Type II diabetes mellitus is the most common form of diabetes. It is estimated that approximately 898,800 Australians (4.4%) have diabetes based on self-reported data from the 2007-08 National Health Survey.
The 1999-2000 Australian Diabetes, Obesity and Lifestyle study is the most recent national study to measure blood glucose levels to diagnose diabetes. It found that approximately 7.4% of Australians aged 25 years and over had diabetes. Around half the people surveyed were unaware they had diabetes.
It occurs mostly in people aged 50 years and over but, although still uncommon in childhood is becoming increasingly recognized in that group. Australian Institute of Health and Welfare.
The complications associated with diabetes have physical, social and economic consequences. They include hypoglycaemia and hyperglycaemia, both of which can have serious consequences for a person short and long term. Other long term complications of diabetes include retinopathy, cataracts, neuropathy, nephropathy, coronary heart disease and peripheral vascular disease. (Burden 2003).
The number one factor contributing to type 2 diabetes is obesity, followed by increased age, family history and genetics. Indigenous Australians are also high risk as is Maori, Pacific Islanders or people of Asian descent. (New Zealand Guidelines group 2003) (Australian Institute of Health and Welfare).
Diabetes is “a metabolic disorder of multiple aetiology characterised by chronic hyperglycaemia, with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.” (New Zealand guidelines, group, 2003, p.1.)
Type 2 diabetes is characterised by the body’s “resistance” to the usual effects of insulin and/or a decrease in the amount of insulin produced. (Smelter and Bare, 2000).
Lifestyle Modification and Medication
By far the best way to control type 2 diabetes is with lifestyle modifications including a controlled diet and regular exercise without the use of medication in the early stages of the disease. In advanced stages lifestyle modification can reduce the dependence on medication and it is widely accepted that these changes form an integral component of the management of people with type 2 diabetes.
When medication is required there are 5 classes of tablets currently used in Australia for lowering blood glucose levels. They are known as Biguanide, sulphonylureas, thiazolidinediones, meglitinides and alpha glucosidase inhibitors.
1. Biguanides ( Metformin)
They help to lower blood glucose levels by-
-reducing the amount of stored glucose released by the liver.
-slowing the absorption of glucose from the intestine
-helping the body to become more sensitive to insulin so that your own insulin works better.
Side effects can include nausea, diarrhoea, and a metallic taste. To help reduce this the tablets should be taken with or just after a meal.
2. Sulphonylureas (Gliclazide)
-they lower blood glucose levels by stimulating the pancreas to release more insulin.
-they can cause hypoglycaemia so they should be taken before meals to reduce the risk.
3. Thiazolidinediones (glitazones)
They help to lower blood glucose levels by increasing the effect of your own insulin, especially on muscle and fat cells i.e.: they improve insulin resistance
There effect is slow taking days or weeks to begin working. They work well in conjunction with some other diabetes tablets.
A side effect is weight gain. Fat is moved from areas where it is bad for your health (around the abdomen) to other areas, tops of thighs, where you still may not want it but poses less of a health risk. Another side effect is fluid retention which means it should be avoided by people with heart failure.
They lower blood glucose levels by stimulating the pancreas to release more insulin.
They are quick acting and don’t last long so a tablet is taken before each meal. This is good for people who have erratic eating patterns like shift workers.
Side effects can cause hypoglycaemia, gastro upsets and abnormal liver function tests.
5. Alpha glucosidase Inhibitor
They help slow down the digestion and absorption of certain dietary carbohydrates in the stomach.
Side effects include flatulence, bloating and diarrhoea.
Before commencing any exercise program for a person with diabetes they need to be assessed for cardiovascular disease risk factors or other conditions that may poses a health risk. These would include symptoms of shortness of breath, chest pains on exertion, dizziness or light-headness, swelling of ankles and pain in the calves not associated with muscle pain. Other cardiovascular risk factors that need to be assessed include hypertension, cholesterol and lipid profiles resting heart rate, weight, body mass index, waist circumference, family history and previous cardiac history.
The presence of cardiovascular disease and other complications does not preclude a person with diabetes from undertaking an exercise program and in most cases would benefit from such a program.
Other conditions that should be screened for are proliferative and no proliferative retinopathy, peripheral neuropathy, autonomic neuropathy, nephropathy, and microalbuminuria as well as muscularsculoskeletal limitations such as rheumatoid arthritis and other joint problems.
High intensity exercises are contraindicated in people with proliferative and non proliferative retinopathy due to the risk of haemorrhage or people with nephropathy and microalbuminuria. High impact and weight-bearing exercises such as running and jumping are not recommended for people with peripheral neuropathy, arthritis and osteoporosis as they are at greater risk of falls, injuries and foot damage due to poor peripheral sensation.
To develop an individualized program requires assessing their current physical capacity. This will help in tailoring a program that matches the needs of the person. It is important to consider the appropriateness of any exercise program as it needs to accommodate the person physical abilities and limitations. . Therefore any medical or physical concerns will govern the type and intensity of the exercise an individual is capable of performing safely. Lifestyle and socio-economic issues such as motivation, personal goals and preferences, readiness to change and cultural influences will also affect the type of exercise program developed and its implementation. Also the availability and access to services and facilities such as exercise professionals and exercise facilities such as gyms will influence the persons’ compliance to the program.
The strongest predictors of adherence to a person’s long term commitment to an exercise program are the level of support by their physician, family, friends and colleagues. Setting realistic, achievable goals and the persons’ readiness to change and overcome any perceived limitations and obstacles. This cognitive-behavioural approach to program maintenance is a pivotal factor in whether the person will maintain an exercise program for the long term. It is important that that program be tailored towards the individual. Regular monitoring, assessment and goal setting will greatly assist the persons’ ability to achieve long-term behaviour changes. So to will positive re-enforcement such as change in body shape, more energy, weight loss and over all feeling of wellbeing.
There are 2 types of exercise recommended for people with type 2 diabetes but this does not preclude other forms of exercise not mentioned.
Regular aerobic exercise improves blood lipid profiles, blood pressure and resting heart rate, body composition and glycaemic control as well as reducing cholesterol. It also helps in weight loss and is a great mood elevator.
The health benefits, current guidelines recommend that aerobic exercise should be performed for at least 30 minutes at a moderate intensity ; 40-60% of Vo2 max, or 50-70% of maximum heart rate: on most days of the week with no more than 72 hrs between exercise sessions.
It is difficult for someone who has never exercised before to start intensity so an exercise program should initially begin at a level the individual can manage and build on this.
Exercise should be continuous in nature and could include exercise such as walking, swimming, jogging or cycling; however the type of exercise will depend on the persons’ safety and physical activity preference! If they enjoy what they are doing they are more likely to continue exercising.
In the absence of contraindications, people with type 2 diabetes should be encouraged to perform resistance exercise three times a week, targeting all major muscle groups, progressing to three sets of 8-10 reps at a weight that can not be lifted more than 8-10 times. To ensure the exercises are performed correctly, maximising health benefits and minimising risk of injury initial supervision and then periodical re assessment should be carried out.
Exercise can play a major role in prevention and management of diabetes. It can improve glycaemic control, reduce cardiovascular risk and improve a persons’ quality of life. Prescribed correctly and with adequate consideration of the barriers, motivators and medical concerns facing people with diabetes, exercise can be a very effective and safe control strategy.
National Health Australia
Diabetes Australia, Australian Prescriber 2007; 30: 130-3
Diabetesjournels.org, DOC NEWS January 2008vol. 5 no. 11-3
Sports Medicine Australia (Diabetes and Exercise fact sheet)
New Zealand, guidelines, group, 2003, p1.
Smeltzer and Bare, 2000
Medscape Type 2 Diabetes Mellitus, Romesh Khardon. MD< PhD, FACP. Dec 23 2011
Australian Institute of Health and Welfare
Creator of :Changing Your Thoughts, Living Deliberately and Ageless Living.
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