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VOLUME 9 NUMBER 2 • JUNE 2012
69
SA JOURNAL OF DIABETES & VASCULAR DISEASE
REPORT
for a number of hours post exercise. Competition days and extra
carbohydrates will exacerbate the problem. One to two units of
insulin prior to exercise and/or after exercise may counteract this
hyperglycaemic effect.
24
Conclusion
Exercise has been proven to improve physical fitness and strength,
reduce cardiovascular risk factors and improve well-being in type 1
diabetes patients. Regular physical activity or training significantly
reduces insulin dosages and may improve glycaemic control.
4
One
would then assume that patients with diabetes would remain active.
Yet findings indicate that patients with type 1 diabetes, much like
the general public, are not completely comfortable with exercise.
One of the primary reasons for this is the fear of hypoglycaemia.
15
However, in Herbst’s 2006 cross-sectional multi-centre analysis
of 19 143 children and adolescents with type 1 diabetes, the
frequency of activity had a significant influence on glycaemic control
without increasing the risk of severe hypoglycaemia. Furthermore,
patients who exercised on a regular basis planned their insulin and
carbohydrate adjustments more efficiently than patients exercising
sporadically, hence the lower incidence of hypoglycaemia.
25
In
Bernadini’s 2004 study, it was observed that children participating
in more than 360 minutes of competitive sport a week had
significantly better glycaemic control than those children exercising
less than 60 minutes per day.
26
Cardio-respiratory, metabolic and perceptual effort may also be
altered in type 1 diabetes patients and this may impair exercise
performance. In persons with type 1 diabetes, improvement of
HbA
1c
levels with exercise has not been firmly established. The
lack of evidence of improvement in HbA
1c
levels with exercise
may be related to a tendency to over-reduce insulin dosages and
consume excessive amounts of carbohydrates in an effort to avoid
hypoglycaemia. The few randomised, controlled trials conducted
have been small, of short duration and have not provided guidance
on the intensity, duration or type (endurance/resistance) of physical
activity that will provide the greatest benefit.
12
The management of diabetes and exercise therefore requires
consideration of the complex interactions, which makes a single
generic formula inappropriate.
13
Numerous exercise and diabetes
guidelines and books are available for reference. Our physiological
understanding can help guide individuals, but it cannot replace
the importance of individuals monitoring their own blood glucose
responses to a particular exercise.
11
Where appropriate, referral to
an exercise specialist such as a biokineticist, who has training in and
understanding of the complexities of such cases, is likely to be of
great value.
Until we have further long-duration, prospective data, assessing
large cohorts of people with type 1 diabetes in different modes of
exercise and controlling for factors such as diet and adjustment
of insulin dosages, we need to encourage regular activity for the
additional health-related benefits.
Patients with type 1 diabetes who exercise regularly report
that they feel better, sleep better, have more energy and are more
self-disciplined. Ideally, patients should be exercising daily, or on
alternate days, to maximise insulin sensitivity. Patients who exercise
on a regular basis plan their insulin and carbohydrate adjustments
more efficiently than patients exercising sporadically. This would
aid in the prevention and management of hypoglycaemia and
hyperglycaemia, and essentially should lead to better blood glucose
control.
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