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CONTROLLING DIABETES

DEAR READERS,

C.S. is a 25-year-old diabetic man from Kingston 8. He has been diabetic since childhood and is dependent on insulin injections to control his blood sugar. Married less than a year, he is concerned about the amount of weight he has recently gained and would like to begin a programme of regular exercise. He asks LIFELINE "How will exercise affect the control of my diabetes"?

Insulin promotes the use of sugar in the tissues of the body. Lack of insulin leads to the development of diabetes.

Exercise is well known to improve the sensitivity of the body's cells to the hormone, insulin. This means the body will utilise what insulin is available to it more efficiently and more sugar will be removed from the persons blood.

This improved function of insulin is maintained for as long as training and exercise remains a regular part of the individuals life. Exercise will, therefore, facilitate sugar control. Exercise also decreases the risk of cardiovascular events such as stroke and heart attack in both diabetic and non diabetic persons.

Exercise causes a decrease in bad (low density) cholesterol and increases the good (high density) cholesterol. Exercise also reduces blood pressure over time.

Regular exercise along with a proper meal plan can help a lot with weight loss and with maintaining ones weight in both diabetics and non diabetics. Exercise also helps to reduce stress and helps to improve a persons self-esteem.

This is especially important in young diabetics who sometimes have many negative feelings about themselves. Exercising is a good thing to do.

Risks

There are, however, some risks which have to be mentioned before they occur. The blood sugar dropping to unacceptably low levels (hypoglycaemia) is a significant problem in the diabetic. This risk is very significant in diabetic individuals who only exercise sporadically, and do not have a regular exercise schedule to which their diet and medication have been adjusted.

A sudden increase in exercise will use up all the sugar available in the blood. Without either eating a bit more or adjusting (with the assistance of a doctor) the medication down the result can be exercise induced hypoglycaemia.

Some sports carry a greater risk of this complication and scuba diving as a sport is quite hazardous for the diabetic person who uses their abdominal wall as the injection site. The abdominal wall remains relatively immobile even as a person runs, walks, plays tennis or performs most forms of exercise, while the limbs move.

Increased movement of the limbs will increase the rate of movement of insulin from the limbs into the blood stream. This will result in abnormally low levels of blood sugar. Always use the abdominal wall as the insulin injection site before exercise.

The diabetic who exercises late in the evening risks having very low blood sugars going to bed and should have some food supplement before sleeping ­ another area of concern with diabetic individuals who wish to exercise is their feet. Diabetics, after a while, often have some sensory loss in their feet and their perception of pain or injury to the feet is poor.

This means that they may be totally unaware of blisters or other injuries to the feet. Properly fitted athletic shoes should always be worn for exercise and the feet should always be thoroughly inspected after exercise.

Prior to undertaking a programme of exercise a PRE EXERCISE medical evaluation should be performed at which time the doctor and the diabetic individual will agree on the maximum amount of exercise allowed, what activities, if any, to avoid and how to prevent HYPOGLYCAEMIA. An ECG should be performed in diabetics over age 40 years or who have been diabetic for more than 15 years. Wearing an identification bracelet would be an excellent idea.