The other is dealing with the risks associated with exercise, especially the risk of hypoglycaemia in those who are treated with insulin. Thus some people with diabetes may be reluctant to undertake physical activity for fear of the consequences. This book contains valuable information for healthcare professionals who are managing patients with either type 1 or type 2 diabetes to enable them to provide help and support to those patients who wish to undertake regular activity, sporting or otherwise.
The book describes the physiological responses during exercise in patients with type 1 diabetes and discusses suitable nutritional strategies for these people. New chapters address the role of physical activity in the prevention and management of type 2 diabetes, as well as how to combine insulin pump therapy and exercise. Other chapters cover the role of the diabetes team in promoting exercise, encouraging patients to become and stay physically active. The book will prove helpful to all members of the diabetes specialist team: clinicians, Diabetes Specialist Nurses, psychologists, GPs, sports scientists and patients.
Exercise and Sport in Diabetes
This is an excellent book which should be on the shelves in every diabetic clinic. Table of contents Foreword to the First Edition. Preface to the First Edition. Preface to the Second edition. Useful Addresses. Appendix 1: Stretching exercises. Appendix 2: Muscular endurance exercises. Review Text " an extremely useful resource for any member of the diabetes care team " Doody s Health Services "A revised edition is a practical guide for members of a diabetes care team.
Review quote " Rating details. The prevalence of T1D has been increasing considerably throughout the world; it is highest in the Nordic countries and very low in Asia. The microvascular and macrovascular complications of diabetes are usually found in patients with T1D of 15 to 20 years' duration, 8 and are uncommon before the age of On the other hand, cardiovascular disease CVD tends to occur mainly in adulthood, 12 and the prevention of these comorbidities may be the greatest benefit derived from regular physical activity PA.
The influence of PA on the glycated hemoglobin levels HbA1c of children with T1D appears to favor improved glycemic control; most studies have found significant decreases in HbA1c levels after completion of a regular physical activity program. The proven preventive action of PA whether recreational or competitive 14, notwithstanding, levels of physical activity are lower than recommended in most children and adolescents with T1D, which further increases the risk of early-onset microvascular and macrovascular disease. This review sought to address the practical aspects of safe physical activity and sports participation in children and adolescents with T1D, as well as the role of hypoglycemia as a barrier to an active lifestyle and which activities and sports are most indicated in this population.
Children and adolescents with T1D are at greater risk of developing microvascular complications diabetic retinopathy, nephropathy, and neuropathy 10,24 and cardiovascular disease. The main risk factors for development of the aforementioned conditions are lack of adequate glycemic control 10 Table 1 , dyslipidemia, obesity, high blood pressure, and physical inactivity. In spite of the health benefits of engaging in 30 to 60 minutes of moderate to vigorous physical activity on a regular basis, 34,35 most youths do not follow this recommendation.
Aerobic PA uses muscle and liver glycogen, blood glucose, and free fatty acids as its main energy sources, depending on the duration and intensity of activity. One of the main issues complicating PA in children with T1D is the frequent occurrence of hypoglycemia during or even hours after exercise, 44,45 which ultimately discourages these children from engaging in regular PA.
Hypoglycemia may be due to excessive administration of exogenous insulin prior to aerobic exercise, inadequate insulin:glucagon ratio, or increased insulin sensitivity. Insulin-dependent diabetics have no physiological parameters to inhibit insulin action; their sensitivity to the effects of exogenous insulin remains constant during physical exercise. Despite the risk of hypoglycemia, PA is recommended in children with T1D. If measurement confirms hypoglycemia, provide 15 g of a simple carbohydrate, wait 15 minutes and repeat blood glucose measurement.
If blood glucose levels are still below normal range, repeat carbohydrate as necessary. When the child is unable to ingest carbohydrates, however, 1 mg glucagon should be given by intramuscular injection as an emergency measure.
Exercise and sport
The effects of PA on cardiovascular and metabolic risk factors certainly outweigh the adverseness of possible hypoglycemic events. Some studies have indeed proven that regular PA, whether continuous or intermittent, 41 does not increase the risk of hypoglycemia in children and adolescents. The litersture describes two factors as being essential for the prevention of hypoglycemia during PA in children and adolescents. These factors are discussed below. The first precaution before any physical activity should involve carbohydrate CHO replacement, on the basis of pre-exercise blood glucose levels Table 2 , which may signal that exercise should be postponed or even contraindicated.
When PA is not programmed, CHO replacement is the main precaution in avoiding a hypoglycemic episode. In this case, replacement should follow the formula of 1 to 1. Blood glucose levels should always be measured before a carbohydrate is offered. Any changes in insulin dose should be approached cautiously and follow physician recommendations, as many contradictions surround insulin dose reductions, and there is no national or international consensus on the matter.
Reductions in regular insulin dose are warranted when exercise occurs 2 to 3 hours after insulin administration. Conversely, a reduction in preprandial rapid-acting insulin should be prioritized when exercise occurs within 1 hour of administration. When PA occurs in the late afternoon or evening, the dose of rapid-acting insulin administered before the evening meal should be reduced instead. The Brazilian Diabetes Society Sociedade Brasileira de Diabetes, SBD 56 advises a reduction in insulin dose according to the intensity and duration of physical exercise, based on the data reported by Rabasa-Lhoret et al.
Changes in blood glucose during physical exercise vary according to the type and intensity of activity; therefore, we will discuss the effects of both aerobic and anaerobic exercise. Continuous moderate PA is effective in reducing blood glucose in patients with T1D, as it increases skeletal muscle glucose uptake. Furthermore, aerobic exercise increases insulin sensitivity, exacerbating the action of insulin when it is administered prior to PA.
In high-intensity exercise, hypoglycemic episodes are less common than in light-to-moderate continuous activity, 41 as the non-insulin-independent mechanisms of glucose regulation are preserved in people with T1D. Therefore, during vigorous activity, hepatic glucose production will be controlled by catecholamine release. In addition to modulating endocrine functions such as insulin secretion and rate of glycogenolysis, catecholamines epinephrine, norepinephrine, dopamine have excitatory and inhibitory effects on the peripheral nervous system, and act on the central nervous system CNS as well.
In vigorous exercise, the main concern is not post-exercise hypoglycemia, but rather hypoglycemia, as the insulin-mediated regulatory mechanisms are absent. Therefore, extra carbohydrate replacement or insulin dose reduction may exacerbate post-high-intensity exercise hyperglycemia. Intermittent, moderate to vigorous physical activity. Recent studies suggest this is the ideal type of exercise for children and adolescents with T1D. Intermittent vigorous exercise produces a less pronounced decline in blood glucose, as it stimulates hormonal and metabolic responses antagonistic to blood glucose reduction.
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This type of PA raises serum lactate levels, which may contribute to a lesser reduction in blood glucose by antagonizing the action of insulin whether endogenous or exogenous on peripheral glucose reuptake 68 and stimulating glucose production by hepatic gluconeogenesis. Furthermore, the catecholamine spike that occurs in response to intermittent vigorous exercise stimulates hepatic glucose production and simultaneously inhibits insulin-mediated glucose uptake. Not only is aerobic PA indicated in children and adolescents with T1D, but engaging in resistance training two or three times a week is also recommended 33,35 with the objectives of maintaining or increasing muscle strength, increasing energy expenditure, reducing visceral fat, and improving bone density.
According to Andersen, 71 resistance exercises may be an alternative for the training of T1D patients and diabetic patients with lower extremity microvascular complications such as peripheral neuropathy and diabetic foot who are unable to engage in high-impact exercise. Furthermore, only one participant in their study developed hypoglycemia.
On the other hand, Ramalho et al. The countless benefits of regular physical exercise outweigh the risk of hypoglycemia occurring during physical activity. Herbst et al. Indeed, some studies have shown that regular PA, whether continuous or intermittent, 41,66,73 does not increase the risk of hypoglycemia. Were one to follow this line of reasoning, the most indicated types of PA would be those which feature a progressive increase in effort over a prolonged period of physical stimulation.
The chosen activity or sport should also be age-appropriate; sports in early childhood should thus have as their main objectives playing, taking short walks, running, jumping, swimming, turning cartwheels, etc. Between the ages of 6 and 9, competitive activities with flexible rules may be introduced, as may sports such as gymnastics, competitive swimming, cycling, skateboarding, and team sports. From the ages of 10 or 12, sports such as football, swimming, tennis, volleyball, artistic gymnastics, dancing, and water sports may be introduced with a specific focus on competition and the acquisition and betterment of individual abilities.
It must be stressed that moderate aerobic exercise interspersed with periods of high-intensity physical activity is effective in reducing the rate of hypoglycemia, and that sports participation is safe for children and adolescents with type 1 diabetes. However, caution is indicated in following current guidelines on rapid-acting insulin dose reduction, in light of the different types of insulin available on the market.
Furthermore, as few randomized, double-blind, controlled trials have been conducted in the pediatric population, insulin dose adjustments must be personalized and discussed with the patient's endocrinologist. Encouraging T1D patients to take part in recreational or competitive sports, whether individually or as part of a team, plays an essential role in controlling metabolic and lipid profiles and blood pressure, as well as other factors such as well-being, self-esteem, and self-confidence.
This may help reduce the morbidity and mortality associated with the complications of diabetes and, concomitantly, improve quality of life in pediatric T1D patients. Silink M. Childhood diabetes: a global perspective.senjouin-renshu.com/wp-content/72/17-quiero-hackear.php
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Harry Potter. Popular Features. New Releases. Exercise and Sport in Diabetes. Description The new edition of this acclaimed title provides a practical guide to the risks and benefits of undertaking sport and general exercise for patients with diabetes. Fully updated to reflect the progress and understanding in the field, the book features new chapters and material on insulin pump therapy and exercise, physical activity and prevention of type 2 diabetes, dietary advice for exercise and sport in type 1diabetes, and fluid and electrolyte replacement. Other books in this series.
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