Training the Juvenile Diabetic

By Carlos Alberto Rivas, M.S., C.S.C.S.

Nobody welcomes a disease. However, it is not what happens to you, but rather how you react to it that matters. There are a few fundamental concepts that each juvenile diabetic must embrace in order to manage diabetes properly. And, for trainers, the health status of the individual should always be a major consideration; it determines the intensity and duration of exercise.

EXERCISE GUIDELINES

Engaging in a consistent program of cardiovascular exercise is important. The American College of Sports Medicine (ACSM) recommendations are as follow: perform exercise bouts of 30-60 minutes 5-6 days per week at low to moderate intensity. Walking, riding the stationary bike, using a treadmill or elliptical trainer, swimming, etc. may accomplish the cardiovascular session. Remember, the best exercise for you is the one you like doing. For resistance training, the ACSM recommends the following: perform 8-10 exercises, 12-15 repetitions for all major muscle groups 2-3 times per week on nonconsecutive days with low to moderate weights.

REASONS TO EXERCISE

• Cells of exercising muscles can extract glucose from the blood much more efficiently than those of resting muscles.
• Exercise is a powerful tool that can lower blood sugar levels and reduce the amount of insulin.
• Exercise increases the cell sensitivity to insulin. Therefore, as sensitivity increases, the insulin requirements begin to decrease.
• Exercise reduces the "stickiness" of blood, which could lead to a clot.
• Consistent exercise can help prevent damage to the eyes and kidneys in the insulin-dependent diabetic.

THE CHALLENGES

• Personal and family lifestyles play a major role in the control of diabetes. The goal should be to have the entire family participate in regular physical activity. It is much easier for the diabetic to maintain their exercise program when an entire family is actively engaged in overall wellness including proper eating habits and proper cardiovascular and resistance training.
• The timing of meals and exercise is extremely significant. The pump enables you to have a constant feed of insulin throughout 24 hours while pumping additional insulin prior to major meals. For those who inject their insulin, it is imperative that you eat and exercise regularly at the same times each day. This helps regulate the insulin uptake and create more of a balance in the day.
• Stress is a major contributor to high blood sugar in a diabetic. You should be aware that a simple cold or flu would dramatically alter blood glucose levels. It is advisable that you avoid exercise until any health crisis is handled.
• The most common concern for a trainer who is working with diabetic clients is to know the signs and symptoms of hypoglycemia (low blood sugar). Carry some hard candy or sugar packets with you in case of a hypoglycemic emergency.
• Hyperglycemia (high blood sugar) can be managed by being fully hydrated and by avoiding exercising until glucose levels stabilize.

THE BOTTOM LINE

Studies have shown that engaging in a consistent exercise program of cardiovascular exercise and resistance training will greatly support the body's ability to properly utilize the insulin and balance internally the hormones that help to keep glucose levels stable. But, finding a trainer who is skilled and knowledgeable about diabetes is a challenge for the diabetic. The exercise leader must know the health status of the client in order to individualize exercise variables such as intensity, duration and type.

Carlos Alberto Rivas, M.S., C.S.C.S., is the fitness/personal training director at the Baptist East/Milestone Wellness Center. Carlos has a master's degree in exercise physiology and has over 10,000 hours of personal training experience. He is also a member of Kentuckiana HealthFitness magazine's editorial advisory board. Carlos can be reached by phone at 502-896-3900, ext.142.