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“I have type 2 diabetes and they tell me I brought this disease on myself,” says Marie Carmen, 35. He said he was diagnosed with Type 1 obesity and then “insulin issues came up”. “Well, I don’t know who came first. It is clear to me that the doctor told me that I should start training and change what I eat. “I have no other option,” he admits with some hesitation.
Diabetes is a disease characterized by poor management of glucose metabolism, leading to increased blood glucose levels. Glucose comes from the food we eat and insulin, which is a hormone produced by the pancreas, is responsible for releasing it so that this glucose can be used as a source of energy in the cells, or stored as glycogen. To be. In type 1 diabetes the body does not produce insulin. In type 2 diabetes, the most common, although there is an alteration in the first phase of insulin secretion, the problem lies in tissue resistance to it. That is, cell receptors do not respond to their interaction, causing their physiological function to stop. If this happens, glucose cannot enter the cell and remains stored in the circulation.
Recently published research by Journal Applied Physiology Believe that exercise and inactivity modify beta cell function and risk of type 2 diabetes. This work analyzes the factors that come into play when a person exercises, when he stops doing so and becomes inactive. “Substances that modify pancreatic beta cell secretion respond to changes produced by exercise or a sedentary lifestyle on muscle, liver, intestine, autonomic nervous system, and adrenal cortex. Pancreatic beta cell dysfunction is the first abnormality that occurs at the onset of type 2 diabetes. This study reinforces the need to prioritize actions aimed at increasing permanent physical exercise and avoiding a sedentary lifestyle in this type of patient,” says Dr. Clotilde Vazquez, Endocrinology and Nutrition at the Fundación Jiménez Díaz University Hospital (Madrid). Head of Department.
lifestyle
“There are many causes of type 2 diabetes, but the most common is pancreatic beta cell dysfunction,” explains Vazquez. “It occurs as a result of environmental factors that result in a person having a certain genetic predisposition. In fact, type 2 diabetes has a much greater hereditary component than type 1 diabetes, but it normally develops only when certain other circumstances occur throughout life, such as the passage of time (which we cannot modify). and others. Modifiable factors: Obesity, especially if belly fat is increased due to increased visceral fat, sedentary lifestyle, and poor diet. About 90% of people with type 2 diabetes are overweight or obese. “There you can see the importance that this fat increase plays in the presence of diabetes.”
“I wake up early, I don’t sleep well, I eat out almost every day, and I’m too busy to exercise,” admits Marie Carmen. It is important to start with small steps to tackle a sedentary lifestyle. The meta-analysis acknowledges that “there is strong evidence that regular aerobic exercise alone or in combination with strength training is effective in improving quality of life in adults with type 2 diabetes.” The importance of that lifestyle is prime. “A sedentary person who is overweight and has a poor diet is much more likely to develop type 2 diabetes, while an active person who has a healthy diet is much more likely to be able to defend themselves, even if They may be overweight and have a genetic predisposition. , The three lifestyle factors affect not only additively, but also exponentially. But physical activity and healthy eating are important,” Dr. Vazquez emphasizes.
May the force be with you
In this sense, strength training is important and we must lose the fear of doing it in a supervised way. Organizations like ACSM (American College of Sports Medicine) has included it in its recommendations. High intensity has a greater beneficial effect than low to moderate intensity strength training in terms of normal glucose management and attenuation of insulin levels, something that is already reinforced by meta-analyses such as those published International Journal of Environmental Research and Public Health,
The international organization recommends performing exercises that involve large muscle groups two or three days a week, but never on consecutive days, at 50% to 69% of 1RM (maximum repetitions), or 70% to 85 of 1RM. Strong up to %. “Over the past decade, there have been enormous advances in the knowledge of the specific benefits of strength activity, muscle training, compared to physical activity without resistance. Strength activity improves insulin sensitivity (that is, it reduces insulin resistance), which significantly contributes to lowering blood sugar levels, enhancing thermogenesis, in addition to many other beneficial effects on emotional, cognitive, metabolic. It also improves the functional autonomy of those people. Those who practice it,” comments Dr. Vazquez.
However, these are just some of the reasons why patients like Mary Carmen should start strength training. possibly, This seems strange to you. “Let’s see, I walked a little, but a little. Lifting dumbbells, I can’t see it at all, it makes me a little hesitant, but if you tell me it can help me, I’ll give it a try,” he said before starting his training program. “Doctors have long recommended aerobic activity based on the available knowledge, but currently, the evidence is so strong that it is a priority, and especially in women. But to do this, our patients have to overcome the fear of strength training because strength exercises are still sometimes associated with the risk of injuries, muscle hypertrophy… To overcome this, turn to a strength training specialist. It is very important to go that evaluates the individual, their capabilities, limitations and progressive “Schedule training in a gradual and sustainable manner.” hospital.
From theory to practice
Know the risks of uncontrolled pathology and provide solutions. “Type 2 diabetes immediately increases cardiovascular risk, along with other risks. Heart disease is the leading cause of death in our society, the most common cause of death in women over the age of 50 and the most common cause of death by far in populations with type 2 diabetes,” says Dr. Vazquez. . “Complex mechanisms involving insulin resistance and the metabolic changes that occur when chronically high blood glucose (with a greater prevalence of arterial hypertension, elevated lipids, kidney damage, and neurologic damage) predispose to a greater likelihood of any ischemic cardiac event occurring.” Let us explain. “There is strong evidence for the preventive action of physical activity, fat loss with the Mediterranean diet and appropriate medicinal treatment.”
Keep in mind recommendations from organizations like ACSM.
- Combine consistent aerobic exercise with strength training, preferably at high intensity, under the supervision of a physical activity and sports professional.
- Medical clearance (and exercise testing) is recommended before beginning vigorous activities more than brisk walking for adults with signs or symptoms of stroke, longer duration of diabetes, older age, or other diabetes-related complications.
- If ketone levels are present at moderate or high levels in the blood or urine, people should not begin exercise with a blood sugar >250 mg·dL−1 (13.9 mmol·L−1). Be cautious during training with blood glucose >300 mg·dL−1 (16.7 mmol·L−1) without excess ketones, stay hydrated, and only start when you feel well.
- Individuals are advised to remain adequately hydrated by drinking adequate fluids before, during, and after exercise, as well as to avoid exercising during the peak heat of the day or in direct sunlight to avoid overheating.
- It is especially important for anyone using insulin to carry fast-acting carbohydrate sources during training to treat hypoglycemia and to have glucagon available to treat severe hypoglycemia (if you are at risk of developing it). There is danger).
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