Special Populations - Diabetes
Diabetes Mellitus is a growing concern in our healthcare industry. According to the American Diabetes Association (ADA) people with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes. The total cast of diabetes and prediabetes in the U.S. is estimated at $322 billion. Any steps that can be taken to help lower costs and keep people healthy is worth pursuing. Lifestyle changes are key but often the most difficult for people to adhere to.
Ninety to ninety-five percent of those with diabetes have Type 2 and it is usually due to inactivity and obesity. Many doctors first encourage nonmedical or noninvasive means such as diet, exercise and self-testing of blood glucose. Oral hypoglycemic agents are also tried before insulin but more than 40 percent of people will progress to insulin injections because they continue a sedentary lifestyle, make poor food choices and remain obese. Both types of diabetes, if uncontrolled, can result in debilitating health problems and premature death.
Getting started on an exercise regimen can be difficult. About 60 to 65 percent of people with diabetes have hypertension. A resting heartrate greater than 120 beats per minute or a resting BP exceeding 180/105 mmHg is contraindicated to exercise. Also, if insulin injections are required to managed blood glucose, it is recommended that they be made into a non-active muscle site on days of physical activity.
Once a regimen has been started it is important to monitor for signs of hypoglycemia (BG < 80). These signs can include but are not limited to trembling, shakiness, rapid heart rate, increased sweating, clammy skin, reduced mental ability, light-headedness, or fainting. On the opposite side of the spectrum, hyperglycemia can also be worsened by exercise. Blood glucose levels above 250 indicate poor glucose control. inadequate insulin and muscle cells will not be able to properly use glucose during exercise. Signs of hyperglycemia during exercise can include flushed skin, cherry-colored lips, fruity breath, increased thirst, GI stress, abdominal pain and disorientation.
Uncontrolled diabetes can lead to a whole host of issues and premature death. Exercise for diabetics can also incur risk and complications, but the benefits of a well-managed diabetes prevention or treatment program that include proper diet and exercise far outweigh any potential risks. The American Diabetes Association states that “all patients with diabetes should have the opportunity to benefit from the many valuable effects of exercise”.
Sources ACE 1999, ACSM 1995, 1997, ADA 2003, Colberg and Swain 2000