The presence of malaise, nausea, and anorexia during illness
may deter patients from eating, yet food is needed to avoid
hypoglycaemia following insulin administration, which should
never be stopped . Suitable foodstuffs for use at
this time are shown in the box.
Weight control:
the role of exercise
Weight control towards optimal levels yields considerable
health benefits to all, notably in this context to those who have
the combined disadvantages of being overweight and having
Type 2 diabetes.
Exercise has a central role in weight reduction
and health improvement. The proven benefits include reduced
insulin resistance (hence enhanced insulin sensitivity) leading
to better glycaemic control which may even be independent of
actual weight reduction. Risk factors for cardiovascular disease
which include high blood pressure, also diminish. Indeed, the
prevention of Type 2 diabetes itself in those at high risk has
been amply demonstrated (see page 6).
People withosteoarthritis, chronic heart failure, and chronic lung disease
all benefit from appropriate exercise programmes and weight
reduction, and there are advantages to those recovering from
myocardial infarction.
A healthier life is also gained by the very
old and by the overweight child. For those with Type 2 diabetes
it is recommended that exercise of moderate intensity should
be undertaken for about 30 minutes each day. This can include
walking, as well as both aerobic and resistance exercise.
The effects of exercise in Type 1 diabetes present the
hazard of hypoglycaemia and it is not a specific contributor to
improvement of diabetes control.
Advice is required on the use
of insulin and the need for additional food (in particular
carbohydrate) before, during, and after periods of exercise
especially (since hypoglycaemia may develop after cessation of
exercise) for those engaged in major sports and athletics. The
challenge for sportsmen can be extreme but nevertheless
people with Type 1 diabetes are known for huge achievements.
Great credit went to Sir Steven Redgrave for his ingenious food
and insulin regimen which enabled him to win a rowing gold
medal in the 2000 Olympic Games.
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