Diabetes is any of several metabolic disorders marked by excessive discharge of urine and persistent thirst, especially one of the two types of diabetes mellitus. This usually occurs as a result of problems with the production, supply, and use of insulin in the body.
Insulin is the body’s key blood sugar-regulating hormone. Without insulin, our bodies cannot obtain the necessary energy from our food. Insulin is made in the pancreas and is released by cells known as beta cells. When a person has diabetes, either their pancreas does not produce the insulin they need (Type I), or their body cannot use its own insulin effectively (Type II). As a result, people with diabetes cannot effectively utilize glucose from food. This leads to a rise in blood glucose levels called hyperglycemia. If a person secretes too much insulin, this leads to lower blood sugar levels, also known as hypo-glycemia or low blood sugar.
Insulin Dependent Diabetes Mellitus (IDDM – formerly Type I):
People with IDDM are unable to produce insulin. This disease can affect people of any age, but usually occurs in children or young adults. People with IDDM require daily injections of insulin as a means of controlling their blood glucose levels. Their doc- tor will usually prescribe a combination of “fast acting” and “slow acting” insulin. The slow acting insulin is usually injected once per 24 hour period, and the fast acting is usually used just before a meal.
The dosages of the fast acting are calculated based on the carbohydrate load or amounts of the meal to be had. Lack of insulin, as well as an incorrect insulin dosage to a person with IDDM can be deadly.
The symptoms of IDDM are often subtle, but can become severe if not addressed.
• Increased thirst
• Increased hunger (especially after eating)
• Dry mouth
• Frequent urination
• Unexplained weight loss (even though they are eating and feel hungry)
• Fatigue (weak, tired feeling)
• Blurred vision
• Numbness or tingling of the hands or feet
• Slow-healing sores or cuts
• Loss of consciousness
Non Insulin Dependent Diabetes Mellitus
(NIDDM – formerly Type II):
People with NIDDM do not usu- ally require injections of insulin. NIDDM used to be called adult-onset diabetes or Type II. However, as a consequence of increased obesity among children, NIDDM is becoming more common in children and young adults.
Usually, blood glucose levels can be controlled by diet, exercising regularly, and by taking oral medication. Those with NIDDM often rely on a class of drugs known as thiazolidinediones (TZDs) to make their cells more sensitive to insulin. NIDDM is most common in people older than 45 who are overweight; however, as noted earlier, more and more cases of children of all ages are being diagnosed with NIDDM, caused by childhood onset obesity. NIDDM is the most common type of diabetes and accounts for 90 – 95% of all people with diabetes.
Data from a long-term study suggests that postmenopausal women who are physically active have less risk of developing diabetes mellitus over women who are sedentary. According to a study published in a recent American Journal of Public Health, approximately 8% of NIDDM cases in older women could be prevented with regular physical activity. If people with NIDDM are not diagnosed and treated, they can develop serious complications, which could result in death. Worldwide, millions of people have NIDDM without being aware of it, and without access to adequate medical care.
NIDDM may show some of the same symptoms as those of IDDM. Most often, there is a very gradual development of symptoms, or there are no noticeable symptoms at all. In fact, half of all people with NIDDM don’t know they have it.
Additional symptoms include:
• Slow-healing sores or cuts
• Itching of the skin (usually in the vaginal or groin area)
• Yeast infections
• Recent weight gain
• Velvety dark skin changes of the neck, under arm, and groin called acanthosis nigricans
Regular exercise has been proven effective in preventing the development of NIDDM. Research has shown that exercise promotes cardiovascular fitness and increased insulin sensitivity which may lower the dosage of oral hypoglycemic drugs required. A healthy person’s blood sugar is usually between 70 and 110 mg/dl (milligrams of glucose per deciliter of blood). It can also be expressed in millimoles; where between 3.9 and 6.0 mmol/L is considered normal. Impaired glucose tolerance (IGT) is a level of blood glucose which is higher than normal, but not high enough to be in the range where doctors classify this as diabetes. A fasting blood glucose level of 126mg/dl is usually the determining number for a diabetes diagnosis (NIDDM).
Gestational diabetes is another type of diabetes that occurs in pregnant women. This may be a temporary form of diabetes that usually disappears when the pregnancy is over. Women who have this type of diabetes are at higher risk of developing NIDDM later in life. Because of the high amounts of insulin secreted by women with Gestational Diabetes, the fetus’ organs are overdeveloped and the child may be born with internal organs that are too large for the body’s systems to support. Within this group, there is a higher risk of being born with or becoming IDDM patients, or to end up developing NIDDM at a very young age. When this happens, the fetus is so overly developed that most gestational diabetes babies have to be delivered via Caesarean.
Exercise is an effective treatment for clients of all ages who have IDDM and NIDDM. Clients in this group should be instructed on how to integrate diet and hydration management with workouts and glucose monitoring. The personal trainer must refer diabetic clients to a Registered Dietitian, familiar with sports nutrition, so he or she can create an individualized custom nutrition program. Clients should also be encouraged to consult a podiatrist for proper footwear, as well as regular follow ups with an endocrinologist specializing in diabetes. It is also important to design adequate warm-up and cool-down routines within the program designs for these individuals. Timing of high-energy snacks, workouts and fluids is crucial. Usually, no specific exercise modifications are required for diabetes patients unless they have complications, but a best practice includes recommending that diabetics stay hydrated while exercising, as exercise causes fluid loss via perspiration. In diabetic patients, perspiration can lead to increased blood glucose levels due to a decrease in serum/blood volume, secondary to fluid loss. It is recommended to not exercise if blood glucose levels are under 150-200mg/dl before exercising.