Optimal Metabolic Control
The diabetic person exercising in a state of good metabolic control (adequate levels of insulin and normal blood glucose concentration), typically shows a gradual decrease in plasma glucose with prolonged exercise, which can lead eventually produce symptomatic hypoglycemia. In this situation, consumption of glucose by the muscle increases adequately, but the blood sugar levels decrease, since the absence of a decrease in exercise-induced plasma insulin inhibits hepatic glucose production (glycogenolysis, gluconeogenesis) as well as mobilizing fatty acids from fat reserves. That is, the exercise equipment works normally, but the power supply line is cut.
Several factors determine the extent of the decrease in blood glucose and risk of hypoglycemia. The fall of blood sugar precipitates if the exercise is performed at the time of peak action of insulin injected. This occurs in 2 to 4 hours after injection of insulin regular and intense exercise is more likely to cause hypoglycemia at the time. As shown in Figure 2, there is evidence that the rate of absorption of insulin is magnified, and the rate of decline of blood glucose is higher if the injection is made in the member exercise (Koivisto & Felig, 1978 .) For example, brokers may recommend that insulin be injected in the abdomen before exercise, and not in the thigh. The later is the period after the injection, the less likely that this effect occurs. The diabetic child must also know that a decreased blood glucose is exaggerated by the exercise of longer duration and greater severity (Hagan, Marks, & Warren, 1979).
Under conditions of adequate insulin, the level of blood sugar drop also depends on the initial level of glucose. Higher concentrations predispose to increased glucose decreased physical activity, an effect that can be seen as beneficial to the diabetic control (Persson & Thoren, 1980). However, even prolonged exercise can lead to hypoglycemia, with excessive fatigue, dizziness, disorientation, syncope, and seizures. In addition, some patients may produce low blood glucose levels up to 15 hours after completion of the exercise, continuing effects of glucose uptake by muscle cells that have been exercising, as they replenish their intracellular stores of glucose (MacDonald, 1987 .) Every diabetic patient needs to know your own personal response to exercise through blood glucose monitoring, since the risk of hypoglycemia with exercise can vary greatly from one person to another. Based on this information, we can develop strategies to increase carbohydrate intake and insulin dose adjustments, in order to allow full participation in sports. These tactics will be discussed later in this article.
There is a clear relationship between insulin deficiency and these chronic complications of diabetes. More specifically, it is unclear if tight control of sugar levels in the blood favorably influence the natural course of the neurovascular manifestations of diabetes (DCCT Research Group, 1988). Still, the fact to avoid fluctuations in blood glucose concentrations outside the normal range, is considered an important goal for most physicians caring for these patients.
The observation made by McMillan (1979) that physical activity has been recommended for the treatment of diabetes mellitus from “time immemorial” is probably not an exaggeration. Historians have marked the relationship between exercise and diabetes as early as 600 BC, when the Indian doctor Sushruta prescribed physical activity for patients with this disease. Among his successors, who were also convinced of the benefits of regular exercise on diabetes, were the Roman doctor Celsus and the prominent Chinese Yuan-Fang Chao, who practiced during the Sui Dynasty in 600 AD. What these doctors saw was a better sense of well being in patients with diabetes, and the subsequent demonstration that physical activity may lower blood glucose levels in this disease, suggested another reason to include exercise in their treatment. When Lawrence (1926) noted that physical activity improved the hypoglycaemic effect of insulin administered, regular exercise has become a key element in the triad in the treatment of diabetes: insulin, exercise, and diet (Joslin, 1959).
The enthusiasm for exercise was based on the premise that the effects of glucose decreased by physical activity would improve metabolic control, thereby improving the quality of life of patients with diabetes. A scientific assessment of the relationship between exercise and diabetes, made in the past two decades, he has supported only a part of such hopes, but in the overall analysis, regular exercise continues to play an important role in the health of these children and adolescents.
In addition to any specific effect of exercise on diabetes, children with this disease deserve to enjoy, like young non-diabetics, the same social and health benefits of regular physical activity. Still, fear of the metabolic changes during exercise which could precipitate a hypo-or hyperglycemia causes many children with diabetes avoid physical activity. Physicians have the opportunity to contribute to the welfare of these patients by helping them to adapt their treatment so as to allow safe participation in sports events.
Poor Metabolic Control
When the diabetic child performs exercises under conditions of poor metabolic control with insulin deficiency and hyperglycemia, the metabolic response to exercise and the risks are completely different (Horton, 1988) (Table 1). Low insulin levels allow further breakdown of liver glycogen to glucose and fatty acid mobilization, but peripheral consumption of glucose by the muscle is impaired. Worsens hyperglycemia and ketoacidosis occurs: that is, exercise can raise the poor metabolic control. Now, the line input is working fine, but the energy substrate can not enter the muscle cell exercise. In this state, intense exercise is contraindicated, and when blood glucose levels exceed 250 to 300 mg / dl, diabetic control needs to be improved with additional insulin before sports participation. Therefore, the diabetic patient, needs to be aware of their metabolic control before intense physical activity
The aim of physical training, is to make the best possible conditions the muscles of women, especially the abdomen, spine and pelvis, during the months preceding the time of delivery and help them recover quickly after the expected time. Physical activity causes the body to release endorphins, which help you relax and ease the tensions and concerns. The rapid circulation of the blood caused by exercise will ensure a better oxygenation of your body and your baby.
In summary, regular exercise and maintain muscle tone and strength, protects against back pain, helps prevent excessive accumulation of fat in the body and has a positive effect on energy level, mood and self-image. For mom exercising regularly will give satisfaction both from the standpoint of physical and emotional: it is a good way to prepare for changes that will emerge in the coming months.
Some benefits of physical activity for the mother are:
• receive a positive emotional due to the release of hormones.
• Improve your self-esteem through learning new ways to use your body.
• You may find, in the exercise classes for pregnant women, new friends in other mothers.
• You can share your workout with your partner or other family members.
• Through the exercise done regularly can help ease back pain, constipation, leg cramps and shortness of breath.
• Increase your energy level.
• Be better prepared to resume their activities after delivery.
• Recover more quickly your fitness prior to pregnancy.
PHYSICAL ACTIVITY DURING PREGNANCY
Today is very common during pregnancy gymnastics. Physical activity is the best way to get to the birth of healthy, controlled by doctors and recommended by sports professionals.
The changes that occur in the body are many, when a woman is expecting a child. Therefore it is necessary that the body will adapt little by little all these new sensations. The specific and controlled physical activity is best for mom enjoyment with the least amount of hassle or pain, nine months pregnant and also get in top physical condition at birth, which is no less important.
Gymnastics for pregnant women is not something that has always existed. Times have changed, and this need is intensified, in particular, little more than two decades. The doctors began to realize that the woman who had performed physical activity during pregnancy was more prepared at the time of delivery, more actively involved, their physical condition was much more appropriate and thanks to which, there was a visible decline in visits for pain and discomfort before and after childbirth.
Currently, the specific physical activity for pregnant women has been extended and are the doctors themselves who advise expectant mothers about their benefits. Importantly, physical activity enables the body to release chemicals that help the mother to relax, adding to the rapid blood circulation caused by gymnastics allows better oxygenation of the body of the pregnant woman and her baby.
Throughout the entire pregnancy exercises are located, to work all those areas of the body that alter and reduce the most common conditions: back pain, discomfort under the ribs, sloping shoulders forward. Also, moms learn and work all the exercises to be implemented at the time of delivery.
Finally comes the expected time. Here the mother is in the instance of post-partum and now, as then, it is important for physical activity. Through it, the body of the mother can return quickly to normal to continue agile, active and beautiful, now with his baby.
The time of pregnancy for women is a stage of life where the desires of self-care and baby occupy much of your expectations. Perhaps no other moment in the life of women in which it is most needed regular exercise practice, bearing in mind that giving birth means a great physical activity and, as in any other of them can not be expected happy ending but it does have some prior learning or development.
The first observations of children attending diabetes camps support this idea (Gabriele & Marble, 1949). Sterky (1970) reported that juvenile diabetes experienced less glucosuria in this environment of high activity, and Kinsell (1955) described a 40% reduction in insulin doses in children with diabetes who went to the camps, which he attributed to exercise. These results may have been interfered with, both by the accompanying scheme, both for food control in the administration of insulin, but the first studies that show improvements in metabolic control after physical training support their conclusions.
Engerbretson (1965) observed a lower urinary secretion of glucose, lower blood glucose levels and lower insulin dose in 5 diabetics, after 6 weeks of interval training. Ludvigsson (1980) provided a financial questionnaire to 143 children and adolescents with diabetes, and found a positive correlation between regular physical activity and metabolic control (proportion of daily tests without glucosuria). However, when Larsson, Persson, and Sterky (1964) subjected to six children with diabetes to an exercise program of one hour a week for 5 months, no changes in urinary glucose. What was missing in these studies, plus a sufficient number of subjects and an appropriate exercise regime was satisfactory means for measuring metabolic control over a long period of training time.
In 1980, Dahl-Jorgensen, Meen, Hanssen, and first used Aagenaes levels of glycosylated hemoglobin (HbA1c) to assess the effect of physical training in children with diabetes. Glycated hemoglobin is that portion of total hemoglobin that is attached to a molecule of glucose and HbA1 concentrations in the circulation is a reflection of blood glucose levels during the average life span of red blood cells. Therefore, expressed in percentages of total hemoglobin, HbA1 serves as a valuable marker of glycemic control during the 4 to 6 weeks before their determination. Consequently, HBAL levels have become useful tools to monitor patients.
Dahl-Jorgensen et al. (1980) studied the effects of an exercise program for 5 months on HBAL levels in 14 diabetic children aged between 9 and 15. Although during training HBAL levels decreased, the results were weakened by methodological problems. At the end of the VO2 max program. not increased, suggesting that exercise intensity was low. Blood samples were frozen, and determined the levels of HBAL, 5 months after the end of the study. In 7 of 8 control subjects, the HBAL also declined, and not evaluated in this group the level of regular physical activity.
Campaign, Gilliam, Spencer, Lampman, and Schork (1984) found a beneficial effect of regular exercise on metabolic control in nine diabetic children 5 to 11 years of age. In these children, HBAL levels and fasting blood glucose decreased significantly after a training program for 12 weeks. However, in a second training study with 14 adolescents with juvenile diabetes, no significant improvements in the control group (Campaign et al., 1985). HBAL average levels remained unchanged in 12% (normal 7.1 ± 0.11%), after a 3-month program of aerobic exercise three times a week.
Prevention education
As usual, the “To be born healthy,” has continued to spread through courses and conferences, all members of the group ECEMC in different provinces across the country. In these activities, along with mailings, have distributed more than 27,000 copies of brochures, including the three leaflets of the Foundation 1000, on preventive measures, the SITE and folic acid. In addition, the Community of Castilla y León has reissued the brochure on the 20 questions for prevention, and is spreading throughout the Community. Even been translated into 6 languages, so you can reach the immigrant population. Also, has given us translations, and the Royal Board on Disability within the Foundation Programme 1000 “To be born healthy,” with whom he collaborated, make a great shot to spread throughout the country.
SPORTS TRAINING AND CONTROL OF DIABETES
The finding that acute exercise could lower blood glucose in diabetic subjects led to the hope that regular physical activity, or training, may help normalize blood sugar and reduce insulin requirements on a chronic basis. One would expect, on the other hand, this fact would reduce the complications of diabetes, the long term. Table 2 summarizes the results of studies examining this possibility, and these are discussed in subsequent sections.
METABOLIC EFFECTS OF ACUTE EXERCISE
The child with diabetes is a particular difficulty in regulating blood glucose during exercise, better understood in relation to the normal metabolic responses to physical activity in individuals without diabetes (Kemmer & Berger, 1983; Larsson, 1984; Vranic & Berger, 1979). During acute exercise series, the energy demands for more muscular contraction are met through increased oxygen delivery (increase in ventilation and cardiac output), and largest source of fuel (glucose, fatty acids). When you start the exercise, glucose derived from glycogen stored within muscle cells serves as the main source of energy. With increasing exercise intensity, this source is empty, and muscles and blood glucose seek circulating fatty acids.
With high stress loads, the energy requirements reach 10 to 20 sometimes needs rest, and this high rate of consumption of glucose in the blood quickly cause hypoglycaemia, if not for the constant replenishment of glucose by the liver. This is critical, since the maintenance of normal blood glucose levels is essential during exercise, both for normal brain function in maintaining the level of muscle energy substrates. The liver serves as a donor of glucose necessary during prolonged exercise, with its output quite similar to its use through the breakdown of liver glycogen (glycogenolysis) and the conversion of glucose formation from protein (gluconeogenesis) . A failure in hepatic glucose production during exercise, lead hipoglucermia and exhaustion.
This sequence of events is mediated a complex hormonal interplay involving decreased insulin and increased contraregulatorias hormones (catecholamines, cortisol, and glucagon). The drop in insulin levels with acute exercise increases the release of fatty acids from peripheral depots, and stimulates hepatic glycogenolysis and gluconeogenesis. Despite these low levels of insulin, it is clear a high consumption of glucose by muscle, a phenomenon perhaps explained by the increased sensitivity of muscle cells to insulin during exercise.
These metabolic events are not as well orchestrated by the diabetic patient. In these individuals, insulin levels are not determined by physiological responses to exercise, but for the moment and the amount of injected daily. Consequently, diabetic subjects experience no period of stable blood glucose levels, their levels vary according to the plasma insulin concentration, duration and intensity of exercise, site of injection, diet, and other factors.
Extreme during pregnancy to observe the general rules of personal hygiene, food and the surrounding environment. Consider using appropriate clothing, avoiding those that compression, prevent or impede circulation and normal fetal movements.
Pregnant women should avoid handling or toxic substances. Must also take care not to be close to deposits or stores such products or substances without proper security measures.
Avoid the pregnancy activities requiring considerable physical effort, which require to remain in harmful environments, or involve exposure to other hazards or risks. The exposure of pregnant women at high temperatures increase the probability of occurrence of certain central nervous system defects of the baby.
It is especially important that pregnant women take precautions in handling animals, as they can be transmitters of
