The importance of physical exercise in Diabetes by Inês Abrantes

It has been proven that physical exercise brings several benefits to people with Diabetes . Associated with a healthy eating regimen, this behavior is enough for the disease to be delayed and/or avoided. Furthermore, it allows you to keep it under control after the diagnosis.

To this day, no cure for Diabetes has been discovered. However, it is known that the disease is closely linked to poor eating habits and a sedentary lifestyle.

Considered a global epidemic by the World Health Organization, the number of people with this disease has grown in Portugal, as well as throughout the world. Its presence can cause a deterioration in the quality of life. However, advances in Science allow patients to live a perfectly normal life today.

Still, it is important to highlight that without medical monitoring or health care, Diabetes can cause early death.

What is Diabetes?

Diabetes is a chronic disease that results in a very high amount of glucose in the blood. These levels are associated with the intake of any type of carbohydrates (starch, fruit, milk, sugar, etc.). They are also due to the inefficiency of the pancreas in producing sufficient amounts of insulin to match the food ingested. Therefore, this hormone is unable to deliver glucose (energy) to the cells so that they can perform their functions.

The blood glucose levels recommended by doctors for healthy people are between 80 and 140 mg/dl. These values ​​vary depending on whether it is a pre- or post-meal period.

What are the main types of Diabetes?

Type 1 Diabetes (T1D) , also known as insulin-dependent diabetes, is the rarest form of the disease. Its diagnosis occurs after a rapid process of dysfunction or destruction of the beta cells of the pancreas . It is these endocrine cells that synthesize and secrete insulin, a hormone responsible for regulating blood glucose levels .

The disease is idiopathic , that is, the reasons behind this process are not fully known. However, it is known that it is each individual's immune system that attacks and destroys beta cells. Consequently, antibodies are created against the organism itself, a behavior better known as autoimmunity or autoimmune process.

Type 2 Diabetes (T2D) is caused by an imbalance in the production of insulin by the pancreas, caused by the decrease in beta cells over time. This process proportionally increases the patient's insulin resistance. This variant is generally associated with excessive sugar consumption . Furthermore, other risk factors such as obesity, sedentary lifestyle and genetic predisposition may be at their origin.

Finally, a third variant of the disease occurs during pregnancy : it is called Gestational Diabetes . Although it can appear throughout the nine months, it is more common in the second and third trimesters. During pregnancy , the fetus requires the pregnant woman to secrete a greater amount of insulin. This variant of the disease arises due to the inability of the pancreas to produce the hormone in sufficient quantity.

Typically, gestational diabetes disappears after the baby is born. However, its appearance doubles the likelihood of a woman developing Type 2 Diabetes in the future.

What are the main symptoms of Diabetes?

The onset of Type 1 Diabetes is quite clear, as insulin suddenly ceases to exist in the body. In the case of Type 2 Diabetes, this hormone gradually ceases to exist in sufficient quantity or, in some way, becomes unable to act. However, this happens in a more silent way.

In one situation or another, sugar (glucose) accumulates in the blood, resulting in hyperglycemia . As a result, some of the following symptoms may occur:

• Need to urinate frequently;
• Feeling of constant thirst and dry mouth;
• Constant appetite and difficulty in satiating;
• Lack of energy;
• Generalized itching, especially in the genital area;
• Vision problems.

What is the prevalence of Diabetes in Portugal?

Data from the National Health Service for 2017 indicate that, in Portugal, there are one million people with the disease between the ages of 20 and 79. Speaking specifically about Type 2 Diabetes, 44% of patients do not know they are diabetic . It is a silent condition in which the first symptoms only appear when the condition is already advanced.

The Type 1 variant is better known as “ Young Diabetes ”. In 2015, according to the Directorate-General for Health, it affected 3,327 individuals up to the age of 19. The numbers have remained stable in recent years.

Regarding Gestational Diabetes , data – also from 2015 – indicated that the disease affected 7.2% of pregnant women. There was also a direct proportional relationship between the occurrence of this type of Diabetes and the age of the pregnant woman.

Complications arising from Diabetes

Around 40% of the population with Diabetes tends to develop late complications associated with the disease. The most common are disorders of blood vessels and nerves (the feet are among the most affected areas), sexual disorders, infectious episodes and healing problems.

Means of controlling the disease

The prevention and treatment of Diabetes are based on 4 fundamental points that help to improve metabolic control . Its knowledge and application make it possible to delay or even avoid chronic complications associated with the disease.

1. Know the disease extremely well. The main success factor in treatment is the level of responsibility with which the patient views their own control;
2. Have the ability to effectively control your blood glucose levels . Patients with T1D must comply with insulin-based treatment, through subcutaneous injection (insulin therapy). Individuals with T2D can control their levels through oral antidiabetics and/or insulin;
3. Follow a diet that is in line with meeting the outlined objectives, including controlling blood glucose, cholesterol and triglyceride levels. Furthermore, it is important to achieve and maintain a balanced weight and adopt a healthy lifestyle;
4. Recognize the extremely important role of physical exercise in controlling Diabetes and preventing associated complications. It is worth noting that physical activity decreases insulin resistance and stimulates its production.

Diabetes, excess weight and physical activity

There is a relationship between a Body Mass Index (BMI) above normal indicators (18.5 to 24.9) and Type 2 Diabetes. In fact, around 90% of the population suffering from the disease is overweight or obese .

The prevalence of this type of Diabetes occurs in people with a BMI greater than 30. This value is approximately four times higher than that of people who are within normal indicators.
Regular physical exercise always has a positive role in controlling Diabetes. This routine enhances insulin segregation and supports its transport to cells. Furthermore, it helps to reduce weight and improve BMI values.

There are some aspects that all diabetics (especially type 1 diabetics) should keep in mind:

• Need to adopt, in general, a healthy diet;
• Intensity and duration of physical exercise;
• Circulating insulin levels;
• Intake of the necessary foods before and during exercise. Carelessness can cause low blood sugar levels or the appearance of ketone bodies in the blood, which provide energy to cells.

Factors to take into account before starting physical activity

Each individual is unique! My experience as a Personal Trainer tells me that when you talk about physical exercise, it becomes more unique, whether you have Diabetes or not.

It is common knowledge that physical exercise contributes to part of the much desired “healthy lifestyle”. However, a diabetic must know how to make the necessary adjustments by assessing blood glucose before starting exercise. But you should also check the levels every 45-60 minutes and at the end of the activity.

Hypoglycemia can appear up to 12 to 14 hours after the end of physical activity. Therefore, more than being alert to this fact, the athlete must make the necessary adjustments so that this is avoided. The entire process must be defined in advance by the medical team .

Physical activity should not be started when the diabetic has a blood glucose level below 90 mg/dl. Likewise, you should not do this with very high blood glucose levels, with the existence of positive ketone bodies.

All of this can be checked at any time by the person suffering from the disease using their personal glucometer. To do this, simply take a capillary blood glucose test (aka finger prick).

My experience as a diabetic and athlete

I have been living with Type 1 Diabetes for almost five years. I graduated in Physical Exercise after discovering this chronic illness.

In my case, strength training is what works best for controlling the disease, due to its long-term regulatory effect. The benefits are increased insulin sensitivity, as well as glucose uptake by the muscle.

Often, during training, glucose levels increase due to the production of other hormones, such as adrenaline and cortisol. However, in the post-workout period, they remain much more controlled than when I perform cardiorespiratory training . In this case, there is a short-term decrease in blood glucose levels, but it tends to rise after exercise.

Although there is scientific evidence that proves the beneficial effect of various types of strength training for controlling Diabetes, this is what happens to me. Therefore, each person must be accompanied by a physical exercise specialist , who can define the type of training that best suits their goals.

If you have Diabetes, you should never hide your illness from anyone. This is not a sentence! Everything is controlled and we have several living proofs that it does not limit us in any way.

Good training!