# Exercise as it relates to Disease/The relationship between type 1 diabetes and heavy exercise
### Diabetes

Diabetes is one the most common chronic disease affecting million of people worldwide. The human body cells resistance to insulin or the inability to take up glucose efficiently causes diabetes. There are two types of diabetes – Type 1 and Type 2. Type 1 diabetes mellitus is an autoimmune disease and is common for people under the age of 40 but may occur at any age. This condition causes insulin dependence as the T cells of immune system attack and the disable the pancreas’s beta cells that produce insulin to help convert food into fuel. In contrast, Type 2 diabetes mellitus is a heterogeneous disease and commonly caused by lack of insulin.
Type 1 diabetes is the result of destruction of the beta cells in the pancreas, which is often caused by confused body’s defence mechanism or immune system attacking the cells thought to be invaders the need for daily insulin injections to control blood glucose concentrations. The amount of insulin can be lowered with exercise because exercise acts very much like insulin. People with Type 1 diabetes have a higher glucose levels ranging from 300 to 400 mg/dll (16.6 to 22.2 mmol/L).

### Exercise

The benefits of exercise for those with insulin-dependent diabetes mellitus include:
* Lower blood glucose concentration during and after exercise
* Improved insulin sensitivity and decreased insulin requirement
* Improve lipid profile such as decreased triglycerides, decreased low-density lipoprotein cholesterol, and increased high-density lipoprotein 2 cholesterol.
* There are also improvement in mild to moderate hypertension and increased energy expenditure resulting to adjunct diet for weight reduction, increased fat loos, and preservation of lead body mass.
* People with Type 1 diabetes doing moderate to heavy exercise may benefit from cardiovascular condition, increased strength and flexibility, and improved sense of well-being and enhanced quality of life.

## Heavy Exercise and Diabetes

Heavy exercise is basically defined as when a person's heart rate is severely increased and causes the body to take rapid breaths such as sprinting, power lifting, resistance training and weight training. Exercise is an essential component of diabetes care and the benefits include possible improvement in blood glucose control for those with Type 2 diabetes. However, exercise is not considered a component of treatment for lowering blood glucose in Type 1 diabetes since it may affect the blood glucose level, which should be approximately 250 mg/dl to be safe.A 5 to 10 minutes exercise can result to 7 to 20 times glucose uptake from the blood thus beneficial to patients with Type 2 diabetes provided their insulin is enough.
However, low-level insulin patients or those that are insulin-dependent with Type 1 diabetes may become more ketotic and extremely hyperglycaemic with heavy exercise due to rising blood sugar. This is because glucose regulation is particularly important for people with diabetes Type 1 because the pancreas cannot produce enough insulin to control glucose in the blood. Therefore, acute rise in blood glucose during heavy exercise can lead to complication such as hypoglycaemia.
Exercise results to life threatening hypoglycaemia, hyperglycemia, and ketoacidosis;. These complications can also lead to hyperglycemia and ketoacid production when people with Type 1 do excessive or heavy exercise. It is therefore necessary that people with Type 1 diabetes regulate their physical activity and exercise in controlled manner otherwise they may suffer from:
* Exercise-induced and late-onset post exercise hypoglycaemia
* Hyperglycemia after a heavy exercise
* Hyperglycemia and ketosis in insulin-deficient people
* Cardiovascular diseases such as angina pectoris, myocardial infraction, arrhythmias, and sudden death
* They may also suffer from worsening of long-term complications of diabetes such as increase proteinuria, retinal detachment, soft tissue and joint injuries.
Exercise for people with Type 1 diabetes should be precise and these include the type, mode, intensity, duration, and frequency of the exercise. These individual should plan with their exercise to avoid hypoglycaemiasuch. According to Sport Medicine Australia (2011), such complication can be avoided by absorbing high glycaemic index carbohydrate if low blood glucose is detected during exercise. Perkins & Riddell (2006)and Regensteiner et al(2009) suggested the use of insulin pump therapy for those people who are likely to exert more like athletes. The purpose is to regulate insulin delivery to prevent exercise induced hypoglycaemia, hyperglycemia, and ketosis. These include warm-up regimen, hydration, and measurement of capillary.

## Recommendations

People with Type 1 diabetes exercising may need to adjust their dose of insulin based on the pattern of blood glucose levels.
* Their exercise should be tailored with their goals and medical condition. They must become proficient and committed in self-monitoring, and be sensitive with the intensity and duration of their exercise according to their condition or blood glucose level. For instance, heavy exercise may require decreases of 30% to 50% for rapid-acting insulin and 20% to 35.
* Constant insulin infusions normalized or moderate glycemia before and after a heavy exercise. For instance, post-exercise administration of insulin increases MCR or metabolic glucose clearance.
* Type I diabetics should exercise a minimum of four to five times per week at a low-to-moderate intensity, for about 30 to 40 minutes.
* It is important for type I diabetics to engage in strength training and flexibility exercises as well.
* Monitor blood glucose before, during, and after physical activity, and consume food during extensive exercise to avoid hypoglycaemia.
* For preparation for exercise include proper warm-up and cool-down periods and adequate hydration.
* Wearing an ID bracelet indicating one’s diabetic condition is important. Because type I diabetics are at risk for low glucose levels.

## Further reading

* Diabetes Australia
* Diabetes ACT

## References

* ↑ Leslie, R., & Robbins, D. (1995). Diabetes: Clinical Science in Practice, Cambridge University, United Kingdom.
* ↑ Woodruff, S., & Saudek, C. (2005), The complete diabetes prevention plan: A guide to understanding the emerging epidemic of pre-diabetes and halting its progression to diabetes, Penguin Press, United States.
* ↑ Ganz, M. (2005). Prevention of type 2 diabetes, John Wiley & Sons, United States.
* ↑ McCarthy, M. (2007). Everything Parent’s Guide to Children with Juvenile Diabetes: Reassuring Advice for Managing Symptoms and Raising a Healthy Happy Child, Everything Books, United States.
* ↑ Levene, S. (2003). Managing type 2 diabetes mellitus in primary care: A practical guide, Elsevier Health Sciences, United Kingdom.
* 1 2 Maahs, D., Taplin, C E., & Fiallo-Scharer, R. (2009). Type 1 Diabetes Mellitus and Exercise, Humana Press, United States.
* ↑ Taylor R, (2006), Handbook of Retinal Screening in Diabetes, John Wiley & Sons, United States.
* ↑ Rubin A, (2011), Diabetes, John Wiley & Sons, United States.
* 1 2 Olefsky, J. (2004). Diabetes mellitus: A fundamental and clinical text, Lippincott Williams & Wilkins, United Kingdom.
* ↑ Riddell, M., & Perkins, B. (2004). Type 1 Diabetes and Vigorous Exercise: Applications of Exercise Physiology to Patient Management, Canadian Journal of Diabetes, 30(1), 63-71.
* 1 2 Gavin, III R. (1988). Diabetes and Exercise, American Journal of Nursing, 178-180.
* ↑ Regensteiner, J., Reusch, J., Stewart., K., & Veves A. (2009). Diabetes and Exercise, Humana Press, United States.
* ↑ Perkins, B., & Riddell, M. (2006). Type 1 Diabetes and Exercise: Using the Insulin Pump to Maximum Advantage, Canadian Journal of Diabetes, 30(1), 72-79.
* ↑ Sport Medicine Australia Sport Medicine Australia. (2011). Diabetes and Exercise Fact Sheet, SMA, Australia
* ↑ DeWitt, D.,& Hisch, I. (2003). Outpatient Insulin Therapy in Type 1 and Type 2 Diabetes Mellitus, Journal of the American Medical Association, 289(17), 2254-2261.
* ↑ Frontera, W., Slovik, D., & Dawson, D. (2006). Exercise in rehabilitation medicine, Human Kinetics, United States.
* ↑ Joslin, E., & Kahn, C. (2005). Joslin’s diabetes mellitus, Lippicott Williams & Wilkins, United Kingdom.
* ↑ Porte, D., Sherwin, R., Baron, A., Ellenberg, M., & Rifkin H. (2003). Ellenberg and Rifkin’s diabetes mellitus, McGraw-Hill Professional, United States.