What fitness and nutrition professionals need to know about diabetes…
Fitness and nutrition professionals are the people best positioned to prevent the epidemic of diabetes, as it is necessarily a disease of faulty lifestyle. Diabetes cannot be treated, but it can be prevented, or delayed indefinitely with lifestyle changes.
At present, about 8% of the population is living with diabetes, and in some urban centers, this percentage is even above 10%. However, more worrisome is a number of people living with prediabetes. These are people who have not developed diabetes yet, but they are quite probable to become diabetic in the coming years. These people have sugars above-average range, but not high enough to be classified as diabetics, and they constitute whooping 30% of the adult population.
So, fitness and nutrition professionals need to work with this population, but before that, they must know a few things about the condition.
Diabetes is not a single disease
ADA (American Diabetes Association) subdivides diabetes into four forms:
- Type 1 – is an autoimmune disease in which immune cells of an individual kills the insulin-producing beta cell in the pancreas. It is a result of both genetics and environmental factors, so partially preventable with lifestyle. However, fitness and nutrition specialist may not get much chance to work with high-risk individuals as it is a disease of young and lean. This kind of diabetes occurs abruptly. Fortunately, the prevalence of type 1 diabetes in less than 9%.
- Type 2– is about insulin resistance, it occurs slowly due to years of neglection, due to faulty lifestyle, lack of exercise and wrong kind of diet. It is a disease of overweight adults and is mostly diagnosed in people above the age of 30, though not necessarily. It is a type of diabetes present in 90% of the cases, and it is a kind of diabetes that fitness and nutrition experts can help prevent and manage. It is generally diagnosed by excluding type 1 diabetes.
- Gestational – first diagnosed in pregnant women, after 24 weeks of pregnancy. If discovered before 24 weeks then it is just undiagnosed type 2 diabetes. Such kind of diabetes may last only as long as the pregnancy continues. However, women diagnosed with it are at high risk of developing type 2 diabetes later in life. This is another critical group for fitness and nutrition specialists to work with.
- Other types– there are many other rare kinds of diabetes. They occur only in a small number of cases.
Diabetes is not just about insulin deficiency
Since 90% of people diagnosed with diabetes are living with type 2, it is necessary to understand that in this type of diabetes insulin deficiency is only a secondary thing. Type 2 diabetes is characterized by insulin resistance, in the beginning, people with this type of diabetes may have normal levels of insulin, but the hormone fails to work well.
Insulin resistance develops due to an excess of calories which is a result of wrong dietary habits and lack of exercise. High calories mean continuous high insulin secretion. Sustained high levels of insulin in the blood leads to the development of resistance. To fight insulin resistance, pancreas starts over-secreting insulin, working overtime, and they finally become exhausted which leads to insulin deficit.
Diabetes is not just high blood glucose
One of the wrong views about diabetes is that it is a disease in which a person has a high blood sugar level. However, it is only partially true. In diabetes, there are disturbances of metabolism of all macro and micronutrients. Measuring blood sugars is just a more predictable way to assess the severity of the disease.
It means that in those living with diabetes there are broad metabolic changes. Most of them are living with dyslipidemia (thus need to correct fat intake). Most of them have elevated levels of bad cholesterol. All those living with diabetes have changed protein metabolism and anabolic processes. Insulin is known as an anabolic hormone.
Further, fitness and nutrition specialists need to know that people with diabetes also have deficiencies of micronutrients. Some micronutrients are useful in helping fight diabetes like selenium, chromium, zinc vitamin D, vitamins of group B, and so on.
Lifestyle changes are better in preventing diabetes than medications – and it is proven by science
Yes, science clearly says that fitness and nutrition professionals are the people who can stop this spread of diabetes. This has been confirmed by numerous large-scale prevention studies in Europe, US, and Asian nations. All the studies had similar outcomes showing that a combination of regular exercise and dietary changes can help prevent diabetes in the 60% of cases, against a mere 30% of cases with the use of a drug called metformin.
Finnish diabetes prevention study was one of the first of its kind. Purpose of the study was to see if the moderate exercise of just 150 minutes a week (30 minutes for five days), and reduction of just 5% of body weight can help prevent diabetes or not. In the study, more than 500 high-risk individuals participated, and the results were so good that researchers discontinued the pilot study to increase its scope. Just a small weight reduction and moderate exercise could reduce the risk of diabetes by almost 60%!
Diabetes prevention study in the US went a step further, and they decided to see if providing metformin (a drug to reduce body weight and insulin resistance) will work better or exercise and nutritional changes. To the surprise of researchers, reducing body weight by about 7%, and regular exercise was much more effective than medications. Lifestyle modification prevented diabetes in 58% of cases against 31% with metformin.
Follow-up studies show that exercise, reduction in body weight, nutritional corrections can help prevent diabetes in most people in the years to come.
It should be noticed that in the above studies body weight reduction was realistic and mere 5-7% over 1-3 years. An exercise was also moderate, with participants doing just 30 minutes of exercise five days a week. Results will be much better if more aggressive methods are used. Similarly, aerobic exercise when combined with anaerobic exercise will work even better.
Weight training is really good as insulin resistance starts due to high accumulation of glucose in skeletal muscles. Moreover, a higher volume of skeletal muscles can consume more blood glucose.
To conclude, early you start lifestyle interventions better would be the outcomes. Further, fitness and nutrition professionals need to know that diabetes prevention interventions would differ a bit from lifestyle interventions used to prevent diabetes from progressing. Creating a fitness and nutrition plan for those living with diabetes is more challenging, as many food items need to be eliminated. In diabetes monitoring intensity of exercise is also challenging due to autonomic neuropathies in many.
Before starting an exercise program ensure:
- That blood fasting glucose levels are below 250 mg/dL.
- When doing exercise, people with diabetes must regularly check blood glucose levels to see the response of the body to different activities.
- Recommend individuals living with diabetes to consume high-quality (slow absorbing) carbs.
- People with diabetes should better exercise in a group.
- There is a need to focus on foot hygiene.
- Exercise may be discontinued if there is severe and unexpected pain.
In those living with diabetes, any lifestyle intervention should be started by taking into consideration the severity of diabetes and the presence of any complications.
What’s Next?
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