Despite the development of new treatment strategies and the improvement of old ones, the incidence of non-insulin dependent diabetes mellitus (NIDDM) has increased world wide in the past decades. Traditionally, the therapy employed by most doctors has been to treat this condition with anti-diabetic drugs, diet modification, and sometimes insulin treatment. Although these therapeutic options do wonders to manage NIDDM, there is a major role to be played by the sports medicine team in the treatment of this potentially debilitating condition.
Diabetes is a metabolic disorder that affects an estimated 16 million Americans. Many of the foods consumed by Americans are metabolized by the body to a sugar called glucose, which we use for energy. In healthy people, the pancreas produces a hormone called insulin that helps get glucose from the blood into the cells of the body. People with diabetes either don’t produce enough insulin or don’t make good use of the insulin that is produced.
Traditionally, two different types of diabetes have been defined: Juvenile diabetes (also knows as type I or insulin dependent diabetes) typically has its onset in children, has vague risk factors, and is caused by autoimmune, genetic and environmental factors. Juvenile diabetes accounts for approximately 5-10 percent of all diagnosed cases of diabetes, according to the Centers for Disease Control.
NIDDM (also known as adult onset or type II diabetes) usually has its onset at a later age than type I. The risk factors for NIDDM are more identifiable and include obesity, older age, physical inactivity, family history of diabetes, and race/ethnicity. This form of diabetes accounts for about 90-95 percent of all cases of diabetes. Many people who have this form of diabetes are unaware of their condition.
Lets first examine how physical activity can help to prevent the onset of NIDDM. Regular exercise can reduce or eliminate many of the risk factors associated with the disorder. Obviously, exercise eliminates the physical inactivity risk factor. If done correctly and with diet modification, exercise can reduce obesity as well. If you have a family history of diabetes or are otherwise at risk for developing NIDDM, you should talk with your doctor about an exercise program that can help reduce your chances of developing the disease. Exercise can be used in the treatment of NIDDM as well as the prevention.
In healthy people, a bout of moderately intense exercise does little to blood glucose levels. However, in the NIDDM patient, exercise can directly reduce the level of blood glucose. The glucose reduction can last well into the post exercise period. This strategy should be used carefully and with your physician’s approval. Glucose enters cells via a transporter known as GLUT4. Higher levels of the transporter correlate with more glucose entry into cells. Fit people have higher levels of GLUT4 transporter than people who are untrained. This is not an immediate effect of exercise. Rather, increases in the number of GLUT4 transporters are seen over time in exercise-trained individuals.
Physical activity can also increase insulin sensitivity. The more sensitive to insulin cells are, the better the chances of proper glucose utilization. Several studies have shown that patients with NIDDM who participate in regular exercise show better overall metabolic control, including insulin sensitivity.
Many of the chronic problems associated with diabetes can be helped with exercise as well. Poor circulation is often a problem in patients with NIDDM. Aerobic exercise serves to increase the peripheral circulation and improve blood delivery to many tissues. Moderate to heavy aerobic exercise also has the effect of reducing the incidence of heart attack, which can be fairly common in diabetics.
Although habitual exercise has the potential to be quite beneficial in the prevention of type II diabetes, it is not a panacea. A healthy lifestyle including exercise, proper diet and nutrition, reducing stress and not smoking cigarettes is necessary to help prevent NIDDM. It is necessary to do everything possible to control the preventable risk factors since there is little anyone can do about the genetic and environmental contributions. Treatment of existing diabetes must be coordinated by your personal physician. An exercise regimen may be incorporated into a treatment strategy along with diet modification, weight reduction and medication in some cases.
If you have diabetes (either type) or have any other health problems, you must consult your physician prior to beginning an exercise program. Diabetics have special considerations such as food, heart, and metabolic problems, which must be carefully considered before starting a workout plan. Also, certain conditions or medications may preclude you from some exercise routines. For example, people with uncontrolled high blood pressure may not be suitable candidates for a weight-training program.
