Personal Training – ‘Diabetes’

In this fitness blog we are looking at one of the common medical conditions that a personal trainer should be aware of when working with the public.

According to Diabetes UK (diabetes.org.uk), there are 2.9 million people diagnosed with diabetes in the UK and an estimated 850,000 people who have the condition but don’t know it.

What is diabetes?

Diabetes is diagnosed when blood glucose levels are not sustained within the normal range of 4-7 mmol/L (millimoles per litre). The disease is characterised by an absolute or relative deficiency in insulin, so either insulin production ceases altogether, or it is not at the right level to move glucose from the bloodstream into fat tissue, muscles, or working tissue for energy.

The two types of diabetes

A personal trainer may have a client with Type 1 or Type 2 diabetes. 

Type 1 diabetes occurs when insulin secretion is deficient due to the damage or destruction of the insulin-secreting beta cells of the pancreas. People with Type 1 diabetes must have regular injections of insulin to replace what the beta cells should be producing.

Type 2 diabetes, the main cause of high blood sugar levels is insulin resistance. So although the pancreas is still producing insulin, the sensitivity of the receptors in the cells is too low, reducing the uptake of glucose from the bloodstream into the adipose tissue (fat tissue).

Consequently, the beta cells of the pancreas secrete more insulin in an attempt to normalise blood glucose levels. Over time they can become exhausted, which causes a decrease in insulin secretion.

Pathology and causes of diabetes

The pathology and causes of Type 1 diabetes are not entirely known, but it appears to be an autoimmune response in which the body’s own immune system attacks the pancreatic beta cells.

It occurs in genetically susceptible people, and fitness instructors should advise their clients that the closer the individual is to other family members with diabetes, the more likely they are to have the disease.

Type 2 diabetes is both genetic and influenced by environmental factors. As with Type 1, the closer the relative the higher the risk. Certain ethnic groups have a propensity towards the disease, for example, people of South Asian and African-Caribbean original are three to five times more likely to have Type 2 diabetes than the rest of the population.

Obesity is a significant contributing factor in the development of insulin resistance: 80% of people are obese at the onset of Type 2 diabetes. Research has shown that 56% of cases of Type 2 diabetes may be preventable through dietary and lifestyle modifications. A balanced diet and a fitness programme devised by a qualified personal trainer are important for anyone at risk. There is also an increased risk with age, particularly from 45 onwards.

Presentations and symptoms

The symptoms of Type 1 diabetes are excessive thirst or excessive hunger, excessive urination, weight loss and fatigue. The onset of Type 1 diabetes is usually very rapid. If insulin is not available symptoms can develop very quickly and, without prompt medical attention, the person may develop diabetic ketoacidosis.

When glucose cannot be metabolised, cells rely increasingly on lipid (fat) metabolism as an immediate source of energy. In poorly controlled Type 1 diabetes, keytone bodies, a by-product of lipid metabolism, may accumulate in the blood. Ketoacidosis is when the level of keytone bodies is high enough to lower the blood’s PH and in severe cases this leads to coma and death.

With Type 2 diabetes, the symptoms can include excessive thirst, sometimes excessive hunger, excessive urination, sometimes weight loss, genital infections and fatigue. The onset of Type 2 diabetes is slower than Type 1. Symptoms can be dismissed or hidden for up to seven years and 50% of those with Type 2 diabetes have a diabetic complication, such as eye disease (retinopathy) or coronary heart disease by the time they are diagnosed.

Treatments for diabetes

The three main treatments for diabetes are:

• Modifying lifestyle via a combination of physical activity, preferably a programme devised by a qualified personal trainer, and behavioural and cognitive therapy
• Eating a healthy balanced diet
• Taking medication to reduce blood glucose levels
• Patients with Type 1 diabetes will be prescribed a mixture of long- and short-acting insulin injections or subcutaneous infusion via a pump.

The main side effects of injections are hypoglycaemia and hyperglycaemia, as well as possible weight gain due to the effectiveness of insulin in storing excess glucose. This often happens when individuals try to juggle their insulin doses and once insulin levels are established this becomes less of a problem.

With Type 2 diabetes, there are drugs available that will:

• stimulate the pancreas to increase insulin output
• improve insulin sensitivity at cell receptor level
• slow down and reduce the breakdown of complex carbohydrates into glucose in the stomach
• suppress the rate at which the liver releases glucose 

Anyone following a personal trainer course will study diseases such as diabetes so that they can recognise a client presenting with symptoms and work with clients who are managing the disease while training at the gym.

We hope you have enjoyed today’s fitness blog.  For more information on working with special populations such as diabetes please see our exercise referral qualification.