than if you exercise later in the day

4 If you are on insulin or taking pills that work by making more insulin, evening exercise may result in low blood glucose while you sleep If you exercise in the evening, you may need to take a carbohydrate snack before going to bed to prevent a low blood glucose reaction while you sleep When exercising, carry information regarding your condition (e.g. medication information, doctor s phone number) Wear lightweight, comfortable clothing Wear shoes that fit properly Inspect your feet after activity for sores Drink 425 g 567 g of water minutes before a workout, and 340 g 425 g of water every 15 minutes during exercise Drink water during exercise sessions even if you re not thirsty Start slowly and gradually increase Always warm up before exercising Cool down after exercises Don t hold your breath, exhale with effort Maintain good posture Listen to your body If you feel pain with exercising, stop Diabetic patients should include cardiorespiratory, resistance and flexibility exercises into their routines Flexibility exercises should be performed 5 7 days a week Cardiorespiratory exercise Aerobic exercise is typically repetitive movements involving large muscle groups. It is aimed at improving aerobic fitness. Examples of aerobic exercise includes walking, swimming and cycling. At least 150 minutes of moderate-intensity cardiorespiratory exercise each week (30 minutes of moderate intensity aerobic activity 5 days a week) is advised for patients with Type 2 diabetes; or vigorous intense aerobic activity 20 minutes or more a day, 3-5 days a week. Patients with Type 1 diabetes are encouraged to exercise every day. Resistance exercise Patients with diabetes should be encouraged to achieve two to three resistance training sessions each week. The goal should be to exercise all the major muscle groups. This includes 8 10 exercises, and repetitions of each exercise

5 Living an active life is important. Here are ways at ensuring you remain active during the day Plan to be as active as possible (walking as often as possible) Take the stairs instead of the elevator Park at the far end of the parking lot and walk to the office or store Get up from your desk during the day to walk around Walk your dog Reduce TV and computer time For more information, please contact the Institute for Sports Research ( ) at the University of Pretoria References: Peirce, N.M Diabetes and exercise. British Journal of Sports Medicine, 33 ( ) Weil, R.M BD Getting started, Exercise and Diabetes, (www.bd.com) Diabetes and exercise fact sheet (Exercise and Sports Science Austarlia & the Sports Dietitians Australia) (Accessed: 20 January 2015) (Accessed: 20 January 2015) (accessed: 20 January 2015)

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