November is National Diabetes Month!
Understanding the Basics of Diabetes
By Judy Hobbisiefken M.S.

Do you understand what Diabetes is? Do you know the difference between type 1 and type 2? Do you know how exercise affects a diabetic person? Chances are with over 10.3 million diagnosed cases of diabetes in the U.S and an estimated 5.4 million more undiagnosed cases, you are going to encounter a diabetic client in your training business (ACSM, 2000). When you do - be prepared!

Diabetes is classified into two main categories. Type 1 diabetes, also called "juvenile onset," is usually associated with insulin deficiency. In these diabetics, the body generally fails to produce enough insulin to supply the body's needs. Type 1 diabetics require insulin therapy to make up for the insulin that they do not produce (Wilmore & Costill, 1999). Type 2 or "adult onset" diabetics make up 90-95% of all diabetic cases and may exhibit a variety of symptoms (ADA, 2000). Some type 2 diabetics may be deficient in insulin, just like a type1diabetic, but other type 2 diabetics may be "insulin resistant."

Insulin resistance is a condition that occurs when the body produces the right amount of insulin, but the cells designed to "accept" insulin in the body have become less sensitive. When the insulin is not accepted it causes problems as if the insulin we not there at all. Insulin's main job is to reduce the glucose circulating in the blood (Wilmore & Costill, 1999). When the body has become resistant to insulin, blood sugar levels rise. For some individuals type 2 diabetes may require insulin therapy, but depending on the seriousness of the disease it can also be treated successfully with diet, exercise, and other pharmaceutical therapies. The good news is the exercise is a modality that can benefit all diabetics.

Physical activity has the same effect on the body as insulin; it lowers blood sugar levels. Exercise can also improve the body's sensitivity to insulin in those diabetics who are insulin resistant. This contributes to lowering blood sugar levels as well. The amount of exercise that will lower blood sugar levels is dependent upon many factors. Generally, obese diabetics experience a decrease in blood sugar levels following mild to moderate activity (approximately 20-30 minutes), but lean diabetics have less predictable responses to the same exercise. Some lean diabetics may experience a reduction in blood glucose levels with exercise, but others may not (ACSM, 2000). This means that you must treat every diabetic as an individual with specific needs.

Another important factor you must consider is that diabetics are at higher risk for many conditions like cardiovascular disease, hypertension, and high cholesterol (ADA, 2000). These conditions, if present, must be responded to with the same individual attention you focus on the previously mentioned blood glucose levels. Special care must be taken when strength training a client with hypertension, just as training heart rate must be closely monitored when a client has cardiovascular disease. These conditions coupled with diabetes require you be responsive to your client's needs.

The best first step in addressing your diabetic client's special needs is to ensure your client has received a comprehensive medical check up prior to beginning training. The severity of the disease will vary from person to person, but many other physical problems associated with diabetes can be serious. A thorough exam includes (ADA, 2000):

• Blood pressure check
  
  
• Blood fat level (cholesterol, triglycerides, etc)
  
  
• Blood sugar evaluation
  
  
• Heart function and circulation
  
  
• Kidney function
  
  
• Eye check
  
  
• Foot check
  

Once your client has been cleared for exercise, you can begin putting together a program. The training regimen should include both strength training and cardiovascular exercise. There are mountains of information available to further your understanding of diabetes and exercise. If you are taking on a client with diabetes, take the time to educate yourself about this increasingly prevalent condition. You will find great information at the following web sites:

American Diabetes Association - www.diabetes.org
International Diabetic Athletes Association - www.diabetes-exercise.org
Joslin Diabetes Center - www.joslin.harvard.edu
National Diabetes Education Initiative - www.ndei.org
National Institutes of Health - www.nih.gov


References

American College of Sports Medicine (2000). Exercise and Type 2 Diabetes: Position Stand Medicine and Science in Sport and Exercise, July 1.

American Diabetes Association (2000). ADA Exercise Information - various web articles.
www.diabetes.org/exercise/info.asp

Wilmore, J.H & Costill, David L. (1999). Physiology of Sport and Exercise. Human Kinetics, Champaign, IL.