Articles/Writing

Working with clients with type 1 diabetes

PT Magazine - 2014
PT Magazine – 2014

Type 1 Diabetes Mellitus (T1DM) is the less common form of the disease with only 10% of diabetics suffering with this form of diabetes as opposed to 90% who suffer with type 2 diabetes. The condition once identified is one that can easily be managed using medication and ensuring a healthy and active lifestyle. Many T1DM sufferers have traditionally stayed away from exercise in fear of suffering a diabetic episode. However exercise is actually a very positive thing for a diabetic to do, this is a view reflected by the medical profession and echoed by Diabetes UK.

 

If we look at what actually causes T1DM, simply this is a condition where a person’s pancreas does not produce insulin. As insulin is a key hormone in the regulation of blood sugar, this means that glucose levels in the body may be poorly regulated.

 

Exercise is important to a diabetic as it helps to improve blood glucose control, as exercise has an insulin type effect. It also helps to reduce excess body weight and then keep it under control. Exercise also helps to reduce blood pressure, resulting in a knock on effect on overall health risk.

 

If diabetes is poorly controlled then it leaves the sufferer open to a number of additional complications including hypertension, loss or reduction in vision, reduced kidney function and a spiralling decline in blood glucose control. Many diabetics suffer greatly with renal issues as the system becomes overloaded as they body try’s to excrete excess glucose. This is what gives a diabetic a constant thirst as they try and flush the excess sugar through the system and their urine then increases in levels of glucose.

 

Other signs and symptoms include slow wound healing, recurrent infections, diabetic ketoacidosis (DKA) leading to sweet/fuity smelling breath, and hypercholesterolemia.

 

It is recommended that T1DM clients take part in aerobic activity on 5 days per week, building up to 30 minutes, at an intensity of around 40-70% of heart rate maximum. In early stages of exercise it may be necessary to split the training time across two sessions in the day, allowing clients to slowly build up to this 30 minute target.

 

In terms of resistance training a full body resistance programme should be implemented 2-3 times per week. The client should aim to work in the hypertrophy zone using a single set of 8-12 reps. A key precaution for resistance based exercise is to stay away from recent injection sites, in terms of muscles worked.

 

A general stretching routine (done 2-3 times per week) would also be very beneficial, this should cover the full body and stretches should be held for 15-30 seconds.

 

Generally when training clients with T1DM the following precautions should be taken:-

 

  • If the condition is currently considered uncontrolled, it may be wise to refer the client until they have the condition controlled.
  • You should ask the client to check their pre exercise glucose levels to ensure they are within their normal levels.       However if levels are high, meaning above 13 mmol/l they should be referred to their doctor or diabetes nurse to be checked over.
  • Exercise 1-2 hours after meals to ensure adequate glucose/glycogen stores are available.
  • Ideally any injection sites should be away from areas that will be predominantly used for exercise, the current sites need to be recapped on by the fitness professional as a site rotation system may be being used.
  • Be aware of delayed hypoglycemia which may occur 36 hours after intense exercise, the client should be made aware of this and encouraged to monitor blood glucose levels.
  • Carry fast acting carbohydrate snacks incase the clients blood glucose levels fall rapidly.
  • Drink plenty of water before and after the sessions.
  • Regular foot inspection to identify any potential issues and if observed refer to a medical professional.

 

On the whole exercise should be seen as a very positive thing for a T1DM to take part in, as it may help to stabalise their condition. It may also help them to feel more confident and improve overall health, with in some cases allowing a reduction in the use of medications and a reduction in the risk of diabetes related complications.

Tom has been involved in the fitness industry for nearly 20 years. He is a specialist in rehabilitation, exercise referral and helping other fitness professionals to improve their business. He is also involved with course development, teaching, assessing and IQA of a range of training courses. He is always willing to meet other professionals so please do contact him via social media with any questions or just to say hello.

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