The link between exercise and illness: “I have type 2 diabetes and they tell me I caused it” | Health and wellness

“I have type 2 diabetes and they tell me I caused it,” explains Marie Carmen, 35. He was diagnosed with type 1 obesity and then “the question of insulin came up,” he adds. “Well, I don’t know which came first. What is clear to me is that the doctor told me that I need to start exercising and change what I eat. “I have no other choice,” he admits with some skepticism.

Diabetes is a disease characterized by poor management of glucose metabolism, causing elevated blood glucose levels. Glucose comes from the food we eat, and insulin, a hormone produced by the pancreas, is responsible for releasing it so that this glucose can be used in cells as an energy source or stored in the form of glycogen. In type 1 diabetes, the body does not produce insulin. In type 2 diabetes mellitus, the most common, although there is a change in the first phase of insulin secretion, the problem lies in tissue resistance to it. That is, cell receptors do not respond to their interaction, preventing their physiological action. If this happens, glucose does not enter the cell and remains accumulated in the circulation.

A recent study published Journal of Applied Physiology recognizes that exercise and sedentary lifestyle are modifiers of beta cell function and the risk of type 2 diabetes. The paper examines the factors that come into play when a person exercises, when he stops doing it and becomes inactive. “Elements that alter the secretion of pancreatic beta cells as a result of changes that exercise or sedentary lifestyle causes in the muscles, liver, intestines, autonomic nervous system and adrenal cortex. Pancreatic beta cell dysfunction is the first abnormality to occur at the onset of type 2 diabetes. This study reinforces the need to prioritize interventions in this type of patient to increase sustained exercise and avoid a sedentary lifestyle,” states Dr. Clotilde Vazquez . , Head of the Department of Endocrinology and Nutrition at the Jiménez Díaz Foundation University Hospital (Madrid).

Life style

“There are many causes of type 2 diabetes, but the most common is pancreatic beta cell dysfunction,” Vasquez explains. “This occurs as a consequence of environmental factors that occur in a person with a certain genetic predisposition. In fact, type 2 diabetes has a much larger hereditary component than type 1 diabetes, but in general it only develops if some other circumstances arise throughout life, such as the passage of time (which we cannot change), etc. Modifiable factors: obesity, especially if abdominal fat gain is associated with increased visceral fat, a sedentary lifestyle and poor nutrition. Almost 90% of people with type 2 diabetes are overweight or obese. “There you can see how much fat gain plays a role in diabetes.”

“I get up early, sleep poorly, eat out almost every day and am too busy to exercise,” admits Marie Carmen. The key to overcoming sedentary lifestyle is to start with small steps. The meta-analysis acknowledges that “there is strong evidence that regular aerobic exercise alone or in combination with resistance training is effective in improving quality of life in adults with type 2 diabetes.” The importance of this lifestyle is key. “A sedentary person who is simply overweight and eating poorly is likely to develop type 2 diabetes, but an active person with a healthy diet is likely to be able to protect themselves, even if they are overweight and have a genetic predisposition. . The three lifestyle factors influence not only additively, but exponentially. But physical activity and a healthy diet are crucial,” emphasizes Dr. Vazquez.

Let the force be with you

In this sense, strength training is key and we must stop being afraid to do it under supervision. Organizations such as ACSM (American College of Sports Medicine) included it in their recommendations. High intensity has a greater beneficial effect than low to moderate intensity strength training in terms of overall glucose control and insulin reduction, which has already been confirmed by meta-analyses such as the one published International Journal of Environmental Research and Public Health.

The international organization recommends performing exercises that target large muscle groups two or three days a week, never consecutively, at a frequency of 50% to 69% of 1RM (rep max) or vigorously at 70% to 85% of 1RM. “Over the past decade, there has been tremendous progress in understanding the specific benefits of strength and muscle training compared to non-resistance physical activity. Strength activity improves insulin sensitivity (i.e., reduces insulin resistance), which greatly contributes to lowering blood glucose levels, among many other beneficial effects on the emotional, cognitive, metabolic level, increasing thermogenesis, as well as improving the functional autonomy of individuals. who practices it,” comments Dr. Vasquez.

These are some of the reasons why patients like Marie Carmen should start strength training, although a priori, this sounds strange to you. “Let’s see, I walked a little, but not enough. When I pick up the dumbbells, I don’t quite see it, it makes me a little hesitant, but if you tell me it can help me, I’ll give it a chance,” he noted before starting his training program. “Doctors have been around for a long time recommend aerobic activity based on current knowledge, but the evidence is now so strong that it is a priority, especially in women.But to do this, our patients need to overcome the fear of strength training, because strength training still sometimes carries a risk of injury, muscle hypertrophy… To eliminate it, it is very important to consult a strength training specialist who will assess the person, his abilities, limitations and plan training gradually, gradually and steadily to reap the enormous benefits that this type of physical activity brings,” recommends Head of the Department of Endocrinology, Department of Endocrinology and Nutrition, Jiménez Díaz Foundation University Hospital.

From theory to practice

Know the risks of uncontrolled pathology and propose solutions. “Type 2 diabetes immediately increases cardiovascular risk along with other risks. Cardiovascular disease is the leading cause of death in our society, the most common cause of death in women over 50, and by far the most common cause of death in the population with type 2 diabetes,” says Dr. Vasquez. “Complex mechanisms in which insulin resistance and metabolic changes that occur with chronically high blood glucose levels (along with a higher prevalence of hypertension, elevated lipid levels, kidney damage and neurological damage) explain the greater likelihood of any ischemic cardiac event occurring. “There is strong evidence for the preventive function of physical activity, the Mediterranean diet and weight loss when combined with appropriate pharmacological treatment.”

Consider recommendations from organizations such as ACSM.

• Combine frequent aerobic exercise with strength training, preferably at high intensity, under the supervision of a physical activity and sports specialist.
• Medical evaluation (and exercise testing) before engaging in activities more vigorous than brisk walking is recommended for adults with signs or symptoms of stroke, long duration of diabetes, advanced age, or other diabetes-related complications.
• People should not begin exercise with blood glucose levels >250 mg dL-1 (13.9 mmol L-1) if moderate or high levels of ketones in the blood or urine are present. Be careful when exercising with blood glucose levels >300 mg dL-1 (16.7 mmol L-1) and without excess ketones, drink plenty of fluids, and only proceed if you feel well.
• People are advised to stay hydrated by drinking enough fluids before, during and after exercise, and to avoid exercising during the peak heat of the day or in direct sunlight to avoid overheating.
• Especially for those using insulin, it is important to carry sources of fast-acting carbohydrates during exercise to treat hypoglycemia and to have glucagon on hand to treat severe hypoglycemia (if you are prone to developing it).

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