- Key Diabetes Facts
- Diabetes Pathology (Type 1, Type 2, Gestational Diabetes)
- What are the main causes of diabetes?
- How is Type 2 Diabetes diagnosed?
- Common misconceptions
- What treatment options are there to help manage and improve diabetes?
- The best type of exercise to do for diabetes
- Realistic lifelong management
- The latest research on diabetes
Key Diabetes Facts
Diabetes. It’s a word that when heard, has some bad associations, and can also be a little scary when you are hearing it for the first time as a diagnosis. The negative associations that come with diabetes (being unfit, lazy, overweight, not taking care of yourself), don’t help matters, and as much as there is a lot of information out there that can help you manage this health condition, it can all be a little overwhelming.
If you have just been diagnosed with some form of diabetes (there are three types, but we’ll get into those differences in the next section), the main thing to remember is, don’t panic! As much as diabetes is increasing in our society (Type 2 diabetes affects 1 in 11 Australian adults), with more diagnosis’ comes more information, and more ways to help those who have it.
Now, there are some key facts and information that people who are living with diabetes have to be aware of. As I said above, it is a health condition, and like all health conditions, if it isn’t managed well, then it can have very serious effects on your overall health and well-being. But take these key message out of the information written below;
- Diabetes Mellitus is just a way of saying the type of disorder that occurs when someone has diabetes.
- Mellitus refers to the inability to metabolise carbohydrates properly.
- When you hear ‘diabetes mellitus’, it is the same as ‘diabetes’.
- A diabetes diagnosis doesn’t have to be as scary as it might seem.
- There is help out there that you can access.
- Feeling overwhelmed is ok!
- Changing small things in your life can add up to big things when it comes to your health.
Getting through the scary stuff
Ok, here are the hard truths. Diabetes can have detrimental effects on your health. 30% of people don’t know they have diabetes because everything feels ok, so they never ask to get tested for it.
Below, you’ll find some statistics regarding type 1, type 2 and gestational diabetes. These aren’t put here to scare you, but to just make you aware that if you leave your diabetes left unchecked, there are consequences to your well-being.
Type 1 Diabetes (sometimes formerly known as Juvenile Diabetes)
- There is no preventative.
- Diagnosed mainly in young children and adolescents (although can occur at any age).
- One of the most chronic childhood health conditions.
- Symptoms tend to appear suddenly.
- Can carry complications such as stroke and kidney disease.
Type 2 Diabetes
- Having type 2 diabetes increases your risk of having a cardiovascular event by up to 4 times.
- Usually develops in adults over the age of 45 years, but is increasingly occurring in younger age groups including children, adolescents and young adults.
- Is more likely in people with a family history of type 2 diabetes.
- For some the first sign may be a complication of diabetes such as a heart attack, vision problems or a foot ulcer.
- Over 100,000 Australian adults develop diabetes each year.
- More than 1.2 million Australians are currently diagnosed with diabetes. Including undiagnosed Australians, it is estimated that about 1.7 million people in Australia have diabetes.
- An estimated 2–3 million Australians have pre-diabetes and are at high risk of developing type 2 diabetes.
- Each year, around 20, 000 women will be diagnosed with gestational diabetes.
- Usually diagnosed in the 24-28th week of pregnancy.
- Between 5%-8% of pregnant women will develop gestational diabetes.
- Usually disappears once the baby has been born.
- Women who have had gestational diabetes are more likely to have type 2 diabetes later in life.
Diabetes Pathology. What is actually happening inside your body? Signs and symptoms
Before we break down the different forms of diabetes, it is important to know the process that diabetes disrupts, in order to understand why some people feel the way they do, to show why signs and symptoms can vary for people, and how management and medication can be vastly different from one person living with diabetes to another.
So what is happening in my body?
When your body breaks food down, it breaks some foods down into a sugar called glucose. For the sake of this report, anytime I mention glucose, I want you to think of sugar. What does sugar do when you give it to your kids before bed? Makes them hyper!! That’s because their little bodies turn that sugar into glucose, to give them all that energy.
Now, once glucose has been made, it floats around in our blood stream waiting to be used by our cells as energy. The problem is, without a hormone called insulin, the glucose can’t enter our cells to be used. The body can store excess glucose that we don’t use, but our storage containers are only small and are limited to how much they can carry.
Think of glucose as someone waiting to cross a road at a red light. Across the road (cell wall) is an important job that this person needs to complete, but they can’t get there without first crossing the road. While the light stays red, more and more people stand waiting to cross to get to this important job. A sensor (the brain) near the traffic light senses that more people need to cross, and so sends a signal (insulin) for the light to turn from red to green (cell responding to insulin and allowing glucose to enter). This allows everyone (glucose) to cross the road to the other side and complete their important job. Once the job is complete, the light turns red again (stop producing insulin), and the process will occur again when a new important job is needed to be completed.
If everything works the way it should, our blood should never carry a lot of glucose in it, and the pancreas should produce insulin only when needed, and then stop producing it when not needed.
Type 1 Diabetes
What causes type 1 diabetes?
Type 1 diabetes is an auto-immune condition in which the bodies immune system is triggered to attack and destroy the cells in the pancreas that produce insulin. To this day, there has been no further information as to why this occurs. It cannot be linked to any modifiable health factors (diet, exercise etc.) and unfortunately has no cure. Once a diagnosis has been made, management and medication becomes the only way to control this condition.
Going back to our example and relating it to type 1 diabetes
We have people (glucose) waiting to cross the road. The sensor (brain) detects that there are quite a few people waiting to get across. It sends a signal (insulin) for the light to turn green to allow these people to cross, however, the system put in place to stop the lights failing (immune system) has detected an issue in the signal function (insulin) and completely destroyed it. The light will unfortunately never turn green, without help from some outside source.
Signs and Symptoms
As mentioned above, symptoms can come about abruptly and for some, no symptoms will be present when a diagnosis is made. You’ll find the signs and symptoms of type 1, type 2 and gestational diabetes fairly similar, and this is because they all affect the same process in the body, but in different ways.
- Being excessively thirsty
- Passing more urine
- Feeling tired and lethargic
- Always feeling hungry
- Having cuts that heal slowly
- Itching, skin infections
- Blurred vision
- Unexplained weight loss
- Mood swings
- Feeling dizzy
- Leg cramps
Type 2 Diabetes
What causes type 2 diabetes?
Type 2 Diabetes is a progressive condition and can occur two ways.
It occurs when the cells of the pancreas can still make insulin, but cannot produce enough to get enough glucose to crossover into the cells. Eventually, the pancreas can stop making insulin altogether.
Remember our crossing the road example?
So, imagine that over time, as most things do, the signal response (insulin) starts to become weaker and weaker. For years the sensor (brain) has been sending this signal (insulin) to the light (cell responding to insulin)telling the light to go from red to green (insulin) and now the signal from the sensor to the light is not as strong as it once was. Sometimes the light won’t turn green until enough signals are sent to make it change, causing lots and lots and lots of people (glucose) to be standing on the side of the road, waiting to cross. Eventually, without maintenance, the light cannot detect any signal at all, meaning the red light cannot change to green without some help. This causes a lot of people to be waiting, and they really want to get across.
This occurs when the cells ignore the signal sent out by insulin to transport glucose from the blood into the cell to be used as energy. You are more at risk of insulin resistance if you are overweight, smoke or have poor sleep patterns and habits.
Back to the example!
So we have people (glucose) waiting to cross the road. The sensor (brain) detects this and sends a signal to the light to turn green. The light understands that it needs to turn green and tries it’s hardest, but some reason, the light doesn’t want to turn red. The sensor keeps sensing more and more signals (insulin).
Signs and Symptoms
Many people with type 2 diabetes won’t have symptoms. As type 2 diabetes is often diagnosed later in life, symptoms are misinterpreted as “a normal part of ageing”. That is why it is so important to get tested regularly, even if you think you are in good health. Once you hit 45 years of age, it is important to have a blood test every 2 years to check.
- Excessive thirst
- Increased frequency of urination
- Cuts and wounds that heal slowly
- Blurred vision
- Mood swings
- Previous gestational diabetes
Gestational diabetes is a type of diabetes that occurs during pregnancy. It is important to know that in most cases, gestational diabetes goes away after the baby is born. However, it does increase the risk of developing type 2 diabetes later in life.
What causes gestational diabetes?
During pregnancy, the placenta produces hormones to help the baby develop and grow. These hormones block the action of the mothers’ insulin causing insulin resistance. As the pregnancy progresses and the baby grows bigger, the mother has to produce more insulin to regulate the amount of sugar in her blood stream.
It’s been shown that later on in the pregnancy, the amount of insulin required to keep blood glucose at a normal level is 2-3 times higher than usual. Now that’s a lot of insulin to be producing! And if the mother isn’t able to produce enough, then the amount of glucose (sugar) in the blood stream will increase, leading to the diagnosis.
Signs and Symptoms
It is common not to have symptoms. If symptoms do occur, it may include
- Excessive thirst
- Increased frequency of urination
Diabetes Advice: An educational conversation with Kirrily Chambers, a Credentialled Diabetes Educator in the Adelaide Hills.
Kirrily answers questions about the 3 different forms of diabetes, what actually causes diabetes, and the symptoms that are most common.
Then Kirrily summarises the latest advice and tips that will help you better manage your diabetes.
Causes of diabetes
Some people might be asking themselves, why has this happened to me? It’s a valid question. Knowing the causes of diabetes once you already have it may not seem important, but it is important to know that the causes are also factors that can make your diabetes worse, if not managed well.
Below, you’ll find the main causes for each type of diabetes. But don’t fret, in the lower sections, we’ll give you the best advice on how to reduce your risk of diabetes, and also improve the management of your diabetes.
Type 1 Diabetes
It’s a lonely list, as they don’t really know the cause of why type 1 diabetes occurs. It has been linked strongly to genetic factors and family history. If you have type 1 diabetes, chances are you couldn’t do much prior to reduce your risk, unless you changed your DNA!
Type 2 Diabetes
The cause of Type 2 Diabetes is unknown, however, factors that increase the risk of developing the condition are largely lifestyle related. People are at higher risk of developing Type 2 Diabetes if they:
- Have a family history of Type 2 Diabetes
- Being over the age of 45
- Have high blood pressure
- Are overweight or obese
- Have low levels of physical activity
- Poor diet
- Smoke or have a history of smoking
- Have a history of gestational diabetes
- Are pre-diabetic
- Have had a cardiovascular event such as heart attack or stroke
There are some risk factors associated with a chance of developing gestational diabetes. If you are a little worried about this, my advice is to seek help from a health professional regarding information on how you can reduce your risk if trying to get pregnant, or are in the early stages.
- being over 40 years of age
- a family history of type 2 diabetes
- being overweight or obese
- being of Aboriginal and Torres Strait Islander descent
- previous gestational diabetes
- some antipsychotic or steroid medications
- previous baby with a birth weight greater than 4.5 kg
- previous complicated pregnancy
- polycystic ovarian syndrome
How is Diabetes Diagnosed?
It is important to reiterate that some people can have no symptoms that they have diabetes at all. Some people can have diabetes without realising for years before a diagnosis is made. As scary as a diagnosis can be, the long and short of it is, that if you have diabetes, you have it whether it is diagnosed or not. So, the sooner you get clarification, the sooner you can get on top of your management.
But how is it diagnosed?
The simple answer is a blood test. This can be taken as a fasting blood test (no fluid or food except water for 8 hrs) or an Oral Glucose Tolerance Test (OGTT).
For the OGTT, you are required to fast for 8 hours, in which a fasting blood test is taken. You are then required to ingest a gel type substance that is very high is glucose (sugar). Another blood sample is then taken, showing the response that your body has to ingesting that sugary substance.
Your GP will indicate which blood test you need.
A diagnosis is then made when one or more of the following occurs;
- Symptoms are present and fasting blood test result is at or above 7.0mmol/L or a random blood test result is at or above 11.1mmol/L
- HbA1c blood test result is at or above 6.5% (48 mmol/mol)
- There have been no symptoms and two abnormal blood glucose tests (as above) on separate days.
Understanding what the numbers mean
There are a few clinic words in the above diagnosis, so read below for an explanation of what it means, and what you need to focus on.
Mmol/L – this is a unit of measure, such as centre mitres (cm) or kilograms (kg). Being above 7 mmol/L means that your body cannot process the glucose in your blood stream as effectively as it should. The higher the number, the higher the risk there is of further impacts on your health.
HbA1c – this is another unit of measure. Essentially, the red blood cells you have in your body last for around 3 months before they die off. During this time, when glucose enters your blood stream, it connects onto the red blood cells to get transported around the body.
Now, a blood test is taken every 3 months, and essentially the lab looks at how much sugar is on your red blood cells (older red blood cells will hold more sugar, younger red blood cells will hold less sugar). An average is then taken from all of your red blood cells, and spits out as a percentage. 6.5% is the cut off number for measuring how effectively your body is at getting rid of glucose in your blood stream. Because the higher the percentage, the higher amount of glucose you have on your red blood cells, and over 3 months, they can dictate that you have more glucose in your blood stream over this period than a person without diabetes.
Common Misconceptions of Diabetes
Myth’s and Reality. All you have to do is use Dr Google, type in “Type 2 Diabetes” and the amount of information that pops up is overwhelming!
You can thank me later, but I’ve brought all the information that you need to know and the stuff you can discard right here, and am presenting it to you in the easiest form.
Before reading on though, remember, listen to your health professionals! GP’s, diabetes educators, exercise physiologists, podiatrists, chemists, pharmacists, nurses….. we all know our stuff! We aren’t telling you things because they don’t matter. You might not want to hear what we have to say all the time, I get it, but the more you actively go against our advice, the less likely you are to know the best management processes for your diabetes.
See below for a table of common Myth’s and then some Reality to these Myth’s regarding type 1, type 2 and gestational diabetes.
|Diabetes isn’t that serious.||Sorry everyone, but it is an incurable health condition with serious effects on your health. Time to start taking your health seriously!|
|Being overweight or obese automatically means you will develop Type 2 Diabetes Mellitus.||Sure, being overweight or obese isn’t the best option for your health, but this doesn’t necessarily mean you will get diabetes. However it is a risk factor, and those who are overweight or obese are more likely to be diagnosed than those who aren’t.|
|Eating too much sugar means you will develop diabetes.||Again, sugar is not very good for you, and I would not recommend to anyone to just eat as much sugar as they want. But developing diabetes is a combination of lifestyle and genetic factors and develops over time.|
|People living with diabetes can’t eat sugar or carbohydrates.||Sugar is a carbohydrate. Did you know that all carbohydrates break down into sugar? And we need sugar to create glucose, in order to have energy to survive! Not eating carbohydrates means you eat no vegetables, salad, fruit or bread. You try making a meal without carbohydrates.|
|Eating lots of fruit is a healthy option.||Fruit is a great option for a healthy snack. But fruit has quite a bit of sugar in it. So having anymore than the recommended 2 pieces of fruit per day will increase your sugar intake sizeably.|
|Taking medication for diabetes means you don’t need to worry about diet or exercise as management tools.||Some medications really do help to control your blood glucose levels (BGL’s). However, it is still very important to make changes to your health. Diabetes is a progressive disease and needs a lot of maintenance, so changing your lifestyle to a healthier one can only have up-side!|
|Diabetes is curable.||I would love to say that is it, but unfortunately, once you have a diagnosis, diabetes is here to stay (unless you have gestational diabetes). The goal from you and your GP should be to make your diabetes as manageable as possible so that your body stays under the 6.5-7% HbA1c 3 month blood test, and BGL’s stay around 6.5-7mmol/mol.|
|I don’t have to look at my blood glucose levels (BGL’s).||Some people are required to use injectable insulin to manage their diabetes (Type 1 and progressive Type 2 diabetes patients). When this occurs, it is vital to take your BGL’s systematically throughout the day to check them. BGL’s can change variably throughout the day, and can alter as you age. It is very important to take your BGL’s approximately 2 hours after eating a meal in order to know how your body has reacted and metabolised what you have eaten. This is a great way of knowing which meals are the best for your body to stay within a ‘normal’ BGL and which meals put your BGL’s higher, meaning you should only have these occasionally.|
|Once you’ve had one health complication from diabetes, you can’t get it again.||Diabetes is a progressive disease that affects your blood. Your blood then affects most things in your body, as most of everything in our body needs blood to survive! One complication with your heart, or with losing feeling in your fingers/toes can lead to more, higher risk complications. This is why it is so important to keep healthy while managing your diabetes.|
Treatment options for managing Diabetes
So, you’ve been diagnosed with diabetes. What now?
The first thing that will be determined by your GP is the type of diabetes you have, and then, based on the blood tests and the results from them, how you should best manage this.
Type 1 Diabetes Mellitus
For those diagnosed with Type 1 Diabetes, it is usually straight onto talking about insulin. As those with Type 1 Diabetes can’t produce their own, they need to inject, or have an insulin pump inserted, to manage their glucose levels. Not having the appropriate amount of insulin in the body can have very large health complications, and these can occur very quickly.
There are a few types of insulin (which I will talk about later in this section), that are administered one of two ways.
Injecting insulin can be administered into the;
- The top and outer part of the thigh [10cm from the fold in the hip and 10cm from the knee]
- Into the fatty part at the back of your arm
- Your buttock
This needs to be done multiple times throughout the day (usually before or after a meal). It is quite important to monitor your BGL’s when using insulin, as the amount of insulin injected can have large effects on your BGL’s.
People living with Type 1 Diabetes may also be eligible to have an insulin pump inserted (ask your GP, as this is not the case for everyone). The insulin pump is a small, battery operated device, approximately the size of a small phone. It is worn on the outside of the body 24hrs/day, and connects into a tube that has a fine needle attached to it. This needle sits just underneath the skin, and can stay there for 2-3 days before being replaced. The insulin pump holds a small amount of insulin that is programmed to pump into the body after a meal is ingested. This mirrors the function of the pancreas, and then throughout the day, slowly releases a small amount of insulin steadily into the body. It is important to know that a pump is just another way of getting insulin into the body, and provides a bit more freedom than having to inject throughout the day.
A person living with Type 1 Diabetes will have to use insulin for the rest of their life, and so a clear management plan is needed with regular updates with health professionals. This is true for both types of management.
Type 2 Diabetes Mellitus
For those diagnosed with Type 2 Diabetes, the management plan will differ greatly from person to person. The results from your blood tests will determine quite a bit of your management plan.
One certainty for management however, no matter the stage of Type 2 Diabetes, is a diet and exercise plan.
You’ve had a blood test, and the GP says you have “pre-diabetes” This is just a term used for those who test results aren’t high enough for a diagnosis of Type 2 Diabetes to take place, but high enough that they are no longer in the “normal” range.
What does this mean for me?
Simple, you need to change something in your life. Your Dr will usually give you 3-6 months of trying to reduce the levels of your blood test before seeking further help. They may send you to a dietician or an exercise physiologist to talk about what you are eating, or your physical activity levels. Changing one of these factors may be enough to get your levels down so you are no longer pre-diabetic. But know that a diagnosis of “pre-diabetes” is the pre-cursor for Type 2 Diabetes. Any change you make to your lifestyle and health must stay in place. Eating healthy and exercising for 3-6 months to get the levels down, then reverting back to old ways, will only prolong what may be coming.
I like to view a diagnosis of pre-diabetes similarly to “Who Wants to be a Millionaire”. This is your phone a friend lifeline. You have an idea that you should do something about your health, and the GP has now given you the reason to start. You can do one of two things. Listen to your lifeline, or stay the course. Staying the course means a possibility that you will have Type 2 Diabetes within a year, whereas listening to your lifeline could mean you don’t have a diagnosis at all.
The choice is clear, listen to your lifeline and win the million dollars.
Diagnosis of Type 2 Diabetes
Some people don’t get the opportunity to change before a diagnosis is made. Unfortunately, this is the case for a lot of Type 2 Diabetics, as the estimate is that 30% of people with Type 2 Diabetes don’t even know they have it yet.
So the question still remains, what can I do?
Most people already know what things they might need to start cutting back on or changing in their diet’s to improve it. The real test is gaining to motivation to do this over a long period of time. One quote that I tend to stick with is this;
‘One healthy meal won’t make you skinny, just like one unhealthy meal won’t make you fat.’
Consistency is the key, and the easiest place to start is by reducing the sizes of your meals, or changing a few ‘unhealthy’ food choices a week into ‘healthier’ food choices.
There are barriers that can make changing your eating habits quite tough to do. A dietician can talk to you about what these are, and give you more ideas on how to get around them. However the best piece of advice is this;
Keep it simple.
If you are looking to change your food choices, start small, then get bigger. Cut out the things you know you won’t miss that much, and replace them with healthier, but safe options. If you know you like carrots, but hate cucumber, then have carrot in your sandwich but not cucumber! Start with enjoyable, healthier options, and the rest will follow.
Exercise is the most inexpensive, easily accessible option for improving your lifestyle that there is. It costs you nothing to get outside and go for a walk, or even jog if you are able. Putting some household items into a non-perishable shopping bag instantly transforms into a weight you can lift for different types of exercise. Fill some old 2L milk bottles up with dirt from your garden, and you have 2 x 4kg weights.
Exercise has an insulin type effect on your body. Exercise can make your cells more permeable, meaning it is easier for glucose to pass from the blood stream into the cell in order to be used as energy. This actively lowers your BGL’s, and can keep them lower, even after finishing exercising.
Now in the following section, “The best type of exercise to complete for your diabetes”, I will explain more to do with what type of exercise to complete for diabetes. But, it is important to just get started. Below are some simple tips to get you going;
- If you sit for 8 hours of the day, try to only sit for 6 hours.
- If you can’t change what you do at work then actively get out of the house when you get home.
- Go for a walk, potter around in the garden, go play with the dog outside if you don’t want to walk them.
- Just being on your feet makes your body have to work harder, increasing metabolism and promoting weight loss.
- Lots of short walks add up to big walks.
- Moving arms and legs helps to promote increased metabolism.
- Everyone can have a few aches and pains. If pain is stopping you from exercising, see an Exercise Physiologist who can tailor a program to suit your needs.
Let’s get started together.
There are medications that your GP may start you on to help manage your diabetes. I am no pharmacist or chemist, so find below a table summary sheet of some types of diabetes medication you may be on.
If you want more information on what these do specifically, ask your GP, diabetes educator or pharmacist.
For those that need to start taking insulin, you are required to talk with a diabetes educator to discuss how to administer, the levels and types of insulin you need to administer, and other things, such as storage and times to take this.
There are essentially two types of insulin, short-acting and long-acting. Usually a combination of these two types of insulin are needed for diabetes management. It is essential that you talk with your health professional to discuss this further.
Here are a few tips to help manage and improve your diabetes;
- Monitor your BGL’s 2 hours after your meal. This allows enough time for the body to process the food and have any glucose transported throughout the blood to enter the cells. If you find your readings are consistently high (above 10), then you may need to see a dietician or diabetes educator for more information on how to lower this.
- Take your BGL’s before and after exercise. Exercise has an insulin type effect on the body, meaning that your BGL’s should reduce after a bout of exercise, and will continue to decrease once you’ve finished. For this reason, we need to know if your BGL’s are too low, or even too high. By knowing an average figure of how much your BGL’s will drop from exercise, this will allow you to schedule appropriate meals either before/after exercise, without having to reach for high sugar substitutes to temporarily raise BGL’s.
- Start Walking. Reducing fat mass in the body is very important in controlling your BGL’s. Reducing your fat mass reduces insulin resistance which means your BGL’s on average should lower. Walking has been shown to be one of the best ways to lose fat mass, and is a great way to get your body introduced to more activity.
- Get Strong. Resistance training is vitally important in managing type 2 diabetes. High BGL’s occur when there isn’t enough energy in the cells to be used. Muscle cells use a lot of energy, as they are responsible for our movement. The larger and denser our muscles are, the more energy is stored in the muscle itself. This allows us to draw on glucose within the muscle first, reducing glucose levels in the blood stream.
- Take your medication. Whether you are on tablets, insulin or diet controlled, you must take all medication recommended by the doctor/diabetes educator. If you feel that your BGL’s are higher or lower due to your medication, make an appointment to see your GP or diabetes educator as soon as possible. Each person with type 2 diabetes has different blood glucose control and must be on a specific plan for them.
- Don’t become too afraid about what you eat. Speaking with a dietician or diabetes educator will give you the best information about what you should be eating. But don’t get to obsessed about what goes into your body. You are still able to go out with friends for coffee and a slice of cake every now and then. You just need to know how your body will respond to that food and how to manage the higher BGL’s you may have after. ‘One bad meal doesn’t make you unhealthy, just like one good meal doesn’t make you healthy.’
- Speak with your friends about your diabetes and educate/talk with as many people as you can. Information is power with any chronic condition. And there are ideologies about type 2 diabetes that people unknowingly project onto those people living with the condition that can be negative. Educating your friends about diabetes and what you need from them is very important. Speaking with other people living with type 2 diabetes can also help if you are feeling alone in managing the condition.
What are the best exercises to do for diabetes management?
One of the first things you’ll be told from a Dr after a diabetes diagnosis is to start engaging in more physical activity.
Exercise has a number of positive affects on the bodies ability to metabolise glucose, meaning there will be less glucose in your blood stream.
Now, while exercise can’t reverse the damage done to insulin producing cells in the pancreas or blood vessels that may have been damaged from the large glucose molecules that may in your blood, it can improve the way your body responds to insulin and glucose. It does this by;
- Increase the efficiency of cells to uptake glucose.
- Improves the response of cells to insulin.
- Effectively stores glucose in the muscle, rather than the liver, meaing it can by-pass the blood to be used as energy.
- Exercise affects can last for some hours following exercise, which is why it’s important to exercise regularly.
- The more consistently you exercise, the more these effects have longer term use.
It’s recommended that when you first start an exercise program that it’s supervised by an Exercise Physiologist. They can write a program that is most appropriate for you and monitor your blood glucose levels response to exercise. This helps keep your blood glucose levels in a safe range.
However, the best thing you can start doing straight off the bat is to start walking, or go for more walks throughout the week.
Most people should be exercising for 30 mins, five times each week at a moderate intensity. This is the daily activity guideline set out for everybody, not just those living with diabetes. But less than 50% of people Australia wide actually complete and maintain the recommended daily activity level for a week.
Now we all know that as we get older, more health barriers may crop up that stop us from completing the activity that we may desire to do. A sore knee joint because of arthritis might mean you can’t walk for 30 mins. A previous heart condition might mean that any exercise makes you very breathless after only 5 minutes. That is why it is important to chat with an Exercise Physiologist to further discuss these issues. There are thousands and thousands of exercises out there, so no matter your health issue, I guarantee that we can find a few that you can do safely and without pain.
Did you Know?
People with type 2 diabetes can receive Medicare rebates for group exercise services provided by Exercise Physiologists, on referral from a GP.
The referral includes an initial one on one assessment followed by 8 supervised group sessions. At myPhysioSA each participant is given an individualised exercise program they can complete at their own pace. An Exercise Physiologist is always in the gym to give help when needed. This can be a great way to get started with an exercise plan under professional supervision!
Get advice on Type 2 Diabetes and find out how much exercise can help.
Stephen, an Exercise Physiologist, at myPhysioSA explains in simple terms why exercise is so important in helping to manage your Diabetes, and outlines the different exercise options you can start right away.
Type 2 diabetes affects 1 in 11 adults and is increasing.
Alarmingly up to 30% of people don’t know they have diabetes and have never been tested by their GP for it.
Having Type 2 diabetes increases your risk of having a cardiovascular event by up to 4 times.
Increasing your physical activity and exercising are key to managing diabetes.
Introducing the myPhysioSA Diabetes program
Get and keep your diabetes well managed. Stephen, one of our Exercise Physiologist’s, chats about our Diabetes program that runs at all our clinics.
Stephen explains all about the program and shows you through one of our private fitness studio’s where the diabetes program classes take place.
Call 1300 189 289 to find out more.
Cardiovascular Training (walking, jogging, cycling, swimming, rowing, dancing etc.)
Cardiovascular training is a type of exercise that encourages people to complete an open ended, continuous movement. This movement requires a lot of oxygen to continually complete, and so it affects and changes the cardiovascular system (heart and lungs), more so than other systems in the body (muscular system). Completing this type of exercise will improve your bodies ability to utilise oxygen within the body, improve the amount of blood you can pump around your body with a single pump, and over the course of a minute (also called ‘stroke volume’).
Cardiovascular training is important for people living with diabetes to complete, as the research shows that those with diabetes have a four times greater risk of suffering from a cardiovascular event such as heart attack or stroke. By improving the fitness (efficiency) of your heart and lungs, you will also decrease your risk of having a cardiovascular event.
Now some people might not be able to complete a 30 min walk due to breathlessness or pain. But breaking this up into 10 mins walks is quite acceptable to do. Try to remember though that any improvement from what you are currently doing will have an impact.
For example, if you are walking the dog 1 x per week for 20 mins, then by increasing this to 3 x per week for 20 mins it will have a significant affect on your health. What is important to account for though, is that the body adapts to exercise very well, and after a few weeks, you may need to increase this walk to 3 x 30 mins walks to see anymore change.
Now with cardiovascular training, the best thing you can do is something that you will enjoy, because you’re more likely to do it. All of the above types of cardiovascular exercise are good for you, but if you don’t enjoy swimming, guess what, you don’t have to swim! Even getting out into the garden can be a cardioavscular exercise. So if you are feeling a bit stuck, find a type of activity that you enoy (golf, fishing, sailing, cycling etc.) and try to do that as much as possible. When you start feeling fitter. Then you can start increasing or changing what other types of activity you complete.
The benefits of cardiovascular exercise on health are well documented. Getting started is the hard part! So set yourself a realistic plan throughout the week. Write down a schedule that is realistic, and stick to it. The feeling of accomplishment is almost as good as the health benefits you’ll receive.
It can be a scary sounding type of exercise, but really, resistance training refers to any type of movement or activity that is completed with an external load. Did you just shovel a whole pile of dirt into the wheelbarrow and shift it 20m? That is a form of resistance training. What is important to know with resistance training is the type of exercises you should be completing, how much exercise you should be doing and why you are doing this specifically.
Type of Resistance Training
If you haven’t completed any resistance training before, it’s good to start off with completing large muscle group exercises. Your legs have got some of the biggest muscle groups in our body, so it is important to complete exercises such as squats, lunges, sit to stands, calf raises and functional lifting. Other large muscle groups to work include the chest and back.
The reason it is so important to strengthen these muscles is because the more muscle mass and muscle density you have, it has been shown that the greater BGL control you can have.
Now if we turn back to earlier in the blog where we talk about the process of glucose entering the cells, it is important to also know that excess glucose becomes stored in liver and in the muscles. Now, storing glucose in the muscle is beneficial, as you don’t have to use the blood to transport the glucose to those working muscles. It is already there, waiting to be used. This means that once the storage of glucose in the muscles has been used up, then the body must turn to the blood stream to gain more glucose to enter the cell to then be used.
It is well known that resistance training, in combination with good nutrition, increases muscle mass, and an increase in muscle mass can have a positive effect on our metabolic rate, both at rest and during exercise. A higher metabolism means that you will burn more calories, both while completing exercise and also while completing your normal day to day tasks. The more calories you burn, the higher chance you have of maintaining or losing some body fat, and as we know from earlier in the blog, being overweight or obese can have a large risk for further health complications for those people with diabetes. That means hat not having as much body fat will improve your diabetes, reduce your health complications risk AND improve your blood glucose levels!
It’s almost as good as taking medication, except it is better, because exercise can be free!
How much resistance training do I need to do?
The recommendation for adequate changes in your muscular system is to complete 2-3 workouts per week of 30-45 mins of strict resistance training, focusing on large muscle group movements.
Each exercise should be completed for between 8-12 repetitions and repeated three times.
It is important to find a weight that feels comfortable to lift in the early stages of starting a resistance training program. Once you feel that the weight you have chosen is too light, or you can easily get through your sets and reps, it is time to increase the weight.
Now some people get a little worried about how much weight they should be lifting, and other medical conditions can affect this. However if you are able, it’s important to lift a weight that makes you feel like you are working.
For our bodies to adapt, it needs to be placed under stress. If we don’t place an adequate stress on the body, then it doesn’t need to change in order to complete what we are asking it to do. That’s why if you have walked for 20 mins, 5 x per week for the last 5 years, you might not feel at the end of your walk like you’ve had to do any work. The body is used to what you are doing, and can adeqautely complete the task without any stress. This will maintain a level of fitness, but won’t make you improve your fitness.
Essentially, but the end of your 8-12 repetitions, you should feel like you could push out another 2 or 3 repetitions if you really had to, but that would be it.
But what if I don’t feel strong enough to complete resistance training?
That’s what we are here for! Our jobs are specifically designed to find an exercise program that anyone with any medical conditions can safely complete and feel comfortable completing at the same time. We will never ask you to complete something you don’t wish to, and we will never ask you to do something that we didn’t think you could do.
Our job is to guide, supervise, encourage and push you to improve your fitness in a fun and safe manner.
The reality of living with Diabetes and what to expect
It’s time to chat about the reality of living with diabetes, and some of the challenges you might face from the first diagnosis and then as you age with this condition.
Always comes with a bit of shock, and a huge influx of information. My advice is this, take some time, talk to some health professionals who can give you information, but make it clear about what you would like to know. Some people like knowing the absolute intricacies of everything, while others just want the footnotes. Health professionals are a well of information, and can give you as much or as little information as you like.
Start implementing some changes straight away, and make sure to start off small. Increased walks throughout the week, cutting down the size of your meals etc.
Finding out what type of management you need
As stated above, some people may be able to control the management of their diabetes with exercise and diet, while others may need to inject insulin. Whatever the management style, listen to your health professional about the potential risks, and find out what works best for you.
Whatever the management style, you need to have an expectation that some components of your lifestyle need to change. If you don’t embrace this fully, you’ll be on the back foot from the get go. Now not everyone likes exercise, and some people find changing their diet very hard to do, but whatever barriers to have, the more stubborn you are to changing these, the quicker your condition will progress. The quicker you implement changes, the easier they will be to uphold.
You need to realise as well that as you grow older, your diabetes will continue to progress. The longer you have type 2 diabetes, the higher chance you have that you will need to take insulin as a medication.
It is important to realise that your management of diabetes will continue to change. What works for you now may not be what works for you in 5 years time. That is why it is important to continue to stay in touch with your GP and have regular checks via blood tests on your diabetes.
You don’t have to stop the things you enjoy
If you enjoy having a coffee and a piece of cake with your friends as a social outing, you don’t have to stop this. People believe that once a diagnosis is made, you have to stop eating all sugar and carbohydrates to avoid your BGL’s going up.
Now the reality is that the coffee and cake you have will most likely increase your BGL’s, however, if you have a diet that manages your diabetes well and exercise the recommended amount, the chances are that you can have a one outing of coffee and cake with your friends a week. But don’t make it a regular habit everyday. Moderation is key, and making sure that you put things in place so that if you want to enjoy a few beers with mates or a glass of wine, make sure you exercise beforehand and the next day, and maybe you choose to either have beer with a salad, or water with a burger. Make choices that have some upside from a health perspective, and it will make you feel a lot less guilty about it.
Surrounding yourself with support and be confident in your management
Now you don’t want to have friends who encourage you to make poor heath choices all the time, but you also don’t want to surround yourself with friends or family who judge everything you put in your mouth. The thing I hear most from people living with diabetes is how frustrated they get when someone asks;
“Should you really be eating that with your diabetes?”
The answer can be a strict, yes, yes I can, if you have proper management. But moving away from the stigma’s of diabetes is just as important as the management of it. So educate your friends about your diabetes if they don’t know a lot about it.
Try not to hide that you have diabetes. Would you hide that your knee is sore? Or that you’ve had a heart attack? Most likely not, so why should diabetes be any different?
If you are making the correct choices for your health, there is no shame in admitting to having this condition, and certainly no shame in enjoying that coffee and cake with friends.
Coming soon …