• It was presumed as a disease for elderly, but recently has been changed, and it could happen in younger age.
• In Belgium 1/15 adults has (type II) diabetes
• Prevalence increases with increasing age
• In Flanders in 2018 : 58 people / 1000 inhabitants are treated for diabetes
  
• Type I diabetes: Generally auto-immune destruction of pancreatic beta cells
• Type II diabetes: Reduced insulin sensitivity of tissue

Diabetes mellitus is characterized by hyperglycemia

• Fasting plasma glucose level at or above 126 mg/dL (7.0 mmol/l).
• Any body part with high capillaries could be damaged

Type I Diabetes, Glucose management…

• In mixed sports, glucose could go up or down. It is imp to monitor blood glucose with ppl performing such sports.
  
• Pre-workout: Ingest glucose
• During workout: check ketones, and it is elevated—> perform only mild exercise.

Type II Diabetes, a typical chronic disease…

• Patients with chronic corticosteroid use would develop Type II diabetes in the future.
• Muscle weakness is seen in late stages
  
• Management gets harder with progression of the disease.

Pre-clinical Diabetes:

• Awareness of the modifyable risk factors
• Active counseling (diet, PA) if impaired glucose tolerance or impaired fasting glucose
• Adequate follow-up
• Follow-up every 1-2 years
• Attention for other CVD risk (tobacco, hypertension, dyslipidemia)
• Drug therapy is not routinely needed
• Self management of PA/diet

Clinical diabetes

• Medication
• Self Management and education
  • Self monitoring of glucose
• Healthy life style
  • Medical nutritional therapy
• Exercise training /Physical activity
  • PA > 150min/wk of moderate intense PA
  • and/or 90min of vigorous PA
  • not more than 2 consecutive days without   PA
  • Resistance training 3/wk
• An exercise test is needed
• Vigorous activity should be avoided in the presence of ketosis (Hyperglycemia)
• Pay attention to hyperthermia when sports on warm days
  

Diabetes with systemic consequences

• In patients with proliferative diabetic retinopathy
  • vigorous aerobic or resistance exercise   may be contra-indicated (hemorage and   retinal detachement)
• Peripheral neuropathy
  • Decreased pain sensation-> skin irritation
  • Charcot joint destruction
  • In severe peripheral neuropathy, non-  weight bearing activities (swimming,   cycling, arm exercises)
• Autonomic neuropathy
  • decrease in cardiac responsiveness to exercise,   postural hypotension, decrease thermoregulation (decrease   skin blood flow/sweating), decrease night vision, increase   risk of dehydratation,  increase risk gastroparesis   (food delivery not guaranteed)
• Foot ulceration “diabetic foot”
• In these patients thorough CV   assessment is imperative!

Resistance training in diabetes

(Gordon Diabetes research and clinical practice 2009.)

• Duration Median 16wk (range 8-52)
• Machine weights, 1 free weights, 1 NR
• Frequency 3/wk 3x8reps (n=6) other regimens (n=5)
• Improved glycemic control (potentially superior to AT) particularly if duration > 10Wks
• Improved skeletal muscle function, and counteracts hypocaloric diet induced loss of muscle strength
• Systematic review: High intensity resistance exercise (75-100% 1RM)seems to improve glycemic control more than low-mod intensity resistance training (20-75%1RM)

Points of attention during exercise

• Hypoglycemia
  • Shaking trembling
  • Sweating (‘cold sweat’), weakness
  • Tachycardia, tingling fingers
  • Hunger
  • Dizziness (lightheaded)
  • Blurred vision
  • Irritability (or sudden mood change, anxiety)
  • Difficulty concentrating
  • Confusion, difficulty speaking, poor coordination, loss of consciousness, seizures
• Hyperglycemia
  • Excessive thirst
  • Polyuria
  • Fatigue
  • Blurred vision
  • Dry mouth
  • Diabetic ketoacidosis (fruity-aceton smellingbreath, rapid breathing, drowsiness)
  • When prolonged: Nausea, vomiting, abdominal pain, weight loss, slow wound healing, recurrent infections.