As a matter of fact, for the latter, excessive amounts of insulin are produced by the body. This, however, damages the beta cell, the part of the pancreas that releases insulin, and causes the depletion of the production of insulin in the long run. This paper will focus on diabetes mellitus 2, the causes of this chronic disease as well as the physiological limitations that it can impose on a person’s exercise program.
It will also include the symptoms that a fitness instructor must watch out for when training an individual suffering from type 2 diabetes. This information will be used to create an exercise program for a subject with this chronic disease. In this section, the intensity, frequency, duration and the method for determining how the program should progress will be identified. Any prescribed medication that may affect the person’s performance should also be considered in the creation of this program.
Although diabetes mellitus II is coined adult-onset diabetes as it normally develops in adults who are forty years and above, the number of children who have been diagnosed with this disease has also increased in number. Although genetics or complications during pregnancy may play a role in the development of this disease, obesity is still identified as the major cause of this problem. An individual who has a Body Mass Index (BMI) that is 20% higher than the ideal has a higher chance of becoming diabetic.
Other major risk factors associated with diabetes are age, family history, race, a history of previous impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), hypertension, a history of gestational diabetes mellitus (GDM) and polycystic ovarian syndrome. (Votey & Peters, 2009) In the past, people ages 40 and above are more prone to this disease. But, now, due to the sharp increase in the number of children with this disease, this might as well be considered as a pediatric disease. A person’s family history should also be considered when determining a person’s risk to acquire this disease.
People with first degree relatives who are diabetic can have a higher chance of acquiring this disease. They may have acquired the gene that stimulates the production of a protein that inhibits the role of insulin in cellular glucose transport. A person’s ethnic group can also increase a person’s risk of acquiring this disease. Afro-Americans, Hipic Americans, Pacific Islanders, American Indians and Asians have a higher chance of becoming diabetic. A person’s blood pressure and cholesterol level can also determine if he is prone to diabetes.
People with a blood pressure of 140/90 mmHg and above, a cholesterol level of 35 mg-dL-1 or below or a triglycerol level of 250 mg-dL-1 will have a higher risk of becoming diabetic. (McArdle, p. 452, 2007) For people with type 2 diabetes, an increase in glucose levels occur because of relative insulin deficiency or the insufficient production of insulin by the pancreas, insulin resistance or the decrease in the effects of insulin on peripheral tissues, especially muscles, or a combination of these two problems.
Of course, insulin resistance, doesn’t necessarily mean that a person has diabetes. This, however, can cause diabetes in the long run, especially if the person’s diet is rich in simple carbohydrates. Because of insulin resistance, glucose is converted to triacylglycerol and is stored as fat. Since fat cells have a tendency to be insulin-resistant due to its reduced insulin receptor density, the person’s insulin resistance can reach a level that exceeds the maximum output of the pancreas.
Both resistance and aerobic training can help in the management of these factors by improving insulin are glucagon responses. Since skeletal muscles consume a lot of glucose, approximately 70 to 90% of the glucose present in the body, resistance training which increases muscle mass can increase insulin sensitivity, leading to better glucose control. Endurance training, on the other hand, “maintains the blood level of insulin and glucagon during exercise closer to resting values. ” (McArdle, p. 451, 2007)
Ideally, the management of diabetes involves dieting, exercising and taking in the prescribed medication, if there is any. There are, however, some cases when the blood sugar level of the patient is too high and exercise needs to be put off. At the same time, although exercise can be very beneficial to diabetics, it can be counterproductive if the condition of the client is not examined properly. Before a client is given a program, the instructor must first make sure that he has his doctor’s consent.
The instructor should also know if the client has the following complications: retinal hemorrhage, increased proteinuria, acceleration of microvascular lesions, cardiac arrhythmias, ischemic heart disease, excessive blood pressure during exercise, postexercise orthostatic hyerptension, increased hyperglycemia, increased ketosis, foot ulcers, orthopedic injury related to neuropathy and accelerated degenerative joint disease. The exercise should be adjusted based on these factors.
Obese individuals, for example, should be given lesser weight-bearing exercises. At the same time, they should also be given longer rest periods in order to avoid increase in blood pressure. People with heart and blood pressure problems must not be allowed to exercise when the temperature is too high or the atmosphere is too humid. They should also be given ample rest in between sets. They should also avoid isometric exercises as well as exercises that involve raising the weight overhead or holding positions wherein the head is lower than legs.
Aside from the risks caused by complications, the instructor should also pay attention to signs of hypoglycemia, especially if the client is taking in insulin or oral hypoglycemic agents. Mild hypoglycemia is characterized by trembling or shakiness, nervousness, palpitations, increased sweating and excessive hunger. People with moderate hypoglycemic reactions experience headaches, irritability and abrupt mood changes, impaired concentration and attentiveness, mental confusion and drowsiness.
In severe cases, the individual becomes unresponsive and unconscious and experiences convulsions. For such instances, the instructor must be attentive to these symptoms so that he can react immediately. Since some patients take ß-blocker medication, hypoglycemic unawareness should be expected and it is up to the instructor to make the client stop exercising, measure his glucose level and have him eat some simple carbohydrates like hard candies and sugar cubes if hypoglycemia is confirmed. The client should then be asked to rest for ten to fifteen minutes.
After that, his glucose level should once again be measured before allowing him to continue the exercise regiment. Another risk that should be avoided is late-onset hypoglycemia wherein the diabetic’s blood sugar remains low even after four to forty-eight hours has passed. This can happen if the client’s exercise is too strenuous for him. For this reason, high-intensity exercise should not be administered to a diabetic individual, especially if he has been prescribed some insulin or hypoglycemic agents.
He should begin with a low-intensity program that gradually increases in intensity. Changes in intensity must be made after a period of three to six weeks so that the individual would be given enough time to adjust. According to Erikkson's study (Janot & Kravitz, 2009), doing some resistance training twice a week is enough to show results. Beginning with this frequency is also advisable as the instructor would be given the time to observe the client's reaction to the exercise. He would also be able to clear him of late-onset hypoglycemia.
The study done by Ishii and his colleagues (Janot & Kravitz, 2009) shows that the range of the load given to diabetic individuals should be 40 to 50% of their 1 rep max. They should do around 2 sets of 25 repetitions. And, they should be given 30 to 120 seconds of rest in between sets. Based on the FITT principle, people with type 2 diabetes can have 3 to 5 times a week of aerobic exercise. The intensity should be 40 to 60% of the maximum HR and the duration should be around 30 to 60 minutes, unless the person is taking hypoglycemic agents or insulin.