“I have type 2 diabetes and they tell me that I brought it on myself,” explains Mari Carmen, 35 years old.
She was diagnosed with type 1 obesity and then “the issue of insulin came up,” she adds.
“Well, I don't know which came first.
What is clear to me is that the doctor told me that I should start training and modify what I eat.
I have no other choice,” she acknowledges with some skepticism.
Diabetes is a disease that is characterized by poor management of glucose metabolism, causing glucose levels to increase in the blood.
Glucose comes from the food we consume and insulin, which is the hormone produced by the pancreas, is responsible for releasing it so that this glucose can be used in the cells as a source of energy, or stored in the form of glycogen.
In type 1 diabetes the body does not produce insulin.
In type 2 diabetes, the most common, although there is an alteration in the first phase of insulin secretion, the problem lies in tissue resistance to it.
That is, the cell receptors do not respond to their interaction, preventing their physiological action.
If this occurs, glucose does not enter the cell and remains accumulated in the circulation.
More information
Dancing is an effective way for obese people to lose weight
Recent research published by the
Journal Applied Physiology
admits that exercise and inactivity are modifiers of beta cell function and the risk of type 2 diabetes. The work analyzes the factors that come into play when a person exercises, when they stop doing so and become inactive.
“Elements that modify the secretion of the pancreatic Beta cell from the changes that exercise or sedentary lifestyle produce on the muscle, liver, intestine, autonomic nervous system and adrenal cortex.
Pancreatic Beta cell dysfunction is the first anomaly that occurs at the onset of type 2 diabetes. This study reinforces the need to prioritize actions in this type of patient aimed at increasing sustainable physical exercise and avoiding a sedentary lifestyle,” states the Dr. Clotilde Vázquez, head of the Department of Endocrinology and Nutrition at the Fundación Jiménez Díaz University Hospital (Madrid).
Lifestyle
“The causes of type 2 diabetes are multiple, but the most common of all is pancreatic beta cell dysfunction,” explains Vázquez.
“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 greater hereditary component than type 1 diabetes, but it only develops in general if some other circumstances occur throughout life, such as the passage of time (which we cannot modify) and others. Modifiable factors: obesity, especially if the fat gain is abdominal with increased visceral fat, sedentary lifestyle and incorrect diet.
Nearly 90% of people with type 2 diabetes are overweight or obese.
"There you can see the importance that this fat gain plays in the appearance of diabetes."
“I get up early, I sleep badly, I eat outside the house almost every day and I'm too busy to exercise,” admits Mari Carmen.
Starting with small steps is key to tackling a sedentary lifestyle.
Meta-analyses admit that “there is strong evidence that regular aerobic exercise alone or in combination with strength training is effective in improving quality of life in adults with type 2 diabetes.”
The importance of that lifestyle is key.
“A sedentary person who is simply overweight and has an incorrect diet is very likely to develop type 2 diabetes, while an active person with a healthy diet is very likely to be able to defend 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 healthy eating are crucial,” emphasizes Dr. Vázquez.
May the force be with you
In this sense, strength training is key and we should lose the fear of doing it in a supervised manner.
Organizations such as the ACSM (
American College of Sports Medicine
) have included it among their recommendations.
High intensity has greater beneficial effects than low to moderate intensity strength training in terms of general glucose management and attenuation of insulin levels, something that is already reinforced by meta-analyses such as the one published by the
International Journal of Environmental Research and Public Health
.
The international organization recommends performing exercises that involve large muscle groups, two or three days a week, but never on consecutive days, at 50% to 69% of 1RM (repetition maximum), or vigorous at 70% to 85% of 1RM.
“In the last decade, there has been enormous progress in the knowledge of the specific benefits of strength activity, of muscle training, compared to physical activity without resistance.
Strength activity improves insulin sensitivity (that is, it attenuates insulin resistance), which contributes significantly to reducing blood glucose levels, in addition to many other beneficial effects at the emotional, cognitive, metabolic, of increasing thermogenesis, also improving the functional autonomy of those who practice it,” comments Dr. Vázquez.
These are some of the reasons why patients like Mari Carmen should start strength training, although
at first glance
it may sound strange to them.
“Let's see, she walked a little, but little.
Picking up dumbbells, I can't finish seeing it, she gives me some qualms, but if you tell me that she can help me, I will give her a chance,” she pointed out before starting her training program.
“Doctors have long recommended aerobic activity based on the available knowledge, but currently, the evidence is so strong that it constitutes a priority, and especially in women.
But to do this, our patients have to lose their fear of strength training because strength exercise is still sometimes associated with the risk of injury, muscle hypertrophy... To eliminate it, it is very important to go to a strength training specialist who assesses the person, their abilities, limitations and schedule training in a progressive, gradual and sustainable manner to obtain the immense benefits that this type of physical activity produces," recommends the head of Endocrinology of the Department of Endocrinology and Nutrition of the Jiménez Díaz Foundation University Hospital.
From the theory to the practice
Know the risks of uncontrolled pathology and provide 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 frequent cause of death in women over 50 years of age and by far the most frequent cause of death in the population suffering from type 2 diabetes,” says Dr. Vázquez.
“Complex mechanisms in which insulin resistance and the metabolic changes that occur when having chronically high blood glucose (along with a greater prevalence of arterial hypertension, elevated lipids, kidney damage and neurological damage) explain the greater probability of having any ischemic cardiac event.
"There is strong evidence of the preventive function of physical activity, the Mediterranean diet and fat loss together with appropriate pharmacological treatment."
Take into account the recommendations of organizations such as the ACSM.
Combine frequent aerobic exercise with strength training, preferably at high intensities, supervised by a Physical Activity and Sports professional.
Medical clearance (and exercise testing) before beginning activities more vigorous than brisk walking is recommended for adults with signs or symptoms of stroke, longer duration of diabetes, older age, or other diabetes-related complications.
People should not begin exercise with a blood glucose >250 mg·dL−1 (13.9 mmol·L−1) if moderate or high levels of blood or urinary ketones are present.
Be careful during training with a blood glucose >300 mg·dL−1 (16.7 mmol·L−1) without excess ketones, stay hydrated, and only start if you feel well.
Individuals are advised to hydrate adequately by drinking adequate fluids before, during and after exercise, as well as to avoid exercising during the peak heat of the day or in direct sunlight to avoid overheating.
Particularly for anyone using insulin it is important to carry fast-acting carbohydrate sources during training to treat hypoglycemia and to have glucagon available to treat severe hypoglycemia (if you are prone to developing it).
You can follow
EL PAÍS Salud y Bienestar
on
,
X
and
.