Back to Sports Medicine1. Increased Insulin Sensitivity. The exercising diabetic may experience increased glucose uptake at a given insulin concentration. Exercise does not promote more production of insulin, but it increases insulin sensitivity by enhancing receptor site biding. This effect can persist for several hours, up to 24 hours in some individuals. Due to it, non insuline dependent diabetics may be able to reduce doses of medication (oral hypoglycemic medications or insulin). Reducing insulin levels, the diabetic become more protect from atherosclerotic damages, because insulin is a comproved factor for vascular smooth muscle growing.
2. A Better Control of Blood Glucose. When a diabetic starts with a exercise program or one is an athlete, he is already aware that he should pay closer attention to his diet and monitor his blood glucose more frequently. This more effective control is the key to reducing complications of diabetic.
3. Reduction of Others Cardiovascular Risk Factors. Diabetes per si is already a risk for coronary disease and heart attack,and the reduction of other risks plays a important role in diabetics life. Studies show that diabetics have 7 times more risks of coronary atherosclerotic disease than non-diabetics.
The exercise contributes for improvement of serum lipids , it reduces LDL and triglycerides and increases HDL cholesterol. Is not uncommun to find type I diabetics with coagulation disturbance with high fibrinogen levels and with exercises the fibrinolysis can be improved.
The reduction of blood pressure is an other benefit from exercising . Loss of weigth and decreased stress are consequnce of exercising and according to American Heart Association these are recognized risk factors.
The great risk of exircising for diabetics occurs when blood glucose level is not very well controlled and monitorized or when complications of desease are already present.
The diabetics should be very well informed to how take their medications and his diet according with what kind of exercise are to be done. Only with a strict control the diabetic can avoid hypo or hyperglycemia, which can be fatal.
Diabetics with peripheral neuropathy or microangiopathy must avoid exercise that may traumatize the feet. The shoes and socks must be very confortable and, if possible, jogging and jumping exercises should be avoid (prefernce to swimming and bicycling). Stremous exercises have to be avoid by patients with proliferative retino pathy in order to do not increase dramatcly blood pressure. Swimming is recomendable, but never alone or without a strict control of blood glucose to avoid a fatal hypoglycemia.
Bellow, there is a summary of potential risks for an active diabetic:
1- Hypoglycemia in patients using hypoglicemic drugs or insulinThe monitorization of blood glucose level before, during , and after an exercise is very important for a safe participation in sports. A metabolic control of ketones must be done too before the beginning of exercise; if ketosis has begun before exercising , ketone production will continue to rise dangerously.
A familial history of coronariopathy or hypertension must be investigated , such as a valuation of seric lipoproteins. The physical examination should be focused on cardiovascular and musculoskeletal systems.
Bellow there is a list of exigencies for a sefe participation in sports by diabetics:
1- Recent levels of glycohemoglobin must be satisfactoryBefore Exercising :
1- If blood glucose was lower than 130 mg/dL, diabetics should take two carboydrate exchange(@60 kcal is one carboydrate exchange) for 35 /45 min of mild exercise (<60% of VO2 max) and three for intense exercise (>70% of VO2 max)
2- If blood glucose was between 130 and 180 mg/dL , diabetics should take only one carboydrate exchange for a mild exercise and two for an intense one.
3- If blood glucose was between 180 and 240 mg/dL , diabetics should not take any carboydrate exchange for a mild exercise , but if exercise will be intense or long (more than 30 min.) diabetics should make another glucose test during exercise and follow the criterias shown above.
4- If blood glucose was 250mg/dL or higher, the exercise must be cancelled. An urinary ketones test should be done and a new insuline dose can be necessary .
During exercise:
If an intense and/or long exercise is to be done , a blood glucose avaliation must be done during exercise for an effective carbydrate replacement to avoid hypoglycemia.
After exercise:
Diabetics have to do a blood glucose test, especially if the exercise wasn’t usual . It is important because adaptations in diabetics body are able to occur and the strategy for a safe exercise can be changed ,depeding on this pos-exercise test, for a higher or lower carboydrate replacement.
The exact control of diet and insulin dose for a perfect adaptation to an exercise will depend on each person, the kind of exercise, and the strict control of blood glucose and urinary ketones.
Patients with ketosis have a higher secretion of glucagon and catecholamines during exercise , which can cause hyperglycemics states even after exercise. A common finding in active diabetics , particulary athletes, is a rise of blood glucose after exercise. The catecholamines secretion can be so intense during exercise that liver’s release of glucose exceeds the rate of utilization by muscle. It could be paradoxal, but diabetic athletes should be attempt to it and should adapt his program according to it.
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