Diabetes treatment aims to prevent or subdue its complications if they are already present, hence it is all encompassing and has many other elemnts to it than just Blood Sugar control. Lifestyle modification with the help of diet control ( which is termed as MNT- Medical Nutrition Therapy by Diabetologists or Diabetes Specialist) and Exercise or increased physical activity are the primary intervention and if done properly one of the most effective ones. Most studies have shown that immediately upon diagnosis if Blood Sugar levels are not very high and patients are not too symptomatic and not having other problems, they should be given an option of strict lifestyle management, which alone may bring down HbA1C by 2-3 %. Lifestyle Modification consists of Dietary management and increased physical activity which should be done under the guidance of an experienced Diabetologist or Diabetes Specialist.
Exercise and Diabetes Therapy
How does it Help?
Increasing physical activity in our day to day lives and doing regular exercise has many benefits for Diabetics and works just like a medicine.
- Helps sensitize our body cells to the insulin thus improving the main defect in Type-2 Diabetes, So body has to depend lesser on external sources of Insulin - thus decreasing medication or Insulin dosage at the same time improving Blood Sugar Control.
- Exercising muscles burn calories thus utilizing excess fat and burning calories- this is helpful in decreasing weight with all ensuing benefits
- Exercise decreases Blood Cholesterol and Triglyceride levels and prevents and reverses atherosclerosis- blockage of Arteries supplying Vital organs like Heart , Brain, Kidneys and Lower limbs.
- Exercise is known to increase the HDL or protective Cholesterol
- Exercise increases blood flow to muscles so the blood vessels regain their elasticity
- Exercise is also Mood elevators and makes us feel good and happy due to neurotransmitters and Hormones screted by the brain during exercise
Which Exercise is recommended ?
Aerobic exercise s which include plenty of muscle movements like Walking, Jogging, Swimming, cycling Outdoor games like Tennis, Football, Volleyball etc are recommended .
How long to exercise ?
It is recommended to exercise 30-45 mins daily - considering your weight, Blood Sugar values,medications , co-existing diseases (if you do not have any heart, kidney or Retina problems) and levels of activity a Diabetologist would recommend the appropriate duration and type of exercise for you. It is always preferable to consult your Diabetes Specialist or Diabetologist in Delhi to find out which are the best and most beneficial exercises for you.
Who Should not Exercise?
Diabetics should consult a Diabetologist or physician before initiating any intensive physical activity. Not all Diabetics are advised all Exercises and some may be harmful as well especially if they have complications like Nephropathy, Retinopathy, Foot Ulcers, CAD. But in majority of Diabetics exercise is beneficial. An extensive discussion is beyond the scope of this article.
Walking – or for that matter any aerobic physical exercise gives the benefit of reducing blood glucose, decreasing insulin resistance in the body, decreasing Diabetes medication, Decreasing Blood pressure, Decreasing blood cholesterol, Increasing blood flow to the heart, Strengthening joints, Decreasing weight – elevating mood socializing – just to name a few. Walking for 30-45 mins a day for 5 days a week is also sufficient to produce these effects, but it should be sustained. Start walking slowly- take a warm up period of 10 mins build up pace so that you feel an increase in your breath and heart rate, do not wind up instantly – slow your pace, allow for cool down period as well of 10 mins.Walking perhaps is one of the best exercises possible for Diabetics. Walk Fast- Walk more
Precautions while walking: If you've ever suffered a Heart Attack or have been Diagnosed with CAD ( Coronary Artery Disease) do not walk fast, walk slowly, if ever feel pain or heaviness in chest - consult your Doctor.
Diabetes Medicines
Diabetes Medicines are prescribed by Diabetologist or other Attending Doctor when Diabetic Diet and Exercise do not bring down Blood Sugar levels to Normal. The following information does not serve to be prescription or recommendation of any type , please consult your Diabetologist or Physician about individual treatment options, DO NOT INDULGE in self medication as it may be very Harmful in Diabetes, watch the perils of Self medication explained by Diabetologist in Delhi Dr Rajesh Kesari by clicking here.. Diabetes Medicines may broadly Divided into Anti Hyperglycemic medicnes ( Which do not allow Blood Sugar levels to increase above normal) and Oral Hypoglycemic Agents ( OHA) or Insulin or other injected Hypoglycemic agents ( Which may bring down Blood Sugar levels from any baseline level).
The most commonly used diabetes medicines in India are:
Insulin Sensitizers:
Make the cells of body more responsive to insulin being produced in the body thus lowering circulating Blood Sugar levels and decreasing the stress on pancreas to produce more Insulin Examples are Biguanides, Thiazolidenidiones. The Advantage of Insulin sentitizers is they almost never cause Hypoglycemia when taken alone favourably affect Cholesterol and some of them may decrease weight as well...
SGLT2 inhibitors:
These are now called Wonder Drugs- and have become very popular with Diabetes Specialist as they have proven to be very beneficial for Diabetes Patients. This group of drugs has been newly introduced in the armamentarium of Diabetes treatment, they work through a novel mechanism of loosing the excess Glucose present in the Blood through Urine. These drugs have many beneficial effects they help in weight loss as well, some of them have proven to increase lifespan and delay Kidney problems preventing and treating Heart Failure which is a common and serious problem in Diabetes patients. Researchers are also looking forwards to using this medicine in Type I Diabetes patients to decrease Insulin dosage.
Secretagogues:
Stimulate the pancreas to secrete Insulin insulin when “asked “ to do so.They literally “squeeze” out all the insulin stores from the Beta cells, Different types of such medicines are widely used varying in time of action, frequency of dosage, safety profile etc.. your doctor is the best judge on which one to prescribe.
Alpha Glucosidase Inhibitors:
They block the absorption of Glucose in the small intestine thus increasing the time period over which same amount of Glucose present in the food item is absorbed, if the Blood Sugar levels increase after meals or are not very high, these are very effective. But if a person taking any of this medicine develops hypoglycemia oral Glucose does not help as it is also not absorbed. Acarbose, Miglitol and the recent addition is Voglibose to this group of medicines.
DPP-4 Inhibitors:
By virtue of their complicated actions inside the intestines they do not allow Blood Sugar to rise after meals, they do not act directly on the Insulin producing Beta cells but rather their beneficial effect is due to the action on Alpha cells of pancreas by suppressing Glucagon- the Blood Sugar raising Hormone as opposed to Insulin.
Injectables:
Insulin:
This is identical to the insulin produced by the Pancreas which is deficient or ineffective in Diabetics. Insulin can only be taken by injections because it is degraded by liver if taken by mouth and rendered useless. There are different types of insulins available commercially with varying time period of action, from ultra short acting to ultra long acting. Different types of Insulin may be used together in a patient. Insulin is the only treatment option for Type I Diabetics.
GLP-I analogues
Or Glucagon Like Peptide -1 analogues - Decrease Blood Sugar by lowering Glucagon levels, they are ineffective in Type I Diabetics and can only be used for the treatment of Type II Diabetes. These have been relatively recently added to the Diabetes treatment armament, major side effects noted so far are vomiting and associated Gastric disturbances. Cost of these injects is also prohibitive for the majority of Diabetes patients.
Insulin is a Diabetics best friend
Insulin is not a monster, It’s the best friend a Diabetic patient may have..
The root cause of Diabetes is lack of Insulin, wether relative or complete..all medicines that are given orally somehow try to manipulate secretion or action of Insulin, except some new agents ( like Januuvia, Trajenta, Galvus, Byetta etc.) which may to some extent be acting by other mechanisms as well, but they also are not fail safe.
Insulin is the only dependable sure shot therapy in Diabetes, When everything else fails only Insulin helps. This has become one of the drawbacks of Insulin, people have started associating Insulin with Last stage of Diabetes, as they generally start late on Insulin when everything else has failed and patients are suffering from life threatening complications of Diabetes.
When a diabetic is suffering from complications like Kidney failure, Diabetic foot, or other acute infections, oral medicines have to be stopped and Insulin is used to control Sugar levels.
One of the greatest advantage of Insulin is the possibility of dose titration, its dosage can be varied from few units to few hundred units, thus invidualized for every patients and even for the same patient may be modified depending on circumstances.
Side effects- there may be 2 undesirable side effects of Insulin, weight gain and Hypoglycemia – low Blood Sugar levels. Weight gain is moderate and avoidable- even if its there, usually 2-3 kgs and not more, Hypoglycemia may also be avoided by timely modifying the dosage and taking proper meals…