EXERCISE FOR DIABETES

“Regularly exercising diabetics can take part in a whole range of sporting activities”

The single most important aspect of treating diabetes is education of the patient. People with diabetes must be their own doctor, dietician and laboratory technician. It’s vital that primary health care teams understand about exercise in relation to diabetes so that they can help diabetics achieve the proven benefits of increased physical activity.

Hypoglycaemia

Hypoglycaemia is a common side effect of insulin therapy, but is less common in patients treated with oral hypoglycaemic agents. It occurs more frequently in patients on long-acting agents such as chlorpropamide and glibenclamide.

Hypoglycaemia is defined biochemically as a blood glucose concentration of less than 2.2 mmol/l, but in practice patients can get symptoms of hypoglycaemia with a blood glucose concentration as high as 4.5 mmol/l.

The effects of hypoglycaemia vary according to the individual but include tremors, sweating, palpitations, blurred vision, pallor, tingling of tips of fingers and/or lips, confusion and coma.

Causes of

hypoglycaemia • Too much insulin or oral hypoglycaemic agents

• Too little food • Delayed meals • Exercise – too much or too strenuous • Alcohol

Appropriate carbohydrate consumption before exercise will prevent most hypoglycaemic attacks. However, recommend that patients carry 10-20g of fast acting carbohydrate eg. glucose tablets, Hypostop gelTM

drink, to use if symptoms begin. This should be followed by a high fibre carbohydrate (eg. a sandwich) for sustained action.

12 SportEX

Dr Nick Webborn is a full-time sports physician and a former GP with a specialist interest in exercise and diabetes. He is a clinical assistant at the sports clinic of the Royal London Hospital, works part-time at Fulham Physiotherapy and is heavily involved in promoting exercise on prescription in Sussex.

Contacts

British Diabetic Sports Association c/o British Diabetic Association 10 Queen Anne Street London, W1M 0BD Tel. 0171 323 1531

Resources

1. Campaigne B.N. & Lampman R.M. Exercise in the clinical management of diabetes. Human Kinetics, USA, 1994

2. Helmrich, S.P., et al., Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. New England Journal of Medicine 1991;325(3):147-52

3. Kohl, H.W., et al., Cardiorespiratory fitness, glycemic status, and mortality risk in men. Diabetes Care 1992;15(2):184-192

, or LucozadeTM

4. Mayer-Davis, E.J., et al., Intensity and amount of physical activity in relation to insulin sensitivity: the Insulin Resistance Atherosclerosis Study Journal of the American Medical Association 1998;279(9):669-74

5. Skinner J.S. Exercise testing and exercise prescription for special cases. 2nd ed. Lea & Febiger, 1993

Checklist One

Use this checklist to alert you to potential pitfalls before giving exercise advice, and to record data for later comparison.

Name: ___________________________ Date: ____________________________ Weight: __________________________ BMI: ____________________________ BP: _____________________________ Current diabetic control: HbA1c ______

Obesity Nephropathy

Peripheral neuropathy Symptoms of IHD

Autonomic neuropathy Peripheral vascular disease Retinopathy

Checklist Two

• Check feet for sensory problems indicated by numbness

• Advise on footwear and inspection after activity – encourage good foot hygiene

• Suggest exercise intensity, duration, type & frequency

• Advise on warning signs of distress or hypoglycaemia and how to respond promptly to symptoms

• Recommend a gradual warm down

• Suggest appropriate drinks or snacks for prolonged activity

• Advise patients with proliferative retinopathy to avoid strenuous and resistive exercise and contact sports.

Yes No Yes No Yes No Yes No Yes No Yes No Yes No

Suggested review date: _____________