Diabetes is a disease that affects millions of people. Olympic champions such as weightlifter Matthias Steiner or tennis pro Alexander Zverev are also among those affected. However, if you suffer from type 1 diabetes like the two athletes, you have to be careful when training.
“Type 1 has a high risk of hypoglycaemia,” explains physiologist and diabetes expert Othmar Moser University of Bayreuth in conversation with inFranken.de. Due to the autoimmune disease, the body produces little or no insulin. However, the hormone is necessary to regulate blood sugar. Sick people have to inject insulin regularly throughout their lives so that there is no metabolic imbalance. Since the body needs more energy when exercising, diabetics can have hypoglycaemia faster. “In any case, the therapy plan must be adjusted with the doctor,” advises Moser. The basic rule is: less insulin, more carbohydrates.
Patients should therefore inject less insulin at the last meal before training. The background is that the hormone has a stronger effect when the muscles are active, describes diabetologist Gerhard Schmeisl from Bad Kissingen in the specialist journal Diabetes Journal.
On the other hand, the amount of carbohydrates consumed should be increased before exercise. “With every short-term effort (e.g. an hour of swimming, an hour of cycling), around 12 grams of carbohydrates should be eaten in addition to long-acting carbohydrates every half hour,” says Schmeisl. The so-called slow carbohydrates are found, for example, in wholemeal bread, nuts, legumes or salad. They are “slow” because it takes a while for them to be broken down into sugar in the digestive tract.
Keeping an eye on blood sugar: CGM is so important for diabetics when exercising
In addition, Moser recommends taking in “fast” carbohydrates as needed during exercise. This could be, for example, a banana, a pretzel or fruit juice. The classic grape sugar is also suitable for this.
But the most important thing for diabetics when exercising is probably measuring their blood sugar. Both before and after training as well as during it. A “CGM” (Continuous Glucose Monitoring) is best suited for this. The devices continuously measure the glucose content in the tissue via a sensor under the skin. The values are then sent to a receiving device, which is also possible with a smartphone. Almost all diabetes patients now use CGM, says Moser. “We also recommend it to everyone because it improves the glycemic control significantly.”
If you always keep an eye on your blood sugar, you can also avoid hypoglycaemia during or after exercise. This can even happen hours later, Schmeisl speaks of the “muscle replenishment effect”. The body wants to replenish its sugar stores in the liver and muscles, causing the blood sugar level to drop. This effect should not be underestimated. It may be necessary to eat slow carbohydrates before bed to avoid hypos at night. You can read about the symptoms of low blood sugar here.
But if exercise seems so dangerous for people with type 1 diabetes, why is it recommended? Regular exercise can help diabetics save on insulin, as it is a natural way to lower blood sugar levels. In the long run, patients also need less insulin because the body responds better to the hormone. Even with less insulin, the cells can then be sufficiently supplied with sugar.
At the same time, exercise lowers the risk of comorbidities such as high blood pressure, obesity or type 2 diabetes. The latter is referred to as “double diabetes”. But in contrast to type 1 diabetes, this form can be cured if the disease lasts for a short time – including through sport. In type 2 diabetics, only insulin resistance has developed, and the hormone is no longer effective. Regular exercise and a healthy diet can improve the effect of insulin again.
However, those affected should first speak to a doctor and obtain permission to exercise. In the case of certain comorbidities, a heart check using a stress ECG may be necessary beforehand. However, pre-existing conditions are usually not a reason against sport. “So far there hasn’t been a patient for whom we haven’t found anything. Even with many serious comorbidities, we give individual exercise recommendations, you just have to be imaginative,” says Moser from his experience in the diabetes outpatient clinic at Graz University Hospital.
What exercise is best for people with diabetes?
His recommendation for all diabetics is at least 150 minutes of exercise per week, spread over about three to four units. “Of course, a combination of endurance and strength training would be ideal,” explains the scientist. The type of sport is not decisive in therapy. “We always tell our patients: try to find something that you enjoy and that you can imagine doing permanently.”
Long term should be best sport-fitness/fitnessroutine-entwickeln-wie-du-langfristig-durchhalten-kannst-mit-trainingsplan-vorschlag-art-5660982" title="Fitnessroutine entwickeln: Wie du langfristig durchhalten kannst - mit Trainingsplan-Vorschlag">establish a training routine. Jogging, cycling or swimming, for example, are suitable for endurance. Strength training can be classic weight lifting with dumbbells or equipment in the gym, but also exercises with your own body weight. Patients can either split up their training per day or train endurance twice a week and train strength once and vice versa the next week. Sports that require strength and endurance, such as football, basketball or crossfit, are of course also suitable.
In addition, the experts recommend increasing physical activity in everyday life. For example, taking the stairs instead of the elevator or walking or cycling shorter distances instead of driving. Simply increasing exercise in everyday life is actually not enough for diabetes therapy. “We only do that in emergencies, when people say they don’t have time for sports. It’s better than nothing,” Moser said.
Sport is a good therapy option for diabetics. People with type 1 diabetes can save insulin through exercise and reduce the risk of comorbidities, such as type 2 diabetes. Those affected by type 2 diabetes can be cured by physical activity, among other things, if the disease lasts only a short time. This is because exercise improves your insulin resistance and over time it will completely clear up. Diabetics should seek medical advice beforehand and adapt their therapy plan to their training. Experts recommend at least 150 minutes of exercise per week, divided into three to four training sessions. A combination of strength and endurance would be ideal. But it is more important to find a sport that you enjoy. Because if you cannot imagine keeping up the training permanently, it is not suitable for treatment either.
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