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 Table of Contents  
REVIEW ARTICLE
Year : 2013  |  Volume : 12  |  Issue : 1  |  Page : 38-43

Information on the effects of physical workout and diet on diabetic patients


Department of Pharmacy, GRD (PG) IMT, Dehradun, Uttarakhand, India

Date of Web Publication19-Apr-2014

Correspondence Address:
Mohammad Asif
Department of Pharmacy, GRD (PG) IMT, Dehradun, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 

Diabetes is a leading cause of premature deaths. Most common type of diabetes, type-2 diabetes, usually begins when a person is in his or her 40s, but diabetes is not inevitable. Minor changes in your life-style can greatly reduce your chances of getting this disease. Diabetes is a disorder in which the body does not use the sugars in food in the usual way. Normally, digested food, changes into glucose, which body uses for fuel. Blood carries glucose to the cells where a hormone called insulin allows it to enter the cells. Type-2 diabetics produce too little insulin in response to a given glucose load in a meal or resistant to insulin action and or dump excess glucose from the liver. High levels of blood glucose lead to serious complications. Type-2 diabetes is a non-communicable disease with increasing prevalence at a global level. As healthy dietary pattern has beneficial effects on both human health and regarding the development and treatment of type-2 diabetes, promoting adherence to this pattern is of considerable public health importance. Type-2 diabetes if not properly managed, can lead to: Heart disease, stroke, kidney disease, blindness, peripheral nerve damage, leg and foot amputations and death.

Keywords: Blood sugars, diabetes, exercise, food, insulin, non-communicable disease


How to cite this article:
Asif M. Information on the effects of physical workout and diet on diabetic patients. Afr J Med Health Sci 2013;12:38-43

How to cite this URL:
Asif M. Information on the effects of physical workout and diet on diabetic patients. Afr J Med Health Sci [serial online] 2013 [cited 2019 Jan 19];12:38-43. Available from: http://www.ajmhs.org/text.asp?2013/12/1/38/129923


  Introduction Top


Diabetes, particularly type-2 diabetes is one of the fastest growing health problems in the world. It has been estimated that the number of diabetes sufferers in the world will double from the current value during the next 25 years. [1] Diet and physical inactivity are one of the major factors now linked to a wide range of diseases including diabetes. Diet constitutes a crucial aspect of the overall management of diabetes, which may involve diet alone, diet with oral hypoglycaemic drugs or diet with insulin and exercise, also depending on age, weight. [2],[3] Diabetes mellitus, one of the major non-communicable diseases, is a condition difficult to treat and expensive to manage. [4] Individuals with Type-2 diabetes are at a high risk of developing a range of complications that can lead to disability and premature death; cardiovascular, neurological, nephropathy disorders. [5] However, a drastic increase of physical inactivity, obesity and type-2 diabetes has been recently observed; a fact, which indicates that obesity and physical inactivity may constitute the main reasons for the increasing burden of diabetes in the developed world. [6] Fortunately, because environmental factors are modifiable, disease manifestation from these factors is largely preventable. [7]


  Types of Diabetes Top


Type-1 diabetes

It usually occurs early in life around age 12 or 13 years. Type-1 is often called juvenile-onset or insulin-dependent diabetes. In this form of diabetes, the pancreas produces no insulin due to the effect of autoantibodies. Without insulin, the body cannot use glucose as a source of energy. Fat is used instead. The result of using fat alone for energy production is the buildup of products called ketones. If untreated, this can result in death. A type-1 diabetic must have daily insulin injections. Treatment also includes regular exercise and development of a meal plan. Symptoms of type-1 diabetes develop rapidly. [8],[9] The symptoms of diabetes are caused by the high blood glucose. Warning signs may include: Rapid weight loss without trying, frequent urination, increased hunger, increased thirst, blurred vision, feeling tired and opportunistic skin and vaginal infections. The goal of type-1 diabetes treatment is to lower the blood glucose with: Insulin, diabetic meal plan and physical activity.

Type-2 diabetes

Most diabetics have type-2, adult-onset, non-insulin-dependent diabetes. A type-2 diabetic doesn't produce enough insulin or cannot use insulin effectively. In many cases, type-2 diabetes can be controlled with diet and exercise alone. However, some people may also need oral medications or insulin injections. Most type-2 diabetics are older adults, overweight and have a blood relative who has the disease. Although there are obese people who do not develop diabetes, obesity is thought to play a significant role by reducing the effectiveness of insulin in the body. Keeping weight down and increasing physical activity will help most people delay or prevent type-2 diabetes. There also are slim or lean people who have type-2 diabetes. For these people, maintaining their body weight and modifying their diets and eating patterns will help lessen glucose problems. [10],[11]

The goal of type-2 diabetes treatment is to lower the blood glucose with: Diabetic meal plan, physical activity, weight loss (if needed) and medication (if needed).

Gestational diabetes

The third type of diabetes, called gestational diabetes, occurs in some pregnant women. Doctors should monitor this type of diabetes closely. The symptoms and treatment will mimic those of the type-2 diabetic and it usually disappears after childbirth.


  General Guidelines for Diabetes Top


The risk of diabetes is more in people who are overweight, people with upper-body obesity, women (50% more often than men), people who have a family history of diabetes and people who are 40 or older. A glucose level of more than 126 mg/dl on more than one fasting occasion indicates diabetes. If diabetes runs in a family, one should have a fasting blood glucose test every year after the age of 20 years. Research has shown that diagnosing and treating diabetes early may prevent further damage to the pancreatic cells that make insulin. Changes in both diet and life-style may stop the progress of type-2 diabetes. Stress and illness affect how well insulin works. Another important consideration is the prevention of heart disease. Diabetics are 2-3 times more likely to develop heart disease. [12],[13],[14] Type-1 diabetes always requires insulin, diet and exercise. Insulin or oral hypoglycemic agents are only prescribed for type-2 diabetics if diet and exercise alone fail to lower blood glucose. If anybody has diabetes there will be a need to have a doctor and nutritionist for good management.

Dietary treatment of diabetes

Balancing your diet when you are diagnosed with diabetes can be challenging. Although the food choices you make and your eating habits are important in helping you manage your diabetes, you should be able to continue enjoying a wide variety of food as part of healthy eating. [15],[16],[17],[18]

Taking steps to balance your diet that will help to control: Blood glucose levels, blood fats-cholesterol and triglycerides and blood pressure.

It will also help regulate your weight. If you are overweight losing weight will help you control your diabetes and will also reduce your risk of heart disease, high blood pressure and stroke.

The aims of dietary treatment of diabetes are:

  • To achieve optimal blood glucose concentrations.
  • To achieve optimal blood lipid concentrations.
  • To provide appropriate energy for reasonable weight, normal growth and development, including during pregnancy and lactation.
  • To prevent, delay and treat diabetes-related complications.
  • To improve health through balanced nutrition.


The usually recommended daily intake for the non-obese diabetic patient is between 1500 and 2500 k calories/day. The recommendation for the overweight diabetic patient is between 800 and 1500 k calories/day, while the underweight (growing children and adolescents) should be allowed at least 2500 k calories/day and above.

Medication

In this form, there may be plenty of insulin in the bloodstream, but the cells are resistant to it. Glucose cannot easily get into the cells and it builds up in the bloodstream. Over the short run, people with uncontrolled diabetes may experience fatigue, thirst, frequent urination and blurred vision. In the long run, they are at risk for heart disease, kidney problems, disorders of vision, nerve damage and other difficulties.

Insulin

People with type-1 diabetes must take insulin shots. With type-1 diabetes when the beta cells are destroyed, the pancreas can no longer make insulin. Insulin must be injected. It cannot be taken by mouth, because insulin is a protein and the gastrointestinal enzymes would digest it. When you eat food, your body breaks down the carbohydrates and sugars into glucose and blood glucose levels go up. [19],[20] The insulin shots work with body cells to bring blood glucose levels back down. People with type-1 diabetes must balance their diet and exercise with their insulin.

Oral diabetic medications

For people who have type-2 diabetes the first approach to diabetes treatment is eating right, losing weight if needed and physical activity. But sometimes these efforts are not enough. In that case, your doctor may have you take oral diabetic medication. There are several types of oral diabetic medication. Some help the pancreas make more insulin; others help the body cells use the insulin better. Taking oral diabetic medication does not replace healthful habits. [18],[21]

Weight loss

For many people with type-2 diabetes, losing weight is a big part of their diabetes treatment. Many times losing weight helps your body cells use insulin better. The best way to lose weight is to adopt a healthy eating plan and to increase physical activity. Often when you go back to your old eating habits you will regain the weight lost. With a diabetic meal plan, you are eating fewer calories because you are filling up with good, healthful foods, not foods high in fat. A diabetic meal plan also emphasizes portion sizes. Slow weight loss is healthier. [18],[21] Regular physical activity also helps with weight loss, as well as helps control blood glucose, blood cholesterol and blood pressure.

Diabetic meal plan

A diabetic meal plan is an important part of diabetes treatment. A diabetic meal plan focuses on providing a healthy diet that controls blood glucose and prevents diabetic complications. What is healthy for someone with diabetes is not different from what is healthy for someone who does not have diabetes. A diabetic meal plan is a healthy diet including a variety of foods. [22],[23] The best meal plan for a person with diabetes is: Low in fat, high in complex carbohydrates like beans, vegetables and grains (breads, cereals, rice, etc.) and moderate in protein. There is no one specific diabetic meal plan. Your diabetic meal plan will depend upon the foods you like, your weight, physical activity, blood cholesterol, blood pressure and medication. Some factors that may be considered in your diabetic meal plan are:

Calories

For many people with type-2 diabetes losing weight is a big part of their diabetes treatment. Losing weight can help your body cells use insulin better. For people who are trying to lose weight, their diabetic meal plan will be moderately lower in calories and lower in fat to help with weight loss. [24],[25] Losing weight and lowering fat intake can also help lower your blood cholesterol and blood pressure if they are high.

Physical activity

Regular physical activity helps the body cells take up glucose and thus lower blood glucose levels. Regular physical activity also helps with weight loss as well as controlling blood cholesterol and blood pressure. You need to let your doctor and dietitian know about the kinds of physical activities you do regularly. Your doctor and dietitian will help you balance your physical activity with your medication and diabetic meal plan. [26] If you are not physically active now, your doctor may recommend that you increase physical activity.

Glucose testing

Your diabetic meal plan, physical activity and medication are all balanced to help keep your blood glucose levels normal. You need to check your blood glucose levels at home to keep track of how you are doing. Soon you will learn how the foods you eat and your physical activity affect your blood glucose level.


  General Dietary Guidelines Top


Modern dietary management of diabetes essentially involves modifications of the quality and quantity of food to be taken by the diabetic patient. The following guidelines are applicable to diabetes irrespective of type, weight status, age, gender or occupation. [27],[28],[29],[30],[31]

  1. Most of the carbohydrate consumed should be in the form of starch (polysaccharides) such as maize, rice, beans, bread, potatoes etc.
  2. All refined sugars such as glucose, sucrose and their products (soft drinks, sweets etc.) should be avoided except during severe illness or episodes of hypoglycemia. These foods contain sugar in a simple form, which is easily absorbed causing rapid rise in blood sugar.
  3. Non-nutritive sweeteners, e.g., Canderel, saccharine, NutraSweet, aspartame are suitable sugar substitutes for diabetic subjects.
  4. Animal fat such as butter, lard, egg yolk and other foods high in saturated fatty acids and cholesterol should be reduced and replaced with polyunsaturated fats such as vegetable oils.
  5. Salt should be reduced whether hypertensive or not.
  6. Protein (fish, meat, beans etc.) and salt are restricted for those with diabetic nephropathy.
  7. The items allowed for free consumption include:
    1. Water, green leafy vegetables, tomatoes, onions, cucumber, peppers, vegetable salad.
    2. Tea, coffee or drinks that contain very low or no calories.
  8. Cigarette smoking should be avoided by diabetic patients.
  9. For patients too ill to eat solid food, a fluid or semisolid diet should be substituted (pap, soya bean, custard, etc.).
  10. Patients treated with insulin or certain oral hypoglycemic agents, e.g., sulphonylureas, must be advised to eat regularly and often to prevent hypoglycemia- three meals a day plus suitable snacks in between, e.g., fresh fruit or two unsweetened biscuits.
  11. Small meals spaced over the day rather than one or two big meals.
  12. The diet should be varied to avoid monotony and provide a wider range of nutrients for healthy living. The goal here is to gain or regain weight. To gain weight the patient must take in more calories than needed to meet the body's physical activity requirements. Emphasis should be on a balanced diet, keeping to his or her favorite foods, regular meals. These patients should also endeavor to choose their daily foods from starches, vegetables, fruits and protein, while limiting the amount of fats. [32],[33],[34]



  Diet and Diabetes Top


Healthy diet is one of the best known dietary patterns for its beneficial effects on human health and seems to have good effects that may act beneficially against the development of Type-2 diabetes, including reduced oxidative stress and insulin resistance. High consumption of vegetables, fruits, legumes, unsaturated fatty acids and high ingestion of dietary fiber are beneficial to control diabetes. [7],[35] The epidemiological studies have shown that diets characterized by a low degree of energy, prevent weight gain and exert a protective effect on the development of Type-2 diabetes, a condition that is partially mediated through weight maintenance. [7] A vegan food pattern was associated with a significant reduction of the risk of developing Type-2 diabetes. [36] Greater adherence to the diet in combination with light physical activity was associated with lower odds of having diabetes after adjustment for various factors. [37],[38] Results from clinical trials support the protective role of the diet on Type-2 diabetes. However, in the study, nutritional education was more intense for the participants assigned to the diet groups. [39] Nevertheless, dietary habits in the developed and in developing world, are changing toward the opposite direction despite the nutritional recommendations for a healthy diet and life-style. [40] Even in countries, more fat, meat, egg, dairy products and sugar and less cereals, legumes, vegetables and seafood are being consumed. [41] Therefore, life-style measures for the prevention of obesity and diabetes are of significant public health importance.


  Exercise and Diabetes Top


Exercise plays a significant role in diabetes management. Through regular exercise, the need for insulin injections or oral medications can often be reduced. This holds true not only for people with type-2 diabetes, but also to some extent for those with type-1. Exercising muscles have a voracious appetite for fuel. When an individual is engaged in regular aerobic exercise, glucose is able to enter the cells without the need for as much-or perhaps any-insulin. Although people with type-2 diabetes can often reduce (and sometimes eliminate) medications when their weight is reduced and food and exercise are better controlled, those with type-1 diabetes will always need a source of insulin. Even so, a good diet and regular exercise can minimize the amount of insulin required. Important benefits of a regular aerobic exercise program in diabetes management include: Decreased need for insulin, decreased risk of obesity and decreased risk for heart disease. Exercise decreases total cholesterol, improves the ratio of low-density lipoprotein (LDL) to high-density lipoprotein (HDL) cholesterol and reduces blood triglycerides. It may also decrease blood pressure and lower stress levels. Walking is one of the easiest and healthiest ways to exercise. This is one activity that anyone can do for a lifetime without special equipment and with little risk of injury. [40],[41],[42],[43]

Physical activity

Regular physical activity helps the body cells take up glucose and thus lower blood glucose levels. Regular physical activity also helps with weight loss as well as controlling blood cholesterol and blood pressure. You need to let your doctor and dietician know about the kinds of physical activities you do regularly. If you are not physically active now, your doctor may recommend that you increase physical activity. [40],[41],[42],[43]

  • Achieve and maintain a healthy body weight by exercising daily and eating healthy.
  • Aim to be active for 150 min/week. Start with brisk walking for 10 min a few times per day and increase gradually. Endurance exercise will help to increase heart and lung capacity.
  • Also include flexibility exercises (gentle stretching) to keep your muscles and joints relaxed.
  • Also do strength exercises 2-4 times/week to strengthen muscles and help your bones.
  • Remember to start slowly and consult your physician before engaging in a new exercise.
  • Also, remember to measure your blood sugar levels before and after exercise.
  • Bring some food (a fruit or high fiber foods) or glucose tablets with you while exercising in case your blood sugar drops too low. Stop if you feel tired or pain.


Keeping active can lower your blood sugar, lower your blood pressure, help you lose weight, help you feel better, reduce the amount of medication you need, relieve tension or stress, improve your heart and lung function and improve your muscle tone.

Mental and physical health benefits associated with physical activity

Research is more and more supporting the notion that regular exercise is so beneficial for everyone and needs to be instituted early in our lives and become a regular habit. Insulin resistance is improved by regular exercise. It seems to make the cells more responsive to the insulin and glucose. Exercise improves the cardiovascular system and keeps all of the joints and muscles lubricated in movements. It has been noted that physical exercise can improve both mental and physical health. [40],[41],[42],[43] There are many benefits to regular exercise.

Exercise improves your mood

Exercise stimulates various brain chemicals, which may leave you feeling happier and more relaxed than the before work out and also make you look better and feel better when you exercise regularly, which can boost confidence and improve self-esteem. Exercise even reduces feelings of depression and anxiety. Exercise can help alleviate stress and make you more productive.

Exercise can put the spark back into your sex life

Regular exercise can leave you feeling energized and looking better, which may have a positive effect on sex life. Exercise improves circulation, which can lead to more satisfying sex and men who exercise regularly are less likely to have problems with erectile dysfunction than are men who don't exercise, especially as they get older.

Exercise combats chronic diseases

Regular exercise can help prevent or manage high blood pressure. It helps to keep blood vessels healthy and moving. Exercise delivers oxygen and nutrients to tissues. Regular exercise seems to boost HDL or good cholesterol while decreasing LDL, or bad cholesterol. This one-two punch keeps your blood flowing smoothly by lowering the buildup of plaques in your arteries. Regular exercise can help you prevent type-2 diabetes, osteoporosis and certain types of cancer. It seems to improve how your cells use insulin and glucose. Aerobic exercise improves cardiovascular endurance, muscle strength and flexibility. Exercise pumps more blood through your veins. This increases the size of your arteries, prevents fat from clogging your arteries and helps prevent blood clots. A strong heart does not have to work so hard so you are less likely to have a heart attack. Regular exercise improves the joints and muscles and even sore or stiff joints feel better after an appropriate exercise session.

Exercise helps you manage your weight

With exercise you burn calories. The more intense the exercise, the more calories you burn-and the easier it is to keep weight under control. You do not even need to set aside major chunks of time for working out. Take the stairs instead of the elevator. Walk during your lunch break. Do jumping jacks during commercials.

Exercise promotes better sleep

It appears that some form of regular exercise can assist you in sleeping at night. A good night's sleep can improve your concentration, productivity and mood. Regular exercise can help you fall asleep faster and deepen your sleep. The timing is up to you-but if you are having trouble sleeping, you might want to try late afternoon workouts. The natural dip in body temperature five to six hours after you exercise might help you fall asleep. Regular physical activity can improve your mood and the way you feel about yourself. Researchers also have found that exercise is likely to reduce depression and anxiety and help you to better manage stress.


  Conclusion Top


Effective life-style modifications including counseling on weight loss, adoption of a healthy dietary pattern, together with physical activity are the cornerstone in the prevention of type-2 diabetes. Therefore, emphasis must be given to promoting a healthier life-style and finding solutions, especially for high-risk individuals. The epidemiological studies and clinical trials evaluating the role of the dietary pattern regarding the development and treatment of type-2 diabetes indicate the protective role of this pattern. As a result, promoting adherence to the diet is of considerable public health importance as this dietary pattern, apart from its various health benefits, is tasty and easy to follow in the long-term. Diet is an important aspect in the management of a diabetic patient. There is no cure for diabetes. However, you can manage or delay diabetes through diet, exercise, weight control and, if necessary, medication.

 
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  Types of Diabetes
   General Guidelin...
   General Dietary ...
  Diet and Diabetes
   Exercise and Dia...
  Conclusion
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