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EXERCISE AND TYPE 2 DIABETES



In a previous article, I talked about how physical activity is a panacea not only for healthy people, but for those suffering from diabetes mellitus too. In the following paragraphs I will talk about training and Type 2 diabetes, which, unlike Type 1 diabetes, can be asymptomatic and occurs due to the combination of genetic and environmental factors. These factors cause an alteration in insulin secretion and fat metabolism resulting in insulin resistance.


Symptoms and complications of Type 2 diabetes

According to the most recent statistics, one in twelve adults worldwide suffers from Type 2 diabetes.


Among the most common symptoms detected in individual with Type 2 diabetes, the most frequent are:


  • excessive thirst (polydipsia)

  • increased quantity and frequency of urination (polyuria)

  • weight loss

  • lethargy

  • infections (especially fungal)

  • blurred vision


Complications include:


  • damage to the retina of the eye (diabetic retinopathy)

  • cardiovascular complications (peripheral arterial disease)

  • kidney diseases

  • neurological disorders (peripheral and autonomic neuropathy)

  • erectile dysfunction

  • coronary heart disease


Luckily, thanks to modern medicine and a change in the lifestyle, Type 2 diabetes can be managed in such a way as to allow those who suffer from it to live an almost normal life. Depending on the individual's personal situation, the doctor will decide whether it is necessary to prescribe oral antidiabetic medicines or insulin. However, the management of the diabetic individual begins at the table, with the prescription of a bespoke food plan by a nutritionist or dietician.


Together with changing eating habits, the introduction of physical activity is a very powerful weapon for managing diabetes. Indeed, a sedentary lifestyle has been recognised by the scientific community as the major risk factor for the development of Type 2 diabetes. It has been estimated that the mere introduction of physical activity into our daily lives can reduce the relative risk of developing Type 2 diabetes by 40-60%. That's a 6% decrease in risk for every 500 calories burned!


The role of physical activity in the management of Type 2 diabetes

Unlike Type 1 diabetes, in Type 2 diabetes there is not absolute, but relative hypoinsulinemia, therefore it is unlikely that physical exercise causes metabolic decompensation.


Hyperinsulinemia, on the other hand, is usually a consequence of insulin resistance and disappears when insulin sensitivity improves (however, this does not occur if hyperinsulinemia occurs following the use of drugs).


Precautions

Before starting a regular training program, it is essential that Type 2 diabetics undergo a preliminary medical examination to evaluate their health conditions and obtain the green light to perform physical activity.


Once the doctor's consent has been obtained, the diabetic subject must be very diligent in self-monitoring blood glucose levels if they are under drug therapy. If your blood sugar exceeds 250mg/dl or ketonuria is present, I advise you to avoid training.


Training mode

The best tool to fight Type 2 diabetes is a training program that involves the combination of aerobic activities that do not require an effort greater than 50-60% of VO2Max (maximum oxygen consumption) or 50-70% of FcMax (maximum heart rate), and resistance exercises (lifting weights). Consider that a single training session promotes the synthesis of glucose, while many sessions carried out over a constant period of time also improve the functionality of the mitochondria and the biogenesis, the production of GLUT4 (a glucose transporter) and the upregulation of metabolic genes!


To get the most out of each workout I recommend you to perform 3 to 5 sessions per week of 30-60 minutes of real work each, that is excluding the warm-up and cool-down phase.


Training in case of complications

At the beginning of this article, I mentioned the complications that can affect those suffering from Type 2 diabetes. When planning a training program, these pathologies cannot be ignored and the necessary precautions must be taken.


Coronary heart disease

Physical activity that causes chest pain or a rapid increase in heart rate should be avoided in favor of low- or moderate-intensity activity (40% of Vo2Max or 50% of HRMax).


Neuropathy

Neuropathy can be classified as peripheral (damage to the nerves in the body extremities) or autonomic (damage to the nerves that control automatic body functions).


In case of peripheral neuropathy, regular aerobic exercise can slow its progression. The recommended exercises include non-weight-bearing activities such as cycling or swimming in order to avoid foot injuries.


In autonomic neuropathy, light exercises and aerobic activities are preferred, but it is essential to pay attention to environmental conditions (temperature) and keep well hydrated.


Diabetic retinopathy

Activities that cause an increase in blood pressure (e.g. high-intensity weight lifting), or in which the Valsalva maneuver is required, or activities that involve physical contact with the risk of receiving sudden blows or shaking (e.g. combat sports), should be avoided in favour of moderate intensity physical activity.


Diabetic nephropathy

As in the case of coronary heart disease, only moderate intensity physical exercise is recommended for diabetic nephropathy.


The best weapons against Type 2 diabetes

Regular physical activity promotes the synthesis of glucose in the muscles both during and after exercise, rebalances the production of glucose in the liver and promotes the use of carbohydrates as an energy source by improving insulin sensitivity regardless of weight loss and diet. All these factors favor a reduction in blood sugar levels, LDL cholesterol (bad cholesterol) and triglycerides, and an increase in HDL cholesterol (good cholesterol).


Therefore, physical exercise is a very powerful therapeutic tool and together with correct nutrition they are the best weapons to fight the pathogenesis of diseases and cardiovascular risk factors linked to diabetes.

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