Type 2 diabetes

WHAT IS TYPE 2 DIABETES?

Diabetes mellitus (DM) is a chronic condition where the body’s regulation of blood glucose is altered. After meals, carbohydrates are broken down into glucose which gets absorbed from the bloodstream via insulin and gets turned into energy. When there is insufficient insulin or the body no longer responds to insulin, glucose stays in the bloodstream and cannot be utilized by the body to produce energy.

Type 2 DM is the most common type of diabetes where the body becomes less responsive to insulin over time. It is more likely to occur in individuals who are overweight. Although it can affect both adults and children, the risk for Type 2 DM is higher in those over 40. Other risk factors include having high triglycerides or low levels of good cholesterol, high blood pressure, and a family history of diabetes.

Type 2 DM is usually managed with lifestyle interventions including diet and exercise. Sometimes, insulin supplementation is necessary to control blood glucose levels. If not well managed, diabetes can increase the risk for heart disease, kidney disease, and stroke. Diabetic retinopathy and peripheral neuropathy are other complications where the nerves in the eyes and hands/feet are affected. These complications respectively cause vision changes and predispose to having wounds which heal with difficulty.

 

IS DIABETES PREVENTABLE?

Yes! Physical activity is one of the best things you can do to prevent Type 2 DM by:

  • Helping to control your weight: a 5% reduction in body weight will reduce your risk of progression towards Type 2 DM by 60% (2018 Diabetes Clinical Practice Guidelines)
  • Increasing your muscle mass, thus increasing your ability to store and utilize glucose

In short, exercise will slow down the process of developing diabetes whereas inactivity will accelerate this process.

 

HOW PHYSIOTHERAPY CAN HELP

The goal of Type 2 DM management is to maintain stable glucose levels in your blood to prevent the secondary complications described above triggered by chronically high glucose levels. There are several ways to control glucose levels, including the prescription of insulin, diet modification, and a regular exercise program.

Physiotherapists are experts in mobility and exercise, especially when it comes to exercising with a chronic illness. Physiotherapy can help you find the dose of exercise that is right for you to manage your diabetes. In diabetes, moderate and vigorous intensity aerobic exercise, such as brisk walking, jogging, and swimming, has an “insulin-like effect”, and over time, exercise can improve your sensitivity to insulin. At the right dose, physical activity can replace use of insulin, or reduce the amount of insulin required to maintain appropriate glucose levels. Resistance training is also recommended to build and maintain strength for daily activities and improve your ability to store glucose.

Due to the complexity of diabetes and the various conditions that can co-exist with diabetes, it is recommended to seek out a physiotherapist to develop a safe and effective exercise program that is tailored to you. For example, exercise testing may be required if you have cardiovascular disease as well as diabetes. You should also consult with your family doctor or nurse practitioner to ensure your glucose levels are adequately controlled prior to starting any exercise program.

 

GENERAL EXERCISE PRECAUTIONS FOR TYPE 2 DM

Because exercise has an insulin-like effect (i.e., lowering your blood sugar levels), hypoglycemia can develop soon or many hours after exercise. Symptoms can include:

  • Sweating
  • Shaking
  • Nausea and vomiting
  • Losing consciousness
  • Confusion

The best way to avoid exercise-induced hypoglycemia is to check your glucose levels prior to starting exercise (should be >5.5mmol/L), and to inject insulin more than 1 hour prior to exercise in a non-exercising area such as the abdomen. It is also recommended to have a snack with you in case you begin to experience any of the symptoms listed above.  Speak with your physiotherapist to help you find the exercise routine that is right for you.

 

SOME TIPS TO BE CONSISTENT WITH YOUR EXERCISE ROUTINE

Being consistent with exercise can be challenging and requires some planning. However, there are some strategies you can use to improve your chances of being consistent with exercise:

  • Set specific physical goals. Here are some ideas:
  1. Sign up for a charity walk or run with a friend and train for it together
  2. Find an exercise group nearby and commit to regular attendance
  3. Plan a hike for in a few months from now and train for it
  • Anticipate likely barriers to physical activity and plan for how you will overcome them:
  1. Weather – if you are planning to exercise outdoors, what is your plan B if the weather is bad? Some people like to walk in malls when the weather is poor
  2. Having an off-day – how are you going to motivate yourself when you do not feel like exercising? Having a fitness buddy who you can regularly check up with is a great way to create accountability
  • Start small and slowly progress

 

Diabetes Canada Clinical Practice Guidelines

 

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