Diabetes is a serious and chronic disease, but there are ways to treat and manage it.
In Type 1 diabetes, the pancreas produces very little or none of the hormone insulin; in Type 2 the body produces insulin but either cannot use it effectively or does not produce it in sufficient amounts. There is also gestational diabetes, which can arise during pregnancy.
Diabetes causes too much sugar in the bloodstream, leading to symptoms such as needing to urinate more frequently, thirst, hunger, weight loss, fatigue and changes to vision. Untreated, diabetes can increase the risk of cardiovascular disease and stroke, as well as problems with the kidneys, eyes and feet.
Treatment of diabetes
Injecting insulin into the bloodstream is the main way to treat Type 1 diabetes. Fast-acting insulin can be used to mitigate rising blood glucose after a meal, but the most commonly used insulin is intermediate-acting, which prevents hypoglycaemia (low blood sugar) over a longer period of time. Another type of insulin, biphasic, is a mix of two different types, which can affect blood glucose levels over both the short and long term.
Lifestyle measures, such as losing weight and changes to diet can help to control Type 2 diabetes. However, most patients will require medication such as metformin or sulphonylureas to help them control their diabetes.
Why is it important for personal trainers to understand diabetes?
Although some personal trainers will add a Level 4 Certificate in Physical Activity and Weight Management for Obese and Diabetic Clients to their list of qualifications, all fitness professionals should have a basic awareness of diabetes and how it may affect their clients.
Blood sugar levels, side effects from medication, diet and lifestyle can all affect a client as they train. Diabetic clients may also be taking other medication, for example for hypertension or hypercholesterolaemia.
Exercise and hypoglycaemia – what to look out for
A personal trainer should be aware of the risk of their client developing hypoglycaemia as they expend energy during exercise. A client with Type 1 diabetes will need to time their medication and food intake and check their blood glucose levels prior to exercising and during a longer gym session. Those with Type 2 diabetes may be affected by hypoglycaemia during or after training.
A work out of high intensity or long duration is more likely to lead to hypoglycaemia. If the client becomes particularly fatigued, dizzy, confused, uncoordinated or has slurred speech or displays uncharacteristically aggressive behaviour, these are all signs of hypoglycaemia.
The personal trainer should immediately halt the session, sit the client down and administer a sugary drink or sweet food rich in carbohydrate. If the client is still unwell after 10 minutes, the fitness professional should call for medical help.
Exercise prescriptions for diabetes
Exercise can help those with both Type 1 and Type 2 diabetes, as it can reduce insulin resistance and help those who are obese to lose weight. Benefits of exercise for diabetics include:
Type 1 – reducing the need to inject insulin ahead of exercising; lower blood glucose levels after a work out; better metabolic control for those who exercise regularly; better blood flow in various vascular beds, including in the eyes and improved function of the endothelium membrane inside the heart and blood vessels.
Type 2 – increased insulin sensitivity and non-insulin dependent muscle glucose uptake, even some time after aerobic exercise in particular; increased concentration of proteins that pull glucose into the muscle cells; increased oxidisation rates of muscle glucose; increased intramuscular lipid accumulation and storage.
While aerobic exercise is considered particularly effective for those with Type 2 diabetes, more recent research has shown that resistance exercise can also reduce blood glucose levels.
When training clients with diabetes, a fitness instructor should be aware of the effects of the intensity and frequency of exercise on the client’s condition. A client should self-monitor their insulin and dietary needs, which may change after increasing or changing the amount or type of exercise they carry out. Longer term, they should see a fall in blood glucose levels through exercise, which may require a change to their medication.
Although medication is often required to treat diabetes, exercise can help diabetics manage their condition and gain better metabolic control.
The positive effects such as lower blood glucose levels can continue for some time after exercise. Longer term, exercise can reduce the risk factors that lead to issues such as cardiovascular problems and reduce the need for medication or the amount of insulin required.