How does lifting weights benefit individuals with type 2 diabetes. What are the specific advantages of strength training for blood sugar control. Why should people with diabetes incorporate weight lifting into their exercise routine. How does strength training protect against diabetes complications.

The Impact of Strength Training on Blood Sugar Regulation

Strength training has emerged as a powerful tool for managing type 2 diabetes, offering benefits that complement and sometimes surpass those of traditional aerobic exercise. Recent research published in the Internal Journal of Cardiology indicates that for individuals with type 2 diabetes, strength training can be more effective in regulating blood sugar levels compared to cardiovascular exercises alone.

Why is strength training so effective for blood sugar control? The answer lies in how our bodies use energy during resistance exercises:

• Utilization of glycogen stores: During strength training, the body primarily relies on stored muscle glycogen for fuel.
• Blood glucose mobilization: As muscle glycogen depletes, the body taps into liver and blood glucose reserves, directly lowering blood sugar levels.
• Increased glucose storage capacity: Trained muscles have a higher capacity to store blood glucose as glycogen, further aiding in blood sugar management.

These mechanisms work together to create a more efficient glucose management system in the body, making it easier for individuals with type 2 diabetes to maintain healthy blood sugar levels.

Combining Strength Training with Aerobic Exercise: The Optimal Approach

While strength training alone offers significant benefits, research published in JAMA suggests that the most effective results come from combining strength training with aerobic exercise. This integrated approach provides a comprehensive strategy for managing type 2 diabetes and improving overall health.

The American Diabetes Association (ADA) recognizes the importance of this combined approach. In their November 2016 position statement, they recommended that adults with type 2 diabetes should:

1. Engage in at least 150 minutes of moderate- to vigorous-intensity physical activity per week (or 75 minutes of high-intensity exercise)
2. Incorporate strength training at least two to three times per week

This balanced exercise regimen ensures that individuals with type 2 diabetes receive the full spectrum of benefits from both aerobic and resistance training, optimizing their diabetes management and overall health.

The Multifaceted Benefits of Weight Lifting for Diabetes Management

Weight lifting offers a range of advantages for individuals managing type 2 diabetes, extending beyond blood sugar control. Let’s explore these benefits in detail:

Enhanced Weight Loss and Body Composition

Can weight lifting contribute to weight loss in individuals with type 2 diabetes? Absolutely. Strength training promotes fat loss through multiple mechanisms:

• Calorie burn during workouts
• Increased lean muscle mass, which boosts resting metabolic rate
• Targeted reduction of harmful visceral fat

Research has shown that losing just 5 to 10 percent of body weight can lead to improvements in A1C scores, which measure average blood sugar levels over two to three months. By promoting fat loss and increasing muscle mass, strength training becomes a powerful tool in achieving and maintaining a healthy weight for better diabetes management.

Targeting Visceral Fat: A Key Player in Insulin Resistance

Visceral fat, the type of fat that accumulates around internal organs, plays a significant role in exacerbating insulin resistance and complicating blood sugar management. How does strength training address this issue?

High-intensity resistance training has been shown to be particularly effective at reducing visceral fat levels. This is crucial because visceral fat cells not only store energy but also produce chemicals and hormones that inhibit the body’s effective use of insulin. By targeting this harmful fat, strength training directly addresses one of the key factors contributing to insulin resistance in type 2 diabetes.

Protecting Against Diabetes Complications Through Strength Training

Beyond its direct impact on blood sugar levels and insulin sensitivity, strength training offers protection against various complications associated with type 2 diabetes:

Cardiovascular Health Improvements

How does strength training benefit heart health in individuals with diabetes? The cardiovascular benefits are multifaceted:

• Increases levels of good cholesterol (HDL)
• Reduces levels of bad cholesterol (LDL)
• Helps lower high blood pressure (hypertension)

Given that type 2 diabetes is a leading risk factor for heart disease, these cardiovascular benefits of strength training are particularly significant. By improving cholesterol profiles and blood pressure, weight lifting helps mitigate the increased cardiovascular risk associated with diabetes.

Bone Health and Density

Individuals with type 2 diabetes often face an increased risk of osteoporosis and fractures. How can strength training help? Weight-bearing exercises and resistance training have been shown to increase bone density, providing a crucial defense against these risks.

By stimulating bone formation and slowing bone loss, strength training helps maintain skeletal integrity and reduces the risk of fractures, which is especially important for older adults with diabetes.

Implementing a Safe and Effective Strength Training Program

While the benefits of strength training for individuals with type 2 diabetes are clear, it’s essential to approach this form of exercise with proper guidance and precautions. How can one safely incorporate weight lifting into their diabetes management plan?

Consulting with Healthcare Providers

Before starting any new exercise routine, including strength training, individuals with type 2 diabetes should consult with their healthcare provider. This step is crucial for several reasons:

• Assessing individual health status and fitness level
• Identifying any diabetes-related complications that may impact exercise choices
• Developing a personalized exercise plan that takes into account specific health needs and goals

Healthcare providers can offer valuable insights into how to safely integrate strength training into an existing diabetes management plan, ensuring that the benefits are maximized while minimizing any potential risks.

Tailoring the Program to Individual Needs

A successful strength training program for individuals with type 2 diabetes should be tailored to their specific needs and health status. What factors should be considered when designing such a program?

• Current fitness level and exercise experience
• Presence of any diabetes-related complications (e.g., neuropathy, retinopathy)
• Individual goals and preferences
• Available equipment and resources

By taking these factors into account, a personalized strength training program can be developed that is both safe and effective, maximizing the benefits for blood sugar control and overall health.

Overcoming Barriers to Strength Training for Diabetes Management

Despite the clear benefits, some individuals with type 2 diabetes may face barriers to incorporating strength training into their routine. What are some common obstacles, and how can they be addressed?

Lack of Knowledge or Experience

Many people may feel intimidated by weight lifting or unsure of how to begin. To overcome this barrier:

• Seek guidance from a certified fitness professional with experience in working with individuals with diabetes
• Start with beginner-friendly exercises and gradually progress
• Utilize online resources and instructional videos from reputable sources

Fear of Hypoglycemia

Some individuals may worry about the risk of low blood sugar during or after exercise. To address this concern:

• Monitor blood glucose levels before, during, and after workouts
• Adjust medication or carbohydrate intake as advised by a healthcare provider
• Always have a quick-acting source of glucose available during exercise

Time Constraints

Finding time for exercise can be challenging. To make strength training more accessible:

• Incorporate short, high-intensity sessions into a busy schedule
• Consider home-based workouts using bodyweight exercises or minimal equipment
• Combine strength training with other daily activities or hobbies

The Future of Strength Training in Diabetes Management

As research continues to uncover the benefits of strength training for individuals with type 2 diabetes, what might the future hold for this approach to diabetes management?

Personalized Exercise Prescriptions

Advancements in genetic testing and personalized medicine may lead to more tailored exercise prescriptions, including specific strength training protocols based on an individual’s genetic profile and diabetes characteristics.

Technology Integration

The integration of wearable technology and smartphone apps may provide real-time feedback on blood glucose levels during strength training sessions, allowing for more precise exercise adjustments and improved safety.

Expanded Research

Ongoing studies may uncover additional benefits of strength training for diabetes management, potentially leading to more refined guidelines and recommendations from diabetes organizations worldwide.

As our understanding of the relationship between strength training and diabetes management continues to grow, individuals with type 2 diabetes can look forward to increasingly effective and personalized approaches to incorporating weight lifting into their overall health and wellness strategies.

Nutrition Considerations for Strength Training with Diabetes

Proper nutrition plays a crucial role in supporting strength training efforts and managing blood sugar levels for individuals with type 2 diabetes. How can nutrition be optimized to enhance the benefits of weight lifting?

Pre-Workout Nutrition

Eating the right foods before a strength training session can help maintain stable blood sugar levels and provide energy for the workout. Consider the following guidelines:

• Consume a balanced meal containing carbohydrates and protein 2-3 hours before exercising
• If needed, have a small snack 30-60 minutes before the workout
• Monitor blood glucose levels and adjust food intake accordingly

Post-Workout Nutrition

After strength training, proper nutrition is essential for recovery and blood sugar management. Key considerations include:

• Consuming a combination of protein and carbohydrates within 30 minutes of completing the workout
• Choosing whole foods that provide sustained energy and promote muscle recovery
• Staying hydrated to support overall health and exercise performance

Working with a registered dietitian who specializes in diabetes can help create a personalized nutrition plan that complements strength training efforts and supports overall diabetes management goals.

Measuring Progress: Tracking the Impact of Strength Training on Diabetes Management

To fully appreciate the benefits of strength training for diabetes management, it’s important to track progress over time. What metrics should individuals monitor to assess the impact of their weight lifting efforts?

Blood Glucose Monitoring

Regular blood glucose checks before, during, and after strength training sessions can provide valuable insights into how exercise affects individual blood sugar levels. Over time, this data can help in fine-tuning exercise routines and diabetes management strategies.

A1C Levels

Periodic A1C tests, which measure average blood sugar levels over the past 2-3 months, can demonstrate the long-term impact of consistent strength training on overall glucose control.

Body Composition Changes

Tracking changes in body weight, body fat percentage, and muscle mass can highlight the positive effects of strength training on body composition, which is closely linked to insulin sensitivity and overall health.

Strength and Functional Improvements

Monitoring increases in strength, endurance, and overall functional capacity can provide motivation and demonstrate the broader health benefits of a consistent strength training program.

By regularly assessing these metrics, individuals with type 2 diabetes can gain a comprehensive understanding of how strength training is impacting their health and diabetes management, allowing for ongoing adjustments and optimization of their exercise routines.

Why You Should Be Lifting Weights if You Have Type 2 Diabetes

No one’s disputing the benefits of regular aerobic exercise for diabetes management. Running, walking, swimming, and biking can all help you keep your blood sugar level in check while boosting your overall health.

But now scientists are finding that people with diabetes can benefit from regular weight lifting, or strength training, as well. In fact, research in the Internal Journal of Cardiology shows that in people with type 2 diabetes, strength training can be more beneficial to blood sugar regulation than cardio,” says Audra Wilson, RD, CSCS, a bariatric dietitian and strength and conditioning specialist at the Northwestern Medicine Metabolic Health and Surgical Weight Loss Center at Delnor Hospital in Geneva, Illinois. That said, she points out that research in JAMA shows the best results come when strength training combines with aerobic exercise.

That’s why in a November 2016 position statement the American Diabetes Association (ADA) recommended that, in addition to performing at least 150 minutes of moderate- to vigorous-intensity physical activity per week (or 75 minutes of high-intensity exercise), adults with type 2 diabetes strength train at least two or three times per week.

RELATED: 6 Great Exercises for People With Diabetes

Before starting any new exercise routine, it’s important to talk with your doctor about any special considerations you need to make. Complications of type 2 diabetes, such as heart disease, peripheral neuropathy, diabetic retinopathy, blood pressure issues, and osteoporosis, can influence which forms of exercise (and strength training) are healthiest for you, according to the ADA.

So what’s so great about weight lifting with type 2 diabetes?

Lifting Weights May Make Managing Type 2 Diabetes Easier

Diabetes is marked by the body’s inability to process glucose and use insulin efficiently, but strength training can help with those issues in various ways.

Burns Up Blood Sugar

Strength training relies primarily on the body’s glycolytic, or glucose using, metabolic system for energy. “As we go through a strength-training workout, we use stored muscle glycogen for fuel,” explains Nick Occhipinti, CSCS, an exercise physiologist based in Red Bank, New Jersey. “Once this stored muscle glycogen runs out, we start to mobilize extra glycogen from the liver and from the blood. This helps to directly decrease blood glucose as well as deplete stored muscle and liver glycogen stores, giving blood glucose a place to go next time we eat.”

Improves Glucose Storage

Your muscles serve as storage facilities for consumed sugar and carbohydrates. “Trained muscle has a higher capacity to store blood glucose in the form of glycogen, aiding in lowering blood glucose,” he says. That means lowered blood sugar levels and easier glucose management.

Spurs Weight Loss

In people carrying extra weight, losing 5 to 10 percent of your body weight can improve A1C scores, the two- to three-month average of blood sugar levels, according to John Hopkins Medicine. Apart from burning calories during your workouts, strength training promotes fat loss by increasing levels of lean muscle mass. “Muscle is one of the few metabolically active tissues in the body at total rest,” explains Occhipinti. “This means that even as we sit around and watch football or sit at a desk and work, the muscle we have on our body is serving to burn calories.”

Targets Harmful Belly Fat 

Abdominal fat, also called visceral fat because it resides in and around the body’s visceral organs, exacerbates insulin resistance and complicates blood sugar management, he says. He explains that, in addition to storing energy, visceral fat cells produce chemicals and hormones that inhibit the body’s effective use of insulin. Fortunately, high-intensity resistance training is effective (even more than cardiovascular exercise) at reducing visceral fat levels and managing blood sugar in people with insulin resistance, per the Internal Journal of Cardiology research.

RELATED: Lose Belly Fat Fast With This Diabetes-Friendly Exercise Routine

Strength Training Helps Protect Against Diabetes Complications

By improving insulin health and lowering high blood sugar levels, strength training helps guard against some of the complications of type 2 diabetes. But it also takes on diabetes complications in other ways, too.

Improves Heart Health 

Type 2 diabetes is a leading risk factor in the development of heart disease, according to the Centers for Disease Control and Prevention. Fortunately, strength training increases levels of good cholesterol in the body while reducing bad levels, Occhipinti says. Research in the Journal of Human Hypertension shows it also helps lower hypertension, or high blood pressure.

Boosts Bone Density

While people with type 2 diabetes often have normal bone mineral density scores, they are at a heightened risk of bone fracture, according to a study published in January 2016 in the journal Bone. Weight-bearing strength training, especially performed from a standing position, builds strength in the bones of the legs, spine, and hips to reduce the risk of bone breaks, Wilson says.

Prevents Age-Related Muscle Loss

Building muscle through strength training directly combats the muscle loss that can occur through the decades. According to the ADA position statement, type 2 diabetes is an independent risk factor for accelerated declines in muscle strength. Research published online in January 2017 by PLoS One has linked severe age-related muscle degradation, called sarcopenia, to loss of physical function, cancer, and depression, and an increased risk of early death.

Reduces the Risk of Peripheral Neuropathy and Vision Loss

“When we have chronically high blood sugar, glucose molecules start attaching themselves to everything, including our red blood cells. This can prevent healthy blood flow many places in the body where we have very small blood vessels,” Occhipinti says. It just so happens that the eyes and nerves of the hands and feet have these small vessels. When these areas don’t get the blood flow they need, peripheral neuropathy and diabetic retinopathy can result. Strength training improves blood flow to reduce the risk of these complications, Occhipinti explains.

RELATED: 7 Ways to Stay Motivated to Exercise When You Have Type 2 Diabetes

6 Tips for Starting to Strength Train with Diabetes

The ADA suggests that people with type 2 diabetes engage in two or three strength-training sessions per week, on nonconsecutive days. Here are some strategies to help you get the most benefits from your strength-training sessions.

1. Talk to Your Healthcare Team

As with any exercise program, check with your healthcare team before starting a weight-training regimen. Especially important is to discuss is your blood sugar management. “People don’t typically associate strength training with low blood sugars, but some patients will have significant impacts on blood sugar with strength training,” Wilson says. Your doctor may recommend testing your blood sugar level before, during, and after exercise, as well as eating carbohydrates around workout time to prevent or address hypoglycemia, she says.

2. Ask for Help 

“To gain more health benefits from physical activity programs, participation in supervised training is recommended over nonsupervised programs,” Wilson says. For some guidance, consider working out with a certified trainer or joining a weight-training class. These are offered both in person and online.

3. Focus on the Body’s Largest Muscle Groups

Work on your glutes, hamstrings, quads, lats, traps, and chest. Some of the best strength exercises to target such groups are compound, multijoint movements such as squats, lunges, dead lifts, hamstring curls, rows, lat pull-downs, chest presses, and push-ups, Occhipinti says.

4. Follow a Plan

Mapping out what you want your workouts to look like can help you make and keep a routine, Wilson says. If you plan to strength train two or three times per week, you’re better off making all of your workouts total-body ones. However, if your strength training is going to be more frequent, such as four or five days per week, alternating between upper- and lower-body workouts, or push and pull workouts, can help ensure that each muscle group still gets the recovery time it needs, she says. Every now and then, try new variations of your favorite exercise, or alter the number of sets or reps you are doing, to keep your workouts, and results, progressing.

5. Prioritize Recovery 

Giving yourself one, if not two, days in between working a given muscle group can help give it time to repair, Wilson says, while still training it with sufficient frequency to adapt and grow. Great options include foam rolling, stretching, and low-intensity cardio like walking or cycling.

6. Consider Multiple Tools

Yes, barbells, dumbbells, and weight machines can be useful strength-training tools, but they aren’t mandatory, Occhipinti says. Resistance bands, filled duffle bags, and other household items are effective in loading the muscles and are especially great for helping you get in more at-home workouts.

RELATED: 8 Ways to Sit Less and Move More Each Day

Building Muscle with Diabetes

Having diabetes won’t stop you from building muscle. However, it’s wise to follow a few precautions when it comes to gaining muscle.

There are many different types of exercise and one of the most popular is strength or power training, which is very effective for building strong bones and muscles.

Strong muscles collect oxygen and nutrients from the blood much more efficiently than weak ones, meaning that any physical activity you do will require less cardiac work and put less strain on your heart

As well as being good for the heart, they also improve weight control and help the body remain sensitive to the hormone insulin, which is vital for keeping blood sugar levels in check and preventing or controlling type 2 diabetes.

Here are some tips on how you can build strong, lean muscle, without affecting your diabetes:

Load up on protein

Protein intake is vital for building muscle.

However, your body constantly drains its protein reserves for other uses such as producing hormones, resulting in less protein available for muscle building.

To counteract this, you need to build and store new proteins faster than your body breaks down old proteins.

You should look to consume about 1 gram of protein per pound of body weight , which is roughly the maximum amount your body can use in a day.

Good sources of protein include:

Remember, the more protein your body stores (protein synthesis), the larger your muscles grow.

Have a protein shake before your workout

Protein shakes are very effective for improving strength.

While many trainers have a post-workout shake, research has shown that drinking a shake containing at least 6 grams of amino acids – the muscle-building blocks of protein – and 35 grams of carbohydrates 30-60 minutes before exercising increases your protein synthesis more than drinking the same shake after training.

“Since exercise increases bloodflow to your working tissues, drinking a carbohydrate-protein mixture before your workout may lead to greater uptake of the amino acids in your muscles,” says Kevin Tipto, PhD, an exercise and nutrition researcher at the University of Texas.

Good quality whey-protein powders usually contain at least 30 grams of protein per serving, as well as a healthy supply of vitamins and minerals.

Other liquid supplements such as weight-gain powders can also provide a lot of high quality protein and nutrients in each serving, but they also tend to be extremely high in calories, carbohydrates and sugar.

While this is sufficient for most weight lifters, it is not ideal for those with conditions such as type 2 diabetes, for whom weight loss may be a key goal.

Work your biggest muscles

If you’re new to weight lifting or strength training, just about any workout will be intense enough to increase protein synthesis and build muscle.

However, if you’re experienced with weights, you’ll see the biggest and fastest results by focusing on the large muscle groups, like the back, legs and chest.

The best exercises for these body parts are squats, dead-lifts, bench press, leg press, pull-ups, bent-over rows, shoulder press and dips. Add two or three sets of 8 or 12 repetitions to your workout, with about 60 seconds’ rest between sets.

Eat a high-quality meal after training

Post-workout meals or snacks should be high in carbohydrates and protein. Carbohydrates are needed to fuel exercise. As well as being a vital energy source they also play a role in the release of insulin, which regulates levels of blood sugar and is also the body’s most potent anabolic hormone.

However, people with diabetes are generally advised to limit their carb intake to keep their blood sugar levels under control as their bodies struggle to produce insulin or don’t use the insulin produced effectively.

The problem with this though is that a lack of stored carbs can result in the body using protein for energy production, thus leaving less protein for building muscle.

The key is to cut out bad carbs such as. refined, processed carbohydrates found in white bread, potatoes, pasta and rice  from your diet and replace them with good , unprocessed carbs from fruit and vegetables, beans, nuts, seeds and whole-grain versions of bread, pasta and rice.

Foods with good carbs generally have a lower glycemic index (GI), which means they tend to break down slowly to form glucose. Low GI foods also have a high nutritional value and provide prolonged release of energy.

Drink plenty of water

Adequate water consumption is one of the most overlooked factors in exercise. Water comprises up to 70% of the human body and if you’re dehydrated, your muscle size suffers as well. The other way of looking at it is that one pound of muscle can hold up to three pounds of water.

Rest

Rest is another hugely overlooked factor in building strong, lean muscle.

The simple fact is that after an intense workout, the body needs the proper nutrients and recovery time to grow bigger and stronger.

In fact, your muscles grow when you’re resting, not when you’re working out.

If you’re a beginner, do a full-body workout followed by a day of rest. Alternatively look at setting aside at least 3 days of rest each week.

Consume good fats

A common misconception among the general public is that all types of fat are bad for you. While saturated fats and trans fats (i.e. bad fats) increase cholesterol and your risk of certain diseases, monounsaturated fats and  polyunsaturated fats can have the opposite effect and benefit your overall physical and mental health

They are also important for muscle growth.

Good sources of healthy fats such as omega-3 fatty acids include:

• Fish – salmon, tuna, mackerel, herring, trout and sardines
• Avocados
• Olives and olive oil
• Nuts – almonds, hazelnuts, pecans, walnuts, cashews and macadamia nuts
• Peanut butter
• Tofu
• Sunflower, sesamen, and pumpkin seeds, and flaxseed

Diabetes and Strength Training – What You Should Remember

This article does not constitute medical advice. Please see your licensed medical physician for information about how best to manage diabetes in your individual case. It’s always a good idea to talk to your doctor before starting a new diet or exercise regimen.

There are a lot of misconceptions surrounding diabetes. Perhaps the most persistent, at least in the world of strength sports, is that people with diabetes should avoid lifting heavy and stressing their bodies as much as other athletes.

The truth is that exercise, including intense exercise and strength sports like powerlifting and weightlifting, can be appropriate and even recommended for patients with the disease. (Just ask Matthias Steiner, an Olympic weightlifting gold medalist who was diagnosed with Type 1 diabetes at eighteen.)

https://www.instagram.com/p/BSElTMnAcS5/

“The benefits of exercise for people with diabetes are too numerous to list,” says Dr. Sheri Colberg, an exercise physiologist and founder of Diabetes Motion. “Basically, all of the benefits that anyone gets from exercise are the same for people with diabetes, and they have the added benefits of often being able to manage their blood glucose levels better and reduce anxiety and depression associated with diabetes management. ”

When it comes to managing the disease, a lot of recommendations are similar to those made for the general population: eat plenty of vegetables, get plenty of exercise, keep your body fat low, avoid sugary foods.

But exercise also affects blood sugar, which is why there are a few things to keep in mind if you have diabetes and you want to try out powerlifting or weightlifting.

Exercise and Blood Sugar

“Exercise is going to make your cells more sensitive to insulin over the long term, so they’re going to do a better job of taking up glucose and using less insulin,” says Amanda Kirpitch, MA, RD, CSSD, CDE, a dietitian practicing in New York City. “So there’s always going to be benefits from exercise.”

For a period of two to seventy-two hours after exercise the body does a better job of using insulin, which is why insulin needs are generally lower in people who exercise regularly. (Though these benefits can be diminished by overeating.)

But Don’t Cardio and Lifting Put Different Demands On the Body?

Yep. For people with diabetes, the main thing to note is that intense lifting can cause a temporary increase in blood glucose levels, compared to cardio training which usually causes a decrease.

“The biggest difference between powerlifting and cardio is the impact on glucose levels,” says Kirpitch. “There’s often a rise in glucose that people don’t anticipate when they do anaerobic activity, strength training, things of that nature, compared to running. People assume that any exercise is going to result in lower blood sugar, and they then come out of an anaerobic strength workout and they have no understanding to how that manifests. So it’s a very different type of situation.”

So what should you do before, during, and after a workout to maximize benefit and minimize risk? It depends on your potential for low and high blood sugar, which varies by patient.

“If you’re not on insulin, the target blood glucose can be lower before starting exercise,” says Kirpitch. “But if you’re on insulin, you probably want the blood sugar to be at least over 100 for powerlifting and weightlifting, even 120. It doesn’t need to be as as high as it needs to be for cardio, because with lifting the blood sugar is likely to rise.”

Whether and how much your blood sugar increases from lifting weights depends on how well-trained you are — the newer you are to lifting, the more likely it is to rise during or immediately after a workout due to counter-regulatory hormones. If you are newish to lifting and you’re working out an hour or more, it might be a good idea to consume thirty to sixty grams of carbs after an hour of work. A cardio warm-down can also help to stabilize blood sugar.

“Powerlifting and weightlifting result in benefits that are directly related to the type of activities these are,” adds Dr. Colberg. “In general, having a greater amount of muscle mass is beneficial because it increases the size of the ‘muscle tank,’ or the primary place we have to store carbohydrates in the body as muscle glycogen. Gaining and keeping as much muscle as possible over a lifetime is beneficial to blood glucose management. Keeping the muscle tank partly empty due to recent activity also increases insulin action. So doing intense activities like powerlifting use up a lot of muscle glycogen, and insulin action will be increased during the time it is being replaced post-exercise.”

That said, people with diabetes are also more prone to overuse injuries, so it’s particularly important for them to do accessory exercises and not perform the exact same heavy workouts every week. But as far as training frequency and intensity, people with diabetes don’t usually need to train very differently to people without it unless otherwise indicated by their doctor.

On Meet Day

So what about on the day of a weightlifting or powerlifting meet? When you’re pushing your body to its absolute limits and your max lifts are being spread out over a period of hours, is there anything different about how you should approach things?

Kirpitch says preworkouts like caffeine, BCAAs, and l-arginine are fine and shouldn’t have a big impact on blood sugar, but she advises against the old crush-a-box-of-donuts strategy.

“You’re always going to be better off with a more balanced intake, pre-workout and throughout the day. High carb is good, but you want to balance that with protein if you can and fat if you can tolerate it, because that’s going to give you a slower rise in glucose. You’d be better off getting a rise that lasts longer, because if glucose rises rapidly, there may be a mismatch with insulin in which case you may dampen your performance.”

Matthias Steiner, Olympic weightlifting gold medalist who has Type 1 Diabetes.
Image via Dacoucou, licensed under CC BY-SA 3.0  and @brandalarm34 on Instagram.

On Bulking Cycles

She also notes that while some powerlifters happily gain significant levels of body fat so as to increase their strength and move up weight classes, this isn’t a good idea if you have diabetes as the disease confers a higher risk of cardiovascular disease.

“There’s no doubt that the overweight fit person is in better health than the person who’s overweight and not fit,” she says. “But you don’t want to increase your body fat significantly, especially if there’s a lot of weight cycling. We would argue that nobody should be doing that. Carrying extra weight may increase joint issues and other health problems, even if you’re fit.”

It’s also strongly recommended that in addition to lifting weights, you engage in some sort of cardio to keep the heart healthy. A lot of lifters shun steady state cardio for fear it will “eat their muscle,” but that’s a powerlifting rule you should break — it’ll improve your recovery between sets, help keep up cardiovascular health, decrease soreness, and promote blood flow to repair your muscles.

A younger Matthias Steiner squatting with his insulin pump displayed on his hip. Picture via Matthias Steiner on Facebook.

Do These Rules Change for Type 1 and Type 2 Diabetes?

There are a lot of differences between the two types of diabetes, but when it comes to strength training, much of the advice remains the same in either case.

“Type 1 diabetes just requires more vigilance to keep blood glucose levels balanced with regards to insulin versus food intake,” says Dr. Colberg. “Type 2 is usually easier to manage with exercise, but a lot of those people are older and have other health issues to deal with as well.”

Again, there are plenty of differences, particularly with regard to insulin dosage, but lifting heavy weights is beneficial in either case and training recommendations don’t change.

“People with Type 2 are optimizing their muscles, and building muscle and losing fat, so they’re going to have more insulin sensitivity, which is great,” says Kirpitch. “And there are a lot of arguments and papers starting to come out on strength training being so important for patients with diabetes — Type 1 and Type 2 — because that’s a part people forget and they often end up just walking, but strength training is critical. Changing the muscle composition and changing the body composition through building muscle is huge, it matters a lot.”

The Takeaway

When it comes to diabetes and lifting weights, nutritionists will give a lot of the same advice whether or not you have diabetes: don’t overtrain, eat balanced meals, keep your body fat low. The main thing to take into account is to avoid overuse injuries, maintain a cardio habit, and avoid the donut plate on meet day.

But as is absolutely always the case, speak to your doctor or a diabetes educator before starting any new diet or exercise regimen.

Thanks to Barbie Cervoni, RD, CDE, for her help putting together this article.

Featured image via Matthias Steiner on Facebook.

The 3 Ways Different Exercises Impact Type 1 Diabetes

Lifting weights at the gym. Running on a treadmill. Joining a soccer team. All three provide great exercise, all with a different effect on glucose control. From the professional athlete to the occasional power walker, people with type 1 diabetes can reap the benefits of exercise with the right management. Here’s a rundown for you before you run.

Aerobic Exercise

Aerobic exercise tend to be longer but less intense.  It includes activities like running, walking, long-distance swimming and biking. Typically these activities will cause blood sugars to drop.

Okay, so I want to go for a run. What do I need to do?

• Figure out through trial and error whether to reduce or maintain your typical insulin intake beforehand. Every person is different. 
• Be alert. The risk for hypoglycemia (low blood sugar) is higher if you are exercising over a long duration. 
• Carry a fast-acting carb as a snack so you’re prepared if you become low.  

Anaerobic Exercise

Anaerobic exercise is generally shorter or in spurts but at high intensity. This includes training like sprinting, boxing, ice hockey and weight training. These workouts are great for building muscle and getting stronger. But because of the intensity, these kinds of activities can cause blood glucose levels to spike.

Okay, so I want to lift weights. What do I need to do?

• Work with your health care provider to determine how much to increase your insulin in anticipation of the rise in glucose that intense physical exertion can cause. 
• Again, be alert. Especially at high intensities, blood glucose can rise quickly. Check often and stay in tune with your body. Hyperglycemia can affect your performance in addition to your health.

Mixed Exercise

Mixed exercise is a combination of the aerobic and anaerobic activities above. Sports like basketball or soccer fall under this. Because it is a mix of an activity that lowers your blood sugar levels and one that can cause them to spike, it’s easy to see why it’s difficult to manage.

Okay, so it’s game day. What do I need to do?

• Through trial and error, determine how to adjust your diabetes management. Tools like a continuous glucose monitor (CGM) can help track the fluctuations that may come with mixed exercise.  
• Watch the weather. In hotter temperatures, athletes use glycogen stores more quickly. Prepare by packing fast-acting sugars like sports drinks and glucose tablets. Plus, don’t forget to drink water and stay hydrated! 
• Be ready for game-day jitters. Sports can be stressful! With adrenaline running high and the game on the line, stress levels will often be heightened, affecting your blood sugar levels.  

Ultra-athlete Eric Tozer, who participates in all three of these types of exercise, talks more about his fitness journey and how he stays fit:

The Benefits of Any Kind of Exercise

Sure, there are more things to think about and prepare for when exercising with type 1 diabetes. But there are also extra benefits! In addition to getting stronger, improving heart health, decreasing stress, aiding weight management and loss and improving general mental health, those with type 1 diabetes can see these benefits:  

• Muscles are better at absorbing glucose when they are contracted. This increased glucose uptake by your muscles increases insulin sensitivity ─ the opposite of insulin resistance, a problem when the body requires more insulin to process glucose. 
• Exercise slows carbohydrate absorption, better using the glucose it has and reducing the insulin you need. This counteracts after-meal hyperglycemia. 

Type 1 diabetes should never hold you back from your fitness goals. There are no exercises specifically for people with diabetes, any workout you want to do is possible. There will be highs and lows as you figure out what works for you, but don’t let them get you down! You’ve got this!

T1D athlete Maddie Maloney uses a combination of yoga and meditation to get in the right headspace for exercise. Watch her explain how she does it.

How Lifting Weights Lowers the Risk of Diabetes

As we get older, our energy levels can decrease. Add to that stress from our ever-so-busy daily lives and it becomes an almost impossible task to get to the gym. I’ve been a runner for over a decade now and, oh, how I miss the stamina and endurance I had in my 20’s. No matter how hard I’ve tried to avoid it, age has caught up to me. Week after week, I have to drag myself to finish running that last half-mile. Knowing that my mother is pre-diabetic and all her siblings are diabetic, I cannot just sit back and wait for it to catch up with me! I run not because it is supposed to be good for me, but because it always feels good to know that my HDL cholesterol levels are above average post yearly physicals.

Since I’m continuing to get older, I knew it was time to focus on other ways to increase my physical activity. Maybe I could outsmart my body to get the same effects from physical activity without the needed endurance? But how? Like any other millennial would do, I turned to the Internet. As it turns out, lifting weights lowers the risk of diabetes. With this new information in hand, I hired a personal trainer to begin incorporating strength training into my fitness routine.

I learned some interesting facts about weight lifting while conducting my research. We lose 3-5% of our muscle on average every decade starting at the age of 30¹. Evidence has shown muscle strength to be inversely related to metabolic syndrome², which makes sense since skeletal muscle mass is the primary site of glucose and triglyceride disposal³. Accumulation of lipids within the muscle cell due to dysregulation of fatty acid metabolism interferes with insulin signaling⁴, ultimately leading to insulin resistance⁵.

At the same time, insulin’s ability to stimulate glucose transporter type 4 (GLUT4) translocation decreases, resulting in reduced GLUT4 transporters at the plasma membrane⁶. Insulin signals GLUT4 to either spend or store glucose within the body. By increasing muscle mass, we are not only increasing storage capacity for excess glucose, but also increasing efficiency of excess glucose storage⁷. Therefore, it becomes evident that lifting weights lowers the risk of diabetes.

So, here I am, continuing to lift kettle balls and stretching resistance bands per my trainer’s instructions. Will it give me the same adrenaline rush as running? Nope, and I have come to accept that.  However, it is reassuring to know that lifting weights lowers the risk of diabetes if, in fact, I’m fated to have this dreadful and chronic condition.

References

1.  Nair. (1995). Muscle protein turnover: Methodological issues and the effect of aging. The Journals of Gerontology, 50A, 107-114.
2. Jurca et al. (2005). Association of muscular strength with incidence of metabolic syndrome in men. Medicine and Science in Sports and Exercise, 37(11), 1849-55.
3. Strasser & Pesta. (2013). Resistance training for diabetes prevention and therapy: Experimental findings and molecular mechanisms. BioMed Research International, Article ID 805217, 1-8.
4. Bonen et al. (2004). Triacylglycerol accumulation in human obesity and type 2 diabetes is associated with increased rates of skeletal muscle fatty acid transport increased sarcolemmal FAT/CD36. FASEB Journal, 18(11), 1144-46.
5. Shulman. (2000). Cellular mechanisms of insulin resistance. Journal of Clinical Investigation, 106(2), 171-76.
6. Zierath & Wallberg-Henriksson. (2002). From receptor to effector: Insulin signal transduction in skeletal muscle from type II diabetic patients. Annals of New York Academy of Sciences, 967, 120-134.
7. Nadolsky. (2013). Pump Iron, Prevent Diabetes. Arnold Schwarzenegger.

WEIGHT LIFTING & DIABETES (+Training Plan)

Quick Summary 

• The more emotionally attached you are to your health and fitness goals, the clearer they’ll be and the greater you’ll value them.
• Lifting weights to look better is a sound reason to get started, as the health benefits always come as a byproduct.
• Increased muscle mass can help reduce diabetes medication needs and improve blood glucose control.
• You should never go into a set completely shattered. Each set needs to be quality.
• It doesn’t matter how good your training program is: if you don’t control your blood glucose levels, you’ll never build the body you desire.
• Each session should provide the body with a different training stimulus.
• Rest is equally as important as the training itself.
• A professional coach is worth their weight in gold.

What you’re in for?

4,000 Words

Reading Time ~ 26 minutes

HOW TO SET UP A WEIGHT LIFTING PLAN FOR DIABETES

We get all sorts of visitors on DiabeticMuscleandFitness.com: both men and women, ranging from the everyday gym goer to professional bodybuilders with diabetes, sports athletes right through to newly diagnosed teens who haven’t an ounce of muscle to their name.

If the idea of building muscle, getting stronger and improving whole body definition sounds good to you, then you’re in the right place.

The training information I am about to share with you is grounded on the latest exercise science, thousands of gym sessions and countless hours coaching people with diabetes of all shapes and sizes.

Let’s get started.

Weight Training and Diabetes 101

Weight training, also known as resistance, body weight or strength training is one of the most beneficial forms of exercise you can perform, especially if you live with diabetes.

When performed properly, weight training delivers a host of health benefits including,

1. Increased physical strength.
2. Denser, stronger bones.
3. Increased metabolic rate at rest (allows you to eat more calories, whilst staying lean)
4. It burns body fat and helps prevent obesity.
5. Releases key endorphins that make you feel great.
6. Improves balance and coordination.
7. It can protect against sarcopenia (age-related muscle loss)
8. Increased glucose uptake (it can help manage diabetes)
9. Improved blood lipids.
10. Plus, looking jacked and toned in your favourite clothes feels great!

In this article, I want to discuss the most important principles for building a highly effective weight training program for people living with diabetes, whose goal is to build muscle and simply look better naked.

If you are a typical reader of fitness magazines like Muscle and Fitness, Men’s Health, Women’s Health and Oxygen, this article is for you.

What this article is not.

This article does not focus on the goal of building maximum strength for sports like powerlifting and Olympic lifting. I will cover these specific training goals in another article.

Let’s get started…

The Diabetic Muscle and Fitness Training Pyramid.

The Diabetic Muscle and Fitness Training Pyramid outlines all the most important variables that make up a successful weight training program in order of importance. Similar to nutrition, many people prioritize the wrong stuff like what is the best exercise for arms over more important stuff like sets, reps, weight used on the bar and personal values for health and fitness (the driving force).

Let’s run through each aspect of the pyramid and highlight everything you need to know when it comes to getting the most out of strength training with diabetes.

Feel free to download the pyramids and upload them onto your social media if you wish. It’s important other people living with diabetes see these. If you’re using a PC right click and ‘Save As’. If you are using a mobile, hold your index finger down and saving the image.

Also, (if you haven’t already) get signed up to my insiders’ mailing list. You don’t want to miss an update. Strength training science is constantly evolving. I’ll keep you in the loop with anything worth knowing. So sign up and don’t miss a thing.

THE MOST IMPORTANT ELEMENTS OF SETTING UP A WEIGHT TRAINING PLAN IF YOU LIVE WITH DIABETES ARE…

1. PERSONAL VALUES FOR HEALTH AND FITNESS.

Change your mindset, before you change your behaviour.

Why are you thinking of getting more muscular and healthy?

The more value you see in your health and fitness goals, the more attention you’ll give them. This is why personal values for health and fitness are the most important aspect of the Diabetic Muscle and Fitness Training Pyramid.

If you want to get the most out of strength training you need to identify how it will benefit your life. For most people, the idea of looking better is more important than health.

Girls, you’ll probably see more value in building a great shaped butt, tight core and strong defined legs over improving your bone density.

Guys, you’ll value a well-cut 6-pack, jacked arms and 300lbs bench with more than improved glucose uptake.

Lifting weights to look better is a sound reason to get started, as the health benefits always come as a byproduct.

The more you value something in life, the more energy and focus you’ll put into it. This is your WHY.

Check out these examples of WHY people value strength training.

• I’ll look better naked.
• Have better sex.
• Have more confidence.
• Be able to wear nicer clothes.
• Physical Strength and Fitness.
• Both physical fitness and a great looking body are signs of self-respect and care.
• Working out feels amazing and lets me clear my head.
• Being strong will help me protect myself.
• Lifting weights allows me to eat more food, (if you follow my insta stories you’ll know I love food. 🙂
• Increased muscle mass lowers my insulin needs – it literally resembles a vacuum for glucose.

Setting Realistic Goals Is Important.

Goal setting is a powerful process for mind and body. Clear goals provide you with direction and motivation to turn your vision into a reality.

However, there is a big difference between positive and realistic goal setting.

What is your goal, is it realistic?

Positive goal setting is like flicking ‘Beast Mode ON’ and thinking you’re going to be Arnold Schwarzenegger in 6 months or Monica Brant after you finish your newest tub of pre-workout.

So many of us fall prey to this mode of thinking. They spend so much time scrolling through Instagram and Facebook comparing incredibly jacked and ripped guys and girls on Instagram, thinking to themselves,

‘I’m going to look like that!’

The problem is, not many people come to terms with the backstory to their favourite fitness photos on Instagram.

• Genetics (different parents, ethnicities).
• Years of training experience.
• Expert coaching and mentorship.
• Use of anabolic steroids.
• More free time (giving them the ability to train multiple times a day).
• No kids to keep them up at night.
• The list is endless…

Be realistic when setting your training goals.

Be original, define YOUR own personal success criteria, do not borrow those belonging to an individual whose life bears no resemblance to yours.

Stay focused and make the best of your own unique circumstances, rather than comparing yourself to everyone else, especially the pro fitness models and bodybuilders who have been at it a lot longer than you.  The acronym S.M.A.R.T is a great framework to base your goals off.

Every time you set a goal, ask yourself, is it…

S –  Specific, Significant, Stretching

M – Measurable, Meaningful, Motivational

A – Attainable, achievable

R – Realistic

T– Time-Based

The best way to set a training goal is to acknowledge;

• How you don’t want to look and feel.
• How you want to look and feel in your new body.

You need to get very specific.

Ask the right questions and you’ll come up with great answers.

• How lean do I want to be?
• How muscular do I want to be?
• How strong do I want to be?
• How do I want feel?

Goals will differ from person to person. Some people will want to look better for the beach, while others will want to look like a hardcore bodybuilding monster.

Once you visualise how you want to look, hold that image in your head and think about it constantly.

So, how do you look? It’s not that far away.

Now we have goal setting and motivation out of the way, let’s look at the fundamental building blocks that make up a highly effective diabetes weight training program.

The Diabetic Muscle and Fitness Training Pyramid outlines all the key elements of strength training program design in order of importance. Too many people prioritise the wrong stuff, like the best exercise to do, or the best weightlifting belt to buy over the much more important stuff like managing blood glucose levels around exercise, adequate training volume and sufficient rest.

We’ve already covered the most important element of the pyramid ‘Personal Values for Health and Fitness’. Now, let’s discuss the other factors and their role in building a successful strength training plan for diabetes.

2. DIABETES MANAGEMENT.

It doesn’t matter how good your training program is, if you don’t control your blood glucose levels, you’ll never build the body you desire. One of the most important take-homes people have when reading my best-selling book, The Diabetic Muscle and Fitness Guide is this:

‘OBSESS OVER PERFECT BLOOD GLUCOSE CONTROL 24/7 – 365 DAYS A YEAR.’

While looking after your diabetes may seem obvious, not many people do it (well).

How dedicated are you to perfecting your control?

What does good diabetes control look like to you?

1. Do you check your blood glucose levels regularly?
2. Do you correct high blood glucose ASAP?
3. Do you question ‘WHY’ your blood glucose levels go outside range, and get to the root of the problem?

Call it obsessed, but some of us want to get more out of training and live longer.

Poor blood sugar control (both short and long term) is the enemy to building a better looking and feeling body.

We live in an age with breakthrough diabetes management tools. There has been no better time to have diabetes. Recognise this reality and make the most of what is on offer.

Dedicate your life to chasing perfect control. Get as close to normal (nondiabetic) A1C levels as you can. Your dedication will pay off.

I’ve also covered a tonne of information on the effects different types of exercise have on blood sugar levels and diabetes in my book The Diabetic Muscle and Fitness Guide.

3. TRAINING ADHERENCE.

The term fitness is defined as, ‘the ability to do a task.’

You may be fit enough for one training program, but not another.

Before you consider exercises, sets, reps and how much weight to use, you must ascertain the following key factors:

• What is the maximum number of days you can train per week?
• How much time can you spend training per session?
• What is your training experience? Do you know your exercises?
• What is your current fitness level?

These factors determine how much training you can handle.

Have you ever jumped into a hardcore program without considering what’s best for you? How did that end up?

If you’re new to training, you’ll lack the basic strength and physical fitness to handle high levels of work. You will get a lot out of a little. Less is more. The great thing is, you will progress quickly and will be hungry for more.

If you are thinking of following the training plans of professional athletes, fitness superstars or pro bodybuilders – be warned! These people are fitter than you, and most likely have more resources in their corner including genetics, supplements, more free time and a coach.

If you have a decent level of experience and strength base, you’ll be able to handle more training. However, it still needs to be manageable from a time and recovery perspective.

This is especially true if you’ve taken time out from training, because of injury or needing a mental break. You’ll not be fit enough to jump back into your old ways of training. You’ll need adequate time to get back in and adapt yourself.

YOU SHOULD NEVER LEAVE THE GYM SICK, IN PAIN, ABSOLUTELY SMASHED or asking yourself, ‘Why am I doing this?’.

Focus on leaving the gym tired, stimulated and challenged.

LEAVE SOME FUEL IN THE TANK FOR THE REST OF YOUR DAY.

So many people hold the misconceived notion that a workout must leave absolutely f***ked. If it doesn’t they automatically assume they haven’t worked hard enough.

This way of thinking isn’t smart.

What good is a workout program that burns you out physically and mentally?

There is a fine line between too much, too little and just enough. Your workouts need to be challenging and enjoyable at the same time. This is much more sustainable and you’ll reap far better results.

Follow a training program that stimulates, not annihilates.

Have an intro week, test how certain exercises feel and how well you recover from set number of training sessions.

Your strength training program should keep you healthy and yield long-term progress rather than burn you out, cause injuries and drive you to resent training.

How Long Do I Need to Train For?

Would you say you are a beginner, intermediate or pro?

This is highly dependent on your personal agenda and lifestyle. If you perform other forms of exercise like football, yoga etc. or work a very heavy laboursome job you will need to be mindful of doing too much and cap training sessions at 2-3 times per week.

As an example, let’s assume you were dedicating all your exercise time to weight training. You training frequency would look like this:

Beginners: 30 mins of strength training x3-4 times per week for the first 3-6 months.

Intermediate: 30-60 mins of strength training x5-8 times per week.

Pro: Sports Specific -30-60 mins of strength training x5-10 times per week.

You also need to consider fitting training around your family. One of the most valuable things you can do is introduce them to exercise, especially loaded movement.

There’s nothing stopping you taking time out to show your partner or kids a few simple exercises like body weight squats or weighted carries. If you have really young kids, just get them moving and playing – embracing the full range of human movement.

Why not make it a family ritual to train together one day every week? You can get a tonne of training done with just bodyweight alone.

4. TRAINING VOLUME AND FREQUENCY.

Training volume is defined as the amount of sets x reps you perform over time for a given body part or movement, in other words, the total amount of work you do.

As a general rule of thumb, your training volume should increase over time.

However, this doesn’t mean you should continually add sets and reps in an endless fashion.

Volume increases only work up to a certain point. If you add too much volume you run the risk of overreaching and building high levels of unwanted fatigue.

As fatigue increases, your performance and training effect will diminish.

In a nutshell, you need to perform enough volume to progress, but not as much as possible. Only increase training volume when you have plateaued or feel very well recovered well.

Frequency refers to how often you train a particular body part or movement.

Generally speaking, you should aim to train each body part at least x2/week. If you have a weak part that needs attention, you may consider going to x3/week if you have the time.

How many reps?

Research has shown muscle gain is possible across a range of rep schemes ^1,2. Gains in muscle mass are pretty much equal regardless of repetition range provided training is carried out to muscle failure

Generally speaking, you could have one day dedicated to 6-10 reps and the other 10-20 reps.

Each session should provide the body with a different training stimulus.

You will need to go to failure on reps over 15 Rep Max, whereas reps between 6-15 rep max are probably the most time efficient and don’t need to be taken to complete failure. What would be the difference in time in the gym for these per session, per week, per month, per training block of three months – this would bring it right into the reader’s mind!

5. INTENSITY & PROGRESSIVE OVERLOAD.

You must give your muscle tissues a reason to adapt. This requires challenging your muscles progressively and changing your training program over time.

Increasing weight is one of the most obvious ways to force an adaption.

Other methods include increasing the number of sets and reps you perform or using advanced training variables like bands, chains, drop sets and supersets.

Does this mean my workouts need to get harder and harder, for the rest of my life?

Not necessarily on every set of every workout, it might take you a few weeks training at a particular weight before you acquire the strength and fitness to move the weights up. Generally speaking, you should strive to get physically stronger on a consistent basis, over the course of the month/year.

Learn to measure your training…

When was the last time you kept a note of your sets, reps and progress, honestly?

Track your progress via photos and a log book. If you aren’t getting stronger, look at your diabetes management, total calories, rest and work effort during training. Something will be out of place.

If the idea of manipulating sets, reps, and training loads seems too complicated for you, don’t panic – I’ve done all the hard work for you by creating two complete done-for-you 16-week training protocols that incorporate all the essential aspects of progressive overload needed for optimal strength and muscle development. They also come in 16-weeks of printable log books.

Diabetic Shred is a 16-Week fat loss training guide -> Get Started!

Diabetic Mass is a 16-Week Muscle Mass and Size -> Get Started!

6. EXERCISE SELECTION.

Exercise selection needs to change between training sessions and block phases. This provides your body with a variety of stimuli and helps avoid injury or niggles.

There is no such thing as a mandatory exercise; however, there are mandatory movement patterns you will need to include in your strength training program.

Movement patterns are fundamental to the proper functioning of the body and involve the use of multiple muscle groups at one time. Exercises are drills that allow you to overload each mandatory movement pattern.

Thousands of exercises exist. However, not all are created the same. I’ve outlined some of the most popular and effective exercises for each movement pattern below.

Consider the muscles involved in each movement.

Squatting

• Front Squat
• Goblet Squat
• Back Squat
• Box Squat

Unilateral (single leg)

• Lunges
• Dumbbell Split Squat
• Single Leg Press

Quad Dominant

• Leg Press
• Leg Extension
• Band Exercises for quads

Hip Hinge/Hamstring Dominant

• KB Swing
• Deadlift
• Romanian Deadlift
• Good morning
• Rope pull through
• Lying Leg Curls
• Seated Leg Curls

Horizontal Pressing

• Bench press
• Close Grip bench
• Decline bench press

Vertical Pressing

• Military press
• Seated Dumbbells shoulder press
• Push Press
• Front Raises
• Lateral Raises

Horizontal Pulling

• Barbell Rows (overhand)
• Dumbbell Row
• Chest Supported Rows
• T-bar rows

Vertical Pulling

Elbow Flexion Exercises

• Any kind of bicep isolation exercise.

Elbow Extension Exercises

• Any kind of triceps isolation exercise.

Carrying

• Farmers walk
• Single arm walk

Core

• Palloff Press
• Abs Roll outs
• Handing Leg Raises

How many Exercises?

How many different exercises did you do in your last session?

Generally speaking, for most body transformation training, 4-6 exercises per workout is more than sufficient. These should include all the exercises above, unless injury is an issue or there are noted weak points in one’s physique, sometimes common in competitive bodybuilders.

Workouts can be split into both whole body or upper/lower based body workouts. I’ve created some very useful templates you can perform each day you train.

WHOLE BODY TRAINING TEMPLATES

Workout #1

X1 Squat/Unilateral Leg Exercise

X1 Hip Hinge/Hamstring Dominant

X1 Horizontal Press

X1 Horizontal Pull

X1 Carry

X1 Core

Workout #2

X1 Unilateral Leg Exercise

X1 Hip Hinge/Hamstring Dominant

X1 Vertical Press

X1 vertical Pull

X1 Core

Workout #3

X1 Quad Dominant

X1 Hip Hinge/Hamstring Dominant

X1 Vertical Press

X1 vertical Pull

X1 Core

UPPER/LOWER BODY TEMPLATES

Workout #1 – Upper

X1 Horizontal Press

X1 Horizontal Pull

X1 Vertical Pull

X1 Vertical Push

X1 Elbow Flexion

X1 Elbow Extension

X1 Core

Workout #2 – Lower

X1 Squat/Unilateral Leg Exercise

X1 Hip Hinge/Hamstring dominant

X1 Quad Dominant

X1 Core

7. REST PERIODS.

How much rest do I need during training?

I’ll keep this ultra-simple and to the point.

You should never go into a set completely shattered. Each set needs to be quality.

• Big Bang Exercises like squats, deadlifts etc. 2 minutes is adequate.

• Moderately Taxing Exercises like pull ups, barbell rows, close grip bench etc. 1-1.5 mins rest is sufficed.

• Isolation Exercises like curls and cable work 30-60 seconds is more than enough.

If you’re new to weight training – take a little longer.

Is it ok to take a break from weight training?

Yes, and I highly recommend you do.

Milk every training session for as long as you can, then take a self-assessed break or period of detraining to recharge your batteries. You can’t just keep adding more.

Have you ever got bored with same the routines, frustrated you’re not progressing?

Generally speaking, every 4-8 weeks of consistent training should be followed up with 5-10 days of detraining or complete rest. The more stress you are under (like poor sleep, stress, illness, not eating enough and high or low blood glucose levels) the shorter your training cycle and the longer your detraining/rest periods should be.

During a detraining period, you’ll need to manipulate:

• Training Volume – Reduce training volume by 50% of your normal routine. So instead of 4 sets, do 2.

• Intensity – This includes the load and how hard you push to failure. Reduce your training load by 60-80% of what you normally use. Don’t bring your sets to exhaustive failure, work with around 60-70% of the effort.

• Frequency – Reduce frequency from 2-3 times per week to 1.

Tempo refers to the speed at which you are lifting across different parts of the rep.

It’s one of the least important factors when it comes to training for a better-looking body.

I’ll get straight to the point with this one.

• Perform all your reps in a safe and controlled manner.

• Maintain consistent control and speed during the negative (lowering) and positive (pressing/pulling) parts of the rep. Generally speaking, 2 seconds is a good speed to go at.

• Pause at the bottom and top of each rep for around 1 second.

• Repeat again until the target number of reps has been achieved.

That was long but worth it.

You’re now equipped with more knowledge than most personal trainers when it comes to designing a strength training program.

I hope you enjoyed what you read and take action on the tips I have shared with you the next time you pick up a barbell.

What key things do you remember, what are you going to take action on?

Here’s some you will want to consider…

Take Home Points

• You must follow a weight training plan that suits your current fitness level and personal schedule.

• Obsess over perfect blood glucose levels pre, during and after exercise.

• Train using a variety of exercises.

• When performing an exercise, do so with intent. Focus on complete quality and putting your body into the most favourable mechanical position.

• Don’t be stupid and train through pain. Get it looked at.

• Perform a range of 6-20 well-controlled reps.

• Progressively increase the weight you use over time. If you don’t have the fortitude to turn double, treble or even quadruple your lifts, then take up fishing.

• Never start a set exhausted. Wait until you have properly recovered.

• Train using a range of movement patterns and exercises.

• Weightlifting belts, squat shoes and heart rate monitors are the least of your worries.

Safe to say, you’re pretty serious about building muscle, aren’t you?

As you know strength training is only a piece of the puzzle when it comes to getting in shape.

There’s so much more to it, especially when it comes to managing blood sugars with diet, supplements and lifestyle to achieve greater fat loss and maximise muscle growth.

But, I can only cover so much in these articles.

If you want to learn more (much more) and master everything there is to know about strength training science, managing your diabetes and becoming your own personal strength coach and nutritionist, then you need to check out The Diabetic Muscle and Fitness Guide.

With over 400+ pages of evidence-based theory on how to build a stronger, better-looking body with diabetes, this is an absolute must for any dedicated gym goer living with diabetes.

IF THAT SEEMS LIKE TOO MUCH INFORMATION FOR YOU…

I HAVE TWO MORE PRACTICAL GUIDES FOR YOU.

If your goal is fat loss -> GET DIABETIC SHRED   

If your goal is lean weight gain –> 

GET DIABETIC MASS

References

1. Schoenfeld BJ et al. Muscular adaptations in low- versus high-load resistance training: A meta-analysis. Eur J Sport Sci. 2016;16(1):1-10. doi: 10.1080/17461391.2014.989922. Epub 2014 Dec 20.https://www.ncbi.nlm.nih.gov/pubmed/25530577
2. Schoenfeld BJ et al. Effects of Low- vs. High-Load Resistance Training on Muscle Strength and Hypertrophy in Well-Trained Men. J Strength Cond Res. 2015 Oct;29 https://www.ncbi.nlm.nih.gov/pubmed/25853914

Dr Dillner’s health dilemmas: can lifting weights prevent diabetes? | Fitness

The Olympics has got us excited about less mainstream sports, such as weightlifting, according to the International Weightlifting Federation. An IWF spokesman commented: “Weightlifting has recaptured British people’s hearts after a very long time.” But rather than just watch it, research says we should be taking up weightlifting ourselves. A new paper in the Archives of Internal Medicine by Harvard School of Public Health shows that pumping iron five times a week can reduce the risk of type 2 diabetes by a third.

Diabetes is common: one in 20 people now have it in the UK. Type 2 is the most common and affects mostly middle aged and older people. It is due to a lack of insulin, either because the pancreas stops making enough or the cells in the body become resistant to it. If uncontrolled, it can reduce life expectancy (for example through heart or kidney failure) by up to 10 years.

A poor diet and lack of exercise can increase the chances of getting type 2 diabetes. But what’s so special about doing weightlifting rather than jogging?

The solution

The study looked at 32,000 men who are part of ongoing analysis – so it does not necessarily mean weightlifting reduces the risk in women but is likely to. It also showed aerobic exercise of any sort reduced the risk, but a combination with weights worked better. One advantage of weightlifting is that you don’t have to be fit to do it, whereas many people find aerobic exercise hard to do.

Weightlifting, if done properly, should increase muscle mass in as little as eight weeks. Other studies have suggested that for people at a high risk of diabetes, weight training increases the amount of muscle in the body, and also reduces the levels of plasma-free fatty acids. It has also been shown that weight training can control (ie lower) blood sugar levels of people who already have diabetes. Researchers in one study found that lifting weights regularly (45 minutes three times a week on machines), reduced blood sugar levels by 1%, resulting in up to a 20% reduction in heart attacks and strokes.

But weight training may have benefits beyond reducing the risks of diabetes. Muscle mass decreases with age, and while aerobic exercise is good for many things, it does not build muscle. Having strong muscles protects your joints from injury, and also aids balance and weight control. Lifting weights (free or on a machine) also strengthens bones and improves your stamina.

To avoid injury, start by warming up, then lift a weight you can handle and repeat for up to 15 times, in a controlled and steady way. Ask for advice on how to do it at a local gym. Have a day of rest between exercising muscle groups. You can gradually build up the weights once you can do more than 15 repetitions easily. Then book your place at Rio 2016.

90,000 Kettlebells and dumbbells help reduce the risk of diabetes in women

January 15, 2014

Updated January 16, 2014

Photo author, GETTY IMAGES

Photo caption,

Dumbbell exercises build muscle mass

Women who love to lift kettlebells and dumbbells in the gym, insure themselves against diabetes.

This is an unexpected conclusion made by researchers from Harvard Medical School, who for 8 years studied the data of one hundred thousand American nurses.

Lifting weights, squats, push-ups and other exercises that require muscle resistance to work, in general, reduce the risk of diabetes in women, scientists say.

They advise to engage in such exercises at least twice a week and do not forget about aerobics, which should also be given at least two and a half hours a week, as it helps to improve the functioning of the lungs and heart.

Experts are convinced that women who devote at least two and a half hours a week to aerobics and spend an hour on weightlifting reduce the risk of type 2 diabetes by at least one third.

Harvard researchers admit that their findings are not flawless, primarily because they relied on the honesty of the respondents without checking exactly what exercises and how long they did.

However, they generally correspond to the results obtained earlier for men.

Explanation Scientists tend to see that high muscle mass serves as a kind of buffer on the path of diabetes.

Type 2 diabetes develops when the cells responsible for insulin production fail, or the insulin itself does not work properly.

Insulin allows the body to convert sugar into energy and store excess sugar in the liver and muscles.

The likelihood of getting type 2 diabetes depends on our genes and lifestyle.

In particular, being overweight increases the risk of disease, and, according to doctors, every kilogram of weight lost reduces the risk of developing diabetes by 15%.

Fixation of the uterus during prolapse – make an appointment, price, treatment

The prolapse or prolapse of the uterus and other internal genital organs is noted today in 50% of women giving birth.During pregnancy, the fetus puts constant pressure on the pelvic muscles, relaxing them. With a gradual weakening of the muscles and ligaments, the vaginal walls descend. In this case, a diagnosis of genital prolapse is made.

By the age of 30, the perineal tissue becomes less elastic. If the first birth occurs at this age, then the risk of tissue injury and, consequently, prolapse of the internal genital organs increases.

Main causes of genital prolapse:
– chronic constipation,
– diabetes mellitus, obesity, hormonal disorders,
– constant weight lifting,
– frequent bouts of severe coughing,
– congenital weakness of the connective tissue.

The prolapse of the internal genital organs occurs gradually.
There are 5 degrees of this process:
The first degree – there is a slight descent of the posterior and anterior walls of the vagina, while the genital slit is gaping.
Second degree – the pelvic floor muscles weaken more significantly, the prolapse of the vaginal walls gradually continues. This also lowers the bladder and rectum (its front wall).
Third degree – the uterus is already lowered, and its cervix is ​​at the level of the entrance to the vagina.
Fourth degree – incomplete prolapse of the uterus occurs. In this case, the cervix is ​​already outside the entrance to the vagina
Fifth degree – the woman has a complete prolapse of the uterus, during which the walls of the vagina are turned inside out. Organ prolapse occurs, as a rule, in old age.

The process of prolapse of the internal genital organs is accompanied by reproductive disorders, while it is also possible:
– urinary disorder,
– difficulty in emptying the intestines,
– the appearance of frequent pain, inflammation,
– a feeling of discomfort when walking, movement, sexual intercourse.
All of the above phenomena significantly reduce the quality of life.

The danger of the problem is that at first it may not declare itself in any way. Therefore, for its prevention, you should be examined by a gynecologist at least once every 6 months.

Call a specialist immediately if you experience the following symptoms:
– sensation of a foreign body in the vagina, urinary incontinence, constipation,
– a feeling of heaviness in the lower abdomen,
– unusual vaginal discharge.

In the Genom-Tomsk clinic, the problem of prolapse / prolapse of internal genital
organs are solved comprehensively, efficiently and reliably, including with the help of
surgical technologies.

physical activity with type 1 diabetes and insulin pump

Exercise with insulin pump

“Will my insulin pump limit my ability to exercise?” Is one of the most common questions I get asked as a clinical diabetes manager.The MiniMed insulin pump allows you to adjust your insulin dose during short training times and longer periods of time. Enlite or Sof sensors, which are used for continuous glucose monitoring (CGM), show sensor glucose (SG) data so you can see trends in glucose levels before, during and after your workout. To find out how your body is affected by different types of physical activity, use LMWH to monitor sensor glucose levels and check your blood glucose (BG) with a meter before, during, and after exercise.

Prevention of hypoglycemia

The risk of developing hypoglycemia associated with physical activity depends on the type, duration and intensity of exercise, and measures to manage this risk should be taken during and after exercise. Some people may need to prepare an hour or two before exercising to ensure that glucose levels are maintained at a safe level. It all depends on the characteristics of the organism. Talk to your health care provider about the type of exercise you will be doing and how best to regulate your insulin delivery before making any adjustments yourself.

If you are using a MiniMed Paradigm Veo pump, Threshold Stop will automatically stop delivering insulin when your sensory glucose values ​​reach a predetermined low threshold.

If you plan on exercising, it is best to always carry 15 grams of fast carbs (for example, 120 ml orange juice or 3-4 glucose tablets) and keep them in an easily accessible place. If you are exercising between meals, check your BG before you start exercising.If your BG is below what you want, you can adjust your basal insulin by adjusting your temporary basal rate (but follow your healthcare professional’s instructions) or have a small snack containing 15 grams of carbohydrates, such as crackers, an apple, or whole wheat toast. If your BG is below 50 mg / dL (2.8 mmol / L), try to get 20 grams of carbohydrates.

Time and duration tracking when adjusting insulin

Consider timing and duration when adjusting insulin, and always follow your healthcare provider’s recommendations.Your insulin requirement can be affected by the time of day you exercise. For example, in the morning BG levels tend to decrease less during exercise due to the presence of hormones that help maintain BG during this time, so you can exercise with insulin settings recommended by your doctor. In the afternoon, your hormone levels drop, so you may need to temporarily lower your basal insulin delivery to prevent hypoglycemia.

Prolonged physical activity (90 minutes or longer), such as running at a moderate pace or swimming, can lower your BG.In this case, a temporary adjustment of the basal insulin may be necessary. According to the study “ Managing Insulin Therapy During Exercise in Type 1 Diabetes Mellitus ”, the recommended starting point is to set a temporary basal rate at 50% of normal or standard basal rate for a period of one to two hours before physical activity (1 ). At the same time, short-term exercise (such as running short distances or lifting weights) can increase blood glucose by triggering the release of hormones, in particular adrenaline, which releases glucose reserves from the liver.Thus, short-term exercise may not require basal insulin adjustments. It is important to check with your healthcare professional before making any changes to determine which option is best for you.

Adjusting bolus insulin with meals

According to the ADA and Robert Walsh, author of Injecting Insulin with a Pump, if you eat up to 90 minutes before starting physical activity, you may need to reduce your meal bolus insulin to maintain optimal BG levels.Below are a few examples of adjustments based on exercise intensity and duration that have been found to be effective in some patients (2,3). Remember to constantly consult your doctor. As with the insulin to carbohydrate ratio, when it comes to insulin and exercise, there is no one-size-fits-all solution. Balance can only be found by trial and error.

• Low intensity, less than 60 minutes: 10% – 20% bolus reduction
• Moderate intensity, over 60 minutes: 50% bolus reduction
• High intensity, less than 60 minutes: 50% bolus reduction
• High intensity exercise, over 60 minutes: Bolus reduction of 70% or more

Disconnecting the pump

Whether or not you need to disconnect your insulin pump depends on how your body responds to physical activity and how it looks.In some cases, the pump must be disconnected, for example, when swimming, surfing or other types of water exercise. There may be times when close physical contact is expected and disconnecting the pump can help prevent damage to the pump. When deciding to disconnect your pump, consider aspects such as time, duration of disconnection and exercise intensity. This will help determine the parameters and the need for insulin adjustments. If you unplug your pump for less than 60 minutes, you usually do not need to change basal insulin, unplug your pump for more than 60 minutes, consider reconnecting after 60 minutes and delivering 50% of your normal basal insulin bolus.As usual, you should talk with your healthcare provider about an insulin replacement plan that you did not receive when your pump was turned off.

Correction of high blood glucose level

What if you go to a workout but your blood glucose is increased? If the BG is significantly outside the target range of 14 mmol / L) and above, a ketone body test should be performed. Activity in hyperglycemia may be somewhat impaired, but if ketone bodies are not available, it is generally safe to exercise.Be sure to talk to your healthcare professional before starting your workout to determine your course of action. Remember to drink plenty of fluids, and Robert Walsh, author of Pumping Insulin, recommends considering administering 50% of the Bolus Wizard’s recommended pre-workout correction (3).

Using fastening techniques during training

There is a wide variety of infusion systems and attachment methods available on the market today for pump users.If you have difficulty shutting off the infusion set during exercise, place it in a location where the skin will not sweat or stretch too much (for example, on the arms or buttocks). Additional dressings (such as Tegaderm or IV 3000) can be used, and tight fitting clothing can be worn over the infusion set to prevent displacement.

We are waiting for your advice and comments, and do not forget to discuss emerging problems with your doctor! Whatever your plans – to increase physical activity, go on a hike or prepare for a marathon – take care of your health!

Literature:

1) Toni, et al. Managing insulin therapy during exercise in Type 1 diabetes mellitus , Acta biomed, 2006; 77; suppl. 1: 34-40.
2) Bolderman, et al. Putting Your Patients on the Pump, Chapter 7 , Alexandria Virginia: American Diabetes Association, 2012.

Guidelines for Patients with Chronic Kidney Disease

This patient guide is based on the 2017 Estonian treatment guide “Prevention and Management of Patients with Chronic Kidney Disease” and the topics discussed therein together with recommendations.The recommendations of the patient guide were compiled from the analysis of the scientific literature based on the principles of evidence-based medicine. In this patient guide, you will find the recommendations that are most important from the patient’s point of view. The patient manual was compiled in cooperation with nephrologists and takes into account the capabilities of the Estonian health care system. The clarity of the text of the patient guide and the importance of the topics described was appreciated by the patients, and feedback from them helped to complement this guide.

The Patient Guide is intended for people with chronic kidney disease and those who are close to them. The patient guide explains the nature of the disease and its possible causes, diagnosis, treatments and possible complications. The guide also tries to answer questions about nutrition and daily lifestyle.

Chronic kidney disease is a slow-onset disease and does not cause particularly many complaints in the patient in the initial stages.Chronic kidney disease includes a variety of kidney diseases in which kidney function declines over several years or decades. If you are diagnosed with chronic kidney disease, it may happen that changes in your lifestyle and diet need to be made to keep your kidney function at the proper level. There is so much you can do yourself to help the treatment.

Usually a person has two kidneys, which are shaped like beans and adjoin the posterior abdominal wall under the ribs.Both kidneys are the size of a clenched male fist.

Healthy kidneys:

• are engaged in the removal of metabolic end products and excess fluid from the body
• helps keep blood pressure under control
• helps produce red blood cells
• helps keep bones healthy

HEALTHY KIDNEY

Imagine that your kidneys are a coffee filter.When making coffee, the filter retains the coffee powder, but at the same time allows the liquid to move through it.

The kidneys do something similar – they retain and leave the necessary substances in the body, but at the same time they filter out unnecessary substances from the body. The metabolic waste products that are filtered out by the kidneys are released into the body during the breakdown processes associated with food, drink, medication, and normal muscle function.

Each kidney contains about a million small filters called glomeruli.Primary urine is formed in the glomeruli, which flows through small tubules, where part of the fluid is absorbed back. The functional unit of the kidney is the nephron – a specific structure consisting of a glomerulus and a tubular system. Nephrons remove residual substances and excess fluid from the blood in the form of urine into the renal pelvis, then urine is transferred into the ureters, and then into the bladder.

In the case of chronic kidney disease, renal function deteriorates – the kidneys are no longer able to sufficiently filter residues and purify the blood.The filtration capacity of the kidneys is assessed based on a special indicator – the glomerular filtration rate (GFR).

Chronic kidney disease is a slow-onset disease and does not cause especially many complaints in the patient in the initial stages. Chronic kidney disease includes a variety of kidney diseases in which kidney function declines over several years or decades. With early diagnosis and treatment, it is possible to slow or even halt the progression of kidney disease.

In the course of international studies of renal function in many people, it was found that almost one in ten had a violation of the kidney function to some extent.

What Causes Chronic Kidney Disease?

The three most common causes of chronic kidney disease are diabetes, high blood pressure and glomerulonephritis.

• Diabetes – In the case of this disease, various organs are damaged, including the kidneys and heart, as well as blood vessels, nerves and eyes.With long-term diabetic kidney damage, many patients have high blood pressure and should be treated accordingly.
• Increased blood pressure (hypertension, primary arterial hypertension) – during hypertension, blood pressure cannot be controlled and it begins to exceed the normal range (more than 140/90 mm Hg). If this condition persists, it can cause chronic kidney disease, brain stroke, or myocardial infarction.
• Glomerulonephritis is a disease resulting from a malfunction of the immune system, during which the filtration function of the kidneys is disturbed by immune inflammation. The disease can affect only the kidneys, but can spread to the entire body (vasculitis, lupus nephritis). Glomerulonephritis is often accompanied by high blood pressure.

Many other conditions can cause chronic kidney disease, for example:

• hereditary diseases – such as polycystic kidney disease, due to which, over the years, a large number of cysts appear in the kidneys, which damage the functioning kidney tissue and therefore renal failure.Other hereditary kidney diseases are much less common (Alport syndrome, Fabry disease, etc.)
• problems caused by obstructions in the kidneys and urinary tract – such as congenital malformation of the ureter, kidney stones, tumors or enlargement of the prostate gland in men
• Recurrent urinary tract infections or pyelonephritis.

Can Everyone Get Chronic Kidney Disease?

Chronic kidney disease can develop at any age.People who have one or more of the following risk factors are at greatest risk of getting sick:

• diabetes
• high blood pressure
• family members previously had kidney disease
• age over 50 years
• Long-term use of drugs that can damage the kidneys
• overweight or obese

What are the symptoms of chronic kidney disease?

If chronic kidney disease progresses, the level of metabolic end products in the blood rises.This, in turn, causes poor health. Various health problems can occur, such as high blood pressure, anemia (anemia), bone disease, premature calcification of the cardiovascular system, and changes in the color, composition and volume of urine (see Complications of Chronic Kidney Disease ).

With the progression of the disease, the main symptoms may be:

• weakness, feeling of exhaustion
• shortness of breath
• sleep problems
• lack of appetite
• dry skin, itchy skin
• muscle cramps, especially at night
• swelling in the legs
• edema around the eyes, especially in the morning

Stages of Chronic Kidney Disease Severity

There are five severity stages of chronic kidney disease (see table).table 1). The stage of the severity of kidney damage depends on glomerular filtration rate (GFR), by which renal function is assessed. Further treatment depends on the severity stage of chronic kidney disease.

Table 1. Stages of severity of kidney disease

To diagnose kidney disease, there are two simple tests that your family doctor may prescribe for you.

Blood test: glomerular filtration rate (GFR) and serum creatinine level. Creatinine is one of those end products of protein metabolism, the level of which in the blood depends on age, gender, muscle mass, diet, physical activity, on what foods were taken before the sample (for example, a lot of meat products were eaten), and some medications.Creatinine is excreted from the body through the kidneys, and if the kidneys slow down, then the level of creatinine in the blood plasma increases. Determining the level of creatinine alone is not enough to diagnose chronic kidney disease, since its value begins to exceed the upper limit of the norm only when GFR has decreased by half. GFR is calculated using a four-parameter formula that takes into account the creatinine reading, age, gender, and race of the patient. GFR measures the level of the kidney’s filtration capacity.For chronic kidney disease, a GFR indicates the stage of kidney disease (see Table 1).

Urinalysis : The albumin content is determined in the urine, in addition, the relationship between the albumin and creatinine values ​​in the urine is determined. Albumin is a protein in the urine that is usually found in minimal amounts in the urine. Even a small increase in urinary albumin levels in some people can be an early sign of onset kidney disease, especially in those with diabetes and high blood pressure.In the case of normal renal function, albumin in the urine should be no more than 3 mg / mmol (or 30 mg / g). If the release of albumin increases even more, then this already speaks of kidney disease. If the excretion of albumin exceeds 300 mg / g, then other proteins are excreted in the urine, and this condition is called proteinuria.

If, after receiving the results of urine analysis, the doctor suspects that there is a kidney disease, then an additional urine analysis for albumin is performed. If albuminuria or proteinuria is re-detected within three months, then this indicates chronic kidney disease.

Additional examinations

Y Ultrasound examination of the kidneys: for the diagnosis of chronic kidney disease is the first choice examination.Ultrasound examination allows you to evaluate the shape of the kidneys, their size, location, as well as determine possible changes in kidney tissue and / or other abnormalities that may interfere with the normal functioning of the kidneys. An ultrasound examination of the kidneys does not require special training and does not pose any risks to the patient.

If necessary and if a urological disease is suspected, an ultrasound examination of the urinary tract (as well as an analysis of residual urine) can be prescribed, for men an ultrasound examination of the prostate gland can also be prescribed and referred to a urologist for consultation.If necessary and if a gynecological disease is suspected, the woman is referred for consultation to a gynecologist.

What you need to know about contrast media tests if you have chronic kidney disease?

Diagnostic tests such as magnetic resonance imaging, computed tomography and angiography are used to diagnose and treat various diseases and injuries. In many cases, intravenous and intra-arterial contrast agents (containing iodine or gadolinium) are used to show the organs or blood vessels being examined.

What is especially important to do before conducting a survey with a plant substance ?

If you have been assigned an examination with a contrast agent, then you need to determine your GFR .

Together with your doctor, you can discuss and evaluate the benefits or harms to your health. If the examination is nevertheless necessary, observe the following preparation rules:

• Drink plenty of fluids (water, tea, etc.) the day before the examination and the day after the examination.). If you are being treated in a hospital, the required amount of fluid will be injected through a vein through a vein. When in hospital, after a contrast agent examination (within 48-96 hours), a blood creatinine test is usually prescribed to assess renal function. Your family doctor will be able to assess your renal function in an outpatient contrast examination.
• Talk to your doctor about what medications should not be taken before the contrast test.Some drugs (antibiotics, drugs for high blood pressure, etc.), together with contrast agents, begin to act as poison. The day before and the day after the examination, in no case should you take metformin, a medicine for diabetes.
• At the earliest opportunity, leave enough time between two examinations with a contrast medium so that the contrast medium used in the first examination has time to leave the body. It is important to exclude repeated examinations with a large volume of contrast medium.

How does contrast medium work on the kidneys?

Sometimes the contrast medium can damage the kidneys. The greatest risk is kidney damage in people with chronic kidney disease. There are two rare but very serious conditions that can arise from the administration of contrast media: nephropathy and nephrogenic systemic fibrosis.

What is contrast medium nephropathy?

Contrast nephropathy is rare and may occur in about 6% of patients.The risk of getting sick is especially high in diabetics, as well as in people with chronic kidney disease.

In the case of contrast-induced nephropathy, there is a sharp decline in kidney function within 48 to 72 hours after the examination. In most cases, this condition goes away and the person recovers, but in rare cases, serious problems can occur both in the kidneys and in the cardiovascular system.

What is nephrogenic systemic fibrosis?

Systemic nephrogenic fibrosis is a very rare but serious condition that affects the skin and other organs.Nephrogenic systemic fibrosis is present in some patients with advanced chronic kidney disease (4%) who underwent magnetic resonance imaging with contrast medium including gadolinium. The disease can develop over a period of 24 hours to 3 months, starting on the day of exposure with a contrast agent that includes gadolinium.

This disease is very rare and in people with mild renal impairment or normal renal function, the occurrence of nephrogenic systemic fibrosis has not been observed.

Treatment options for chronic kidney disease depend on the stage of kidney disease, comorbidities and other health problems.

Treatment may include:

• Treatment of high blood pressure
• Diabetes care
• In case of excess weight – weight reduction.
• Lifestyle changes: eating a healthy diet, reducing the amount of salt consumed, getting enough physical activity, quitting smoking, limiting alcohol consumption (see How can you yourself help the treatment? ).
• Dialysis treatment and kidney transplantation for advanced chronic kidney disease (severity stage 5).
• Psychological counseling and support.

Treatment of high blood pressure for chronic kidney disease

What is blood pressure?

Blood pressure is the pressure that is created by the blood flowing in the blood vessels against the walls of the blood vessels.The unit of measurement for blood pressure is millimeter mercury (abbreviated as mmHg) and blood pressure is defined by two numbers – systolic and diastolic blood pressure – for example 130/80 mmHg. Art. Systolic pressure, or upper pressure value, means the level of blood pressure at the moment when the heart ejects blood from the chamber, i.e. when the heart is compressed.

Diastolic pressure, or lower pressure value, means the level of blood pressure at the moment when the heart is in a moment of relaxation.

High blood pressure (hypertension) is a common disease and often the person himself does not know that his blood pressure is higher than normal. With the progression of the disease, the main symptoms may be:

• headache
• rapid heart rate
• fatigue
• imbalance

Untreated high blood pressure can cause kidney damage, heart disease, stroke, or eye disease.High blood pressure can damage the renal arteries and reduce kidney function. Kidneys with damaged arteries can no longer remove waste products or excess fluid from the body. Due to the excess fluid, the pressure begins to rise even more.

It is important to keep your blood pressure within the normal range. Regardless of age, blood pressure should not exceed 140/90 mm Hg.

If you have chronic kidney disease and additional risk factors are present (eg albuminuria, diabetes, cardiovascular diseases), then the blood pressure should be kept at 130/80 mm Hg.st.

The best way to measure your blood pressure and keep it under control is to measure your blood pressure yourself at home (and at the pharmacy) with a blood pressure monitor.

Discuss your treatment plan with your healthcare provider. If necessary, the doctor will refer you to a cardiologist or ophthalmologist for a follow-up examination. In addition to taking pills and controlling blood pressure, a healthy lifestyle plays an important role in treatment. How can you help the treatment yourself? ).

Diabetes care for chronic kidney disease

What is diabetes?

Diabetes is a chronic disease in which blood sugar levels rise above normal levels. There are also metabolic disorders of carbohydrates, fats and proteins. Normally, in a healthy person, the pancreas secretes enough insulin to balance blood sugar levels.In the case of diabetes, the secretion of insulin from the pancreas is impaired and too little or no insulin is released. Therefore, blood sugar levels begin to rise. This condition begins to disrupt the muscles and many other organs, including the kidneys, heart, blood vessels, nerves, and eyes.

Type I diabetes

It usually starts in childhood and occurs when the body cannot produce the required amount of insulin.Insulin therapy is always used to keep blood sugar under control.

Type II diabetes

May form slowly and initially without symptoms. The reasons for the development of type II diabetes are predominantly heredity (the presence of the disease in close relatives), overweight, metabolic syndrome (high blood pressure, obesity in the lumbar region, high blood pressure), as well as pregnancy diabetes.If a person has type II diabetes, their body still produces insulin, but their levels are very low or cannot be used in the correct way.

In the case of type II diabetes, it is sometimes possible to keep blood sugar levels under control through proper nutrition / diet or physical activity, but usually treatment with pills and / or insulin is still necessary.

Keeping blood sugar levels under control is essential to prevent kidney damage and / or slow the progression of disease.According to the results of many surveys, the best glycated hemoglobin (HbA1c) value in people with diabetes was 53 mmol / mol or less than 7%.

The blood level in the blood can be measured independently using a glucometer. This way you can measure your own blood sugar and keep track of keeping it at the correct level. Ask your family doctor / nurse, endocrinologist or diabetes nurse for advice and more information.

The best time to measure blood sugar is before a meal (on an empty stomach) or 1.5-2 hours after a meal.Below are the recommended blood sugar values.

What you need to know about medications if you have chronic kidney disease?

Medicines for hypertension

In the case of chronic renal disease, angiotensin-converting enzyme (ACE) inhibitors are used to treat hypertension – enalapril, ramipril, fosinopril, captopril, etc., or angiotensin II receptor blockers (ARBs) – for example, valsartan, telmisartan, losartan, olmesartan, candesartan. Studies have shown that these drugs delay the progression of chronic kidney disease.

At the same time, these drugs increase the risk of hyprekalemia (serum potassium rises to a dangerous level), the risk increases with the simultaneous use of both groups of drugs. The risk of hyperkalemia is increased due to decreased renal function (GFR) scores.

All people with chronic kidney disease are advised to have regular GFR checks with their family doctor or other health care provider, the frequency of which depends on kidney function and associated risks.

Diabetes drugs

The primary drug of choice in the treatment of type II diabetes is metformin. Metformin is used to control blood sugar levels and lower cholesterol levels, and in addition, it reduces the risk of cardiovascular disease.In the case of chronic kidney disease due to impaired kidney function, there is a risk of medication-related acidosis.

If your GFR is from 30 to 45 ml / min / 1.73 m2 (stage G3B), then the dose of metformin taken should be reduced, if your GFR is less than 30 ml / min / 1.73 m2 (stage G4 – G5), then taking the medication you need to reduce and use other drugs for this. Discuss your treatment plan with your healthcare provider.

Other common medicines used to treat various diseases

Statins

Statins are used to prevent cardiovascular disease.Statins reduce blood cholesterol levels. The use of statins in patients with chronic kidney disease has shown good results in the prevention of serious cardiovascular disease.

Aspirin

Aspirin is often used in the primary prevention of cardiovascular disease. Aspirin has blood thinning properties and therefore increases the risk of bleeding with the consumption of aspirin. If you have any disease of the cardiovascular system, then when taking aspirin, you should evaluate, together with your doctor, the ratio of the possible benefits to the risk of bleeding, while taking into account your health status and concomitant diseases.

Non-steroidal anti-inflammatory drugs

If you regularly use non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, diclofenac, or celecoxib, it is advisable to have your kidney function checked at least once a year. Avoid NSAIDs if your GFR is too low (up to 30 ml / min / 1.73 m2). Do not take NSAIDs with aspirin. If your cardiologist has prescribed aspirin for you, talk to your doctor about which medications for joint disease and pain can be safely taken with it.

Digoxin

Digoxin is a commonly used medicine to treat heart failure and certain types of irregular heart activity. In the case of chronic kidney disease, digoxin should be taken with caution and renal function should be considered. With a decrease in renal function, the concentration of digoxin in the blood may increase and as a result, accumulation of digoxin in the body may occur.

Antibiotics

Aminoglycosides are a specific type of antibiotic that is used to treat a variety of bacterial diseases (eg, pneumonia, acute bronchitis, and other inflammatory diseases).The use of aminoglycosides is a common cause of toxic kidney damage from medication (nephrotoxic drugs). Sometimes it is still necessary to take aminoglycosides. Aminoglycosides are prescribed by a doctor who, using a blood test, also monitors the concentration of the drug in the blood.

Vitamin D

Before taking vitamin D, be sure to check with your family doctor or health care provider.In case of vitamin D deficiency and chronic kidney disease, vitamin D intake is advisable, based on a certain level of vitamin D (25-OH).

To avoid an overdose of vitamin D, it is necessary to monitor the level of vitamin D in the blood, the frequency of control examinations is prescribed by the family doctor.

Source: Haiglate Liit

When taking vitamin D, side effects may occur, which may depend on the severity of chronic kidney disease (excessive amount of calcium in the blood, rapid progression of chronic kidney disease, etc.).).

Complications of chronic kidney disease

The incidence of complications of chronic kidney disease depends directly on the severity of renal impairment, which can be detected by determining the level of GFR and numerical indicators of albuminuria / proteinuria.As GFR decreases, complications are more common and more severe.

Major complications:

• Malnutrition, which may be due to insufficient calories and / or protein in food.
• Metabolic acidosis is an acid-base imbalance caused by impaired renal function. The kidneys do not filter enough blood and, as a result, the production of acid (hydrogen ions) decreases.
• Blood potassium levels rise above normal (hyperkalemia) if potassium excretion decreases due to impaired renal function. This may be due to the consumption of foods high in potassium and taking medications that interfere with the excretion of potassium (for example, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, diuretics, etc.).
• Disorders of the balance of minerals (lack of calcium and vitamin D and excess phosphorus) and diseases of the skeletal system (renal osteodystrophy).The risk of developing skeletal disease is greatest when chronic kidney disease reaches severity stages 3a-5. Blood levels of phosphorus, vitamin D, and calcium are assessed by a blood test.

Diseases of the skeletal system are frequent complications of chronic kidney disease, because due to kidney damage, excess phosphates are not excreted from the body through the blood and thus hyperfunction of the parathyroid gland occurs (the level of the parathyroid hormone – parathyroid hormone increases), which, in turn, is cause calcium leaching from bones.

Such imbalances in the balance of calcium and phosphorus lead, in the absence of treatment, to a violation of ossification, bone pain and fractures. In case of imbalance of calcium and phosphorus, bone formation (calcifications) begin to cover the internal organs and blood vessels, which is the reason for the disruption of the functioning of these organs.

• Anemia can result from impaired erythropoiesis (erythropoiesis is the formation of red blood cells or erythrocytes) and low blood iron levels.
• Diseases of the cardiovascular system that contribute to dyslipidemia (an increase in the content of cholesterol in the blood and changes in its structure).

Chronic kidney disease is often associated with heart disease. Low physical activity, poor diet and excess weight can increase blood cholesterol levels, which in turn can damage arterial blood vessels in all organs and increase the risk of cardiovascular disease.

Anemia in case of chronic kidney disease

If the kidneys are diseased or damaged, they do not produce enough erythropoietin (EPO). Erythropoietin, produced by the kidneys, is required for the formation of red blood cells (erythrocytes) in the bone marrow. Red blood cells are involved in the transport of oxygen in the body. If the kidneys do not produce enough erythropoietin, and because of this, the number of red blood cells decreases, then anemia or anemia begins to develop.Anemia occurs in most people with chronic kidney disease.

Another common cause of anemia is inadequate iron, B vitamins and folate.

Anemia symptoms:

• pallor
• feeling tired
• lack of energy in daily activities
• lack of appetite
• sleep disorders
• Decreased concentration of attention
• dizziness and headaches
• rapid heartbeat
• shortness of breath and shortness of breath

Anemia most common in patients:

• with moderate to severely impaired renal function (chronic kidney disease stage 3 or 4)
• with end-stage renal failure (severity stage 5)

Not all people with chronic kidney disease develop symptoms of anemia.If you have chronic kidney disease, the hemoglobin (Hb) level in your blood should be measured at least once a year to check for possible anemia. Hemoglobin is part of the red blood cells that carry oxygen throughout the body. If the hemoglobin level is too low, we are dealing with anemia – it is important to find out the cause of the anemia in order to plan the correct treatment regimen.

Treatment for anemia depends on the types of causes that cause it. Treating anemia is very important as it helps prevent heart disease and other health problems.If you already have a heart condition, treating your anemia will help reduce the risk of heart disease progressing.

Anemia treatment options:

• Specific treatment with erythropoietin stimulating drugs (ESA). Your doctor will discuss the benefits and risks of ESA with you before starting treatment and will monitor how ESA works during treatment. ESA treatment is not always justified, sometimes iron supplementation is sufficient.
• Ferrous preparations. Iron supplements are safe for most people.If you are allergic to certain medications, tell your doctor. In some rare cases, side effects of iron supplementation can include low blood pressure, nausea, vomiting, diarrhea, and excess iron in the body. Some reactions can be dangerous and damage your health.
• Your doctor will test your blood to check for iron and will decide a safer and more appropriate method for taking iron supplements. Iron can be taken either as food, tablets or injections.
• Vitamin B ₁₂ or folic acid. These drugs help balance the treatment of anemia. For chronic kidney disease and anemia, your doctor may recommend vitamin B ₁₂ and folic acid or add foods containing them to your diet to help ensure consistent and safe treatment.
• Blood transfusion. If the hemoglobin level in your blood drops too low, you may be given a blood (red blood cell) transfusion.Red blood cells are injected into your body through a vein and this will increase their blood levels, which in turn will increase the supply of oxygen to the body.

In the case of chronic kidney disease, there is no specific diet indicated for the disease. Your doctor will advise you on dietary recommendations based on how kidney function changes during illness. Your doctor will assess, based on the results of blood tests, whether you are getting enough nutrients and calories from your food. As chronic kidney disease progresses, certain substances (such as potassium) may accumulate in the body.In the case of chronic kidney disease, it is important to eat well, to monitor the amount of food and its variety. All this will help the kidneys to better cope with their function. Monitoring your diet with your healthcare provider and changing it appropriately will help protect your kidneys and prevent the progression of chronic kidney disease. In the case of mild kidney damage, the so-called nutritional pyramid can be taken as the basis of the diet, but in the case of severe kidney damage, the diet must be agreed with the doctor.

Determine your healthy weight range and try to keep your weight within it. The healthy weight interval can be easily calculated using the body mass index (BMI) formula (a person’s weight in kilograms divided by the person’s height squared in meters). It is better to discuss additionally with your doctor how valid the obtained values ​​are for you.

Body Mass Index:

• to 19 – insufficient body weight
• 19-24.9 – normal weight
• 25-29.9 – overweight
• more than 30 – obesity

If you are losing too much weight, your doctor may recommend special nutritional supplements.If the body weight is too heavy, it puts a lot of stress on the kidneys. In this case, you need to discuss with your doctor exactly how you can gradually reduce weight, without it being dangerous to your health. If your body weight is increasing too quickly, be sure to inform your doctor about it. A sudden increase in body weight that is accompanied by swelling, breathing problems, and an increase in blood pressure may be a sign that too much fluid is accumulating in your body.

Sodium

Sodium is a mineral that helps regulate the exchange of fluid between blood and tissues in the body, the function of the nervous system, and maintain an acid-base balance.Excess sodium affects the volume of fluid in the body and can cause an increase in blood pressure as well as swelling in the legs. In the case of chronic kidney disease, dietary sodium should be limited.

Sodium is found in high amounts in salt as well as in foods that have added salt. Most of the salt is found in ready-made sauces (such as soy sauce), in seasonings (garlic or onion salt), in prepared foods (canned soups, canned food, dry soups, broths), in processed foods (for example, ham, bacon, sausages, smoked fish), salty snacks, potato chips, salted nuts and biscuits, and most instant foods.

Some recommendations for reducing salt intake:

• Buy and prepare fresh food at home.
• Choose foods with less salt. Do not use more than one pinch of salt when cooking food.
• Avoid adding salt with meals.
• When adding seasoning, use fresh or dried herbs and spices, lemon juice, aromatic vinegar.
• Do not use salt substitutes unless recommended by your doctor.Most salt substitutes are high in potassium.
• Avoid fast food and ready-to-eat foods as they contain a lot of hidden salt.
• Read labels carefully to select foods with less salt.

Proteins

Protein is essential for normal muscle and tissue function, wound healing and infection. Proteins can be of animal or vegetable origin.Both types of protein are needed for daily activities. Sources of animal protein include, for example, eggs, fish, chicken, red meat, dairy products and cheese. Sources of plant proteins are vegetables and grains, legumes and nuts.

In the case of chronic kidney disease, consuming too much or too little protein can worsen your health. A balanced protein intake will help you to reduce both the burden on the kidneys and the content of metabolic end products in the blood, and thus slow the progression of the disease.At the same time, protein foods cannot be completely excluded from the diet, as a protein-free diet can cause weakness, fatigue and malnutrition. Your doctor will help you determine how much protein your food should contain based on your kidney function. If the protein content of food is limited due to chronic kidney disease, then this means that the source of calories can be significantly reduced. In this case, you must receive the missing calories from other sources that do not contain protein.For example, you can increase your carbohydrate intake or add vegetable fats to your diet.

Some recommendations for wise protein intake:

• You should know how much protein you can consume in one day.
• Explore which foods contain protein and choose the one that works best for you.
• Try to eat a small amount of protein at a time.

Potassium

Potassium is an essential mineral that helps muscles, nerves and heart function properly.Too high or too low amounts of potassium in the blood can be dangerous to the body. Usually, the excess potassium is removed from the body through the kidneys. As chronic kidney disease progresses, blood potassium levels begin to rise because the kidneys are no longer able to remove excess potassium from the body (see Complications of Chronic Kidney Disease ). The potassium level in the blood is checked regularly with a blood test. If your blood potassium is too low, your doctor may prescribe potassium substitutes.In the event that the potassium content is too high, medications are prescribed that can balance the potassium level in the blood. The potassium content in the body can be successfully regulated by dietary changes.

If you must limit your intake of foods containing potassium, then:

• Research which foods contain the most and least potassium and make healthy choices.
• Read labels carefully to select potassium chloride-free products.

Phosphorus and Calcium

Phosphorus is a mineral that plays an important role in the functioning of cells, in the regulation of muscle work, the activity of the brain and nervous system, in the formation of teeth and bones. Phosphorus is obtained primarily from animal products. Healthy kidneys excrete excess phosphate from the body, but in the case of chronic kidney disease in advanced stages, the kidneys may not be able to cope with this task.

Calcium is a mineral that is important for the formation of whole, healthy bones and teeth, for blood clotting, and for the functioning of the heart and nerves. Several foods that are good sources of calcium often contain too much phosphorus.

If the phosphorus content in the blood is too high, then the calcium content decreases and calcium is washed out of the bones. Calcium begins to build up in blood vessels, joints, muscles, and the heart – where it shouldn’t normally be (see below). “Complications of chronic kidney disease” ).

In order to prevent calcium leaching from bones and reduce the level of phosphate in the blood, you need to limit the consumption of foods that are high in phosphorus (for example, dairy products, beans, peas, nuts, seeds, cereals, Coca-Cola).

Your doctor may prescribe medications called phosphorus binders. The medicine should be taken with meals according to the frequency prescribed by the doctor.The drug binds phosphorus in such a way that it cannot enter the bloodstream.

• Phosphorus has been added to some packaged foods. To avoid consuming excess phosphorus, be sure to read the label.

Liquid consumption

For mild to moderate chronic kidney disease, fluid intake is usually not restricted. Talk with your doctor or nurse about how much fluid you should be drinking.If you feel that fluid starts to accumulate in your body and your legs swell, be sure to inform your doctor. If kidney disease progresses more and more, it may be necessary to limit the amount of water consumed daily.

If your doctor has prescribed you a limited fluid intake, then:

• Specify the maximum amount of liquid you can consume per day. Start each day by filling the jug with the permitted amount of water.If you also drink coffee or tea during the day, pour the appropriate amount of liquid from the jug. If the jug is empty, it means that you have already used the assigned liquid limit.
• It must be remembered that many solid foods also contain liquid; it is also necessary to take into account the liquid in soups to calculate the consumed liquid.
• Try to choose healthy drinks. Control the sugar, phosphorus and calcium content of your drinks.
• If you sometimes eat canned food, then also take into account the liquid from canned food in the calculation of the daily limit or drain excess liquid from the can before eating.

If you are a vegetarian

If you are a vegetarian, be sure to inform your doctor about this. A vegetarian diet may contain foods with too much potassium and phosphorus, and at the same time, contain less protein. With everyday food, you need to get a balanced and correctly combined amount of plant proteins and the required amount of calories. At the same time, the level of potassium and phosphorus in the blood must be kept under control.If the food is not high in calories, then the body begins to consume proteins for energy production.

Alcohol consumption and smoking

Smoking can have serious long-term effects on kidney function. Smoking damages blood vessels. People with chronic kidney disease are more likely to have heart disease than healthy people. In this case, smoking plays the role of an auxiliary risk factor. If you have chronic kidney disease, work with your doctor to find the best way to quit smoking.

In the case of chronic kidney disease, alcohol consumption is not completely contraindicated. However, alcohol can only be taken in very moderation. Excessive alcohol consumption can damage the liver, heart and brain and cause serious health problems.

Women are not recommended to consume alcohol in the amount of more than 1-2 units, and men – more than 2-3 units per day. Make at least three days in a row alcohol-free for one week.One unit of alcohol is equivalent to 10 grams of absolute alcohol. One unit is, for example, a strong alcoholic beverage (4 cl), a glass of wine (12 cl) or 250 ml of 4% beer.

Physical activity

Physical activity and sports are not contraindicated for chronic kidney disease. On the contrary, getting enough physical activity helps to better cope with the disease.

Moderate physical activity is important because:

• gives you energy
• Improves muscle strength and elasticity
• helps you to relax
• helps keep blood pressure under control
• reduces the content of cholesterol and triglycerides in the blood
• improves sleep, makes it deeper
• helps maintain a healthy weight
• helps prevent the onset of heart disease and diabetes
• Increases self-confidence and general well-being

You can only exercise for a short period of time each day, but the impact of the exercise lasts all day.Be sure to talk to your doctor before starting regular exercise. Your doctor can help you choose the right sports based on your health condition and early training experience. If necessary, the attending physician will refer you for a consultation with a restorative medicine physician.

Aerobic training works well – walking, Nordic walking, hiking, swimming, water gymnastics, cycling (both indoor and outdoor), skiing, aerobics, or other activity that requires a large muscle group.If a more relaxed workout is preferred, then yoga is well suited for this.

If you have not previously played sports regularly, then start with light workouts that last 10-15 minutes a day. By gradually increasing the load, you can increase the duration of your workout to 30-60 minutes and you can train on most days of the week. Start your workout with a warm-up and end with a stretch, these exercises will help you prevent injury. Try to integrate your workout schedule into your day plan – workouts can be done, for example, in the morning or in the evening.After the main meal, you need to wait about one hour with training. It is also not recommended to train just before bedtime (approximately one hour).

The easiest way to control how well your workout is for you:

• During exercise, you should be able to speak to your companion without shortness of breath.
• Within about one hour after training, the heart rate should be restored, the state of health should be normal.If these points are not met, then the next time you need to train in a more relaxed mode
• Muscles should not hurt enough to be an obstacle to the next workout
• the intensity of the workout should be at a comfortable level

Still, there are some signs that you should abandon or interrupt your workouts:

• you feel very tired
• Shortness of breath occurs during exercise
• Feel chest pain, or your heart rate increases suddenly or becomes irregular.
• feel stomach pain
• cramps occur in the leg muscles
• dizziness or drowsiness occurs

Remember that regular physical activity does not give “permission” for uncontrolled consumption of foods that should be limited. Diet and exercise must work together. If you feel that, in addition to increased physical activity, your appetite has increased, discuss this with your doctor or dietitian. They will help you change your diet so that the amount of calories consumed is sufficient.

If you have been diagnosed with chronic kidney disease, then at first it can cause negative feelings.Information about the diagnosis can initially cause shock, it can be difficult to believe in it – anxiety may arise in connection with a specific situation (for example, examination, procedure) or in general (loss of control over one’s life, decreased quality of life).

A person can get angry, blame others and deny the situation – these are the primary normal emotions, but after some time, the person must begin to recognize the disease and get used to it. After that, it is already possible to cope with the necessary life changes emanating from chronic kidney disease.If negative feelings remain strong over time and are the cause of daily problems, you should definitely tell your doctor about them. At the doctor’s appointment it is easier to talk about what is the cause of physical discomfort: fatigue, feeling unwell, dizziness, etc. It is always more difficult to talk about your feelings and they try to avoid it. Caring for the psychological state is also important, the recognition of our feelings and the opportunity to speak about them allows us to free ourselves from them, and the doctor will be able to find an opportunity to help you.

Stress mainly appears due to changes that need to be introduced into your life: change the diet, depending on the state of renal function, get used to the disease, remember to take medications. You can get a lot of new information at the same time, and understanding it can be difficult. The best way to deal with stress is to admit that there is a problem, it needs to be addressed, and it will take time. General ill health and fatigue (both physical and emotional) can be quite common at some point.You may feel tired and easily vulnerable to the point of tears. Several symptoms may be present – for example, irritability, loss of personality, loss of interest in what is happening around, trouble sleeping. Emotional exhaustion is the cause of general fatigue. This condition can occur and progress slowly and almost imperceptibly. If the feeling of sadness is already becoming desperate or hopeless, due to fatigue, there is no longer any motivation to do anything, and this condition lasts longer than 2 weeks, then you need to inform your doctor about this.

Despite the fact that you cannot change the diagnosis, on your part you can do a lot to better cope with the disease:

• Pay attention to your emotions, don’t deny them. Even if you think these emotions are not related to illness, talk about them, as holding on to emotions increases stress. Share them with people you trust – loved ones, friends, your doctor, nurse. No one can read your mind, but people can always come to your aid.
• Find and read information about chronic kidney disease and its treatment, and be proactive in making decisions about your treatment plan. Don’t be afraid to ask questions. Before visiting your doctor, write down any questions you may have. Many patients recognize that being aware of their illness and treatment helps them feel involved in the treatment process. If it seems to you that you cannot remember everything that the doctor said, take a loved one with you to the appointment or write down the important information received.
• Make active lifestyle changes and follow your doctor’s recommendations.
• Take care of yourself. Treat yourself to your favorite activities: listen to soothing music, read your favorite literature or magazines, visit the theater, take walks in nature. It’s perfectly okay to let people know that you feel you don’t want or have enough time to participate in social activities.
• If you feel you don’t want to talk about and discuss your concerns, keep a journal.Sometimes writing down your thoughts helps you better deal with your feelings, and this at some point can make it easier to talk about them as well.
• Seek professional help if necessary. In case of persistent social problems and mood swings, ask your doctor which specialist you should see.
• Accept help when you need it. If people offer help, then they really want to help you. This gives them the confidence that they are involved in your life and that you need them.Your loved ones and friends can be the main stronghold of your support.
• Local chronic kidney disease patient groups or support groups are good places to socialize with other patients. There you can also get practical advice, training courses and emotional support.

Free time and holidays

Do not give up your favorite activities and hobbies. They can help you relax, keep in touch with friends, and keep you distracted.You can decide how much you want to talk about your illness. Rest is important as it is the time you can spend with your loved ones away from your daily responsibilities. If you are planning a trip, inform your doctor about it. Check if the necessary tests have been done for you, if all the necessary medications are stocked, and find out which medical institutions you can contact if necessary.

Operation

Job opportunity is an important source of good self-esteem and life satisfaction for all people.A diagnosis of chronic kidney disease does not mean that you have lost your ability to work until the moment when the disease begins to directly affect activities related to work and daily duties (for example, restrictions during kidney replacement treatment, which become necessary in the last stages of the severity of chronic kidney disease). Of course, you should discuss with your doctor the working hours and types of work (eg lifting weights) that are acceptable in the event of your illness.Your healthcare provider will be able to refer you to a rehabilitation doctor who will teach you the correct movement or work technique. Your employer should be informed if you need to change your work schedule.

Health insurance

Estonia has a health insurance system based on solidarity insurance principles. The principle of solidarity means that all persons with health insurance receive the same health care, regardless of their monetary contribution, personal health risks or age.People who are permanent residents of Estonia or who are in Estonia on the basis of a temporary residence permit or residence permit have the right to health insurance if social tax is paid for them. In addition to these categories, children under the age of 19, schoolchildren, students, conscripts, pregnant women, the unemployed, on parental leave, dependent spouses, pensioners, guardians of disabled persons, persons with partial or absent work capacity and persons who have entered into a voluntary insurance contract.The costs of medical treatment of the insured person are covered by the Health Insurance Fund. You can check the health insurance status on the state portal www.eesti.ee under the heading “Information on health insurance and family doctor”.

Cash compensation

The Health Insurance Fund pays many monetary benefits to insured persons, such as compensation for incapacity for work, supplementary compensation for medicines and compensation for dental treatment and artificial insemination.You can read detailed information on monetary compensation on the website http://haigekassa.ee/ru/cheloveku/denezhnye-kompensacii

Medicines, medical aids and aids

Preferential medicines

Despite the fact that medicines are now very expensive, the Health Insurance Fund helps to compensate for part of their cost. Preferential discount on medicines, i.e. full and partial payment for drugs is one of the ways to provide the population with affordable drugs.This helps to avoid a situation where a person cannot start the necessary treatment because of the too high price for it. For each prescription purchase, the purchaser must pay a mandatory self-financing share that depends on the preferential rate on that prescription. Its value is about 1-3 euros. The rest of the prescription price is subject to a reduced rate based on the percentage of prescription written out. Thus, the buyer, in addition to the obligatory share of financing, pays the remaining part of the price after deducting the benefit.If a ceiling price is set for a given medicine and the price of the purchased medicine exceeds the maximum price, then in addition to the share of mandatory financing and the share remaining after deducting the benefit, the buyer must pay a part of the price that exceeds the maximum price. The last share refers to the part of the prescription cost that cannot be avoided when choosing an expensive drug package. The buyer of the prescription, with a rational choice of a medicine with the same active ingredient, but with a cost not exceeding the maximum price, can save significant amounts.

Medical aids

The Health Insurance Fund compensates the insured for the necessary medical aids that are used at home and with the help of which diseases and injuries can be treated or the use of which prevents the deepening of the disease. The need for medical aids is assessed by the attending physician and prepares a digital card for the purchase of a medical aid with a benefit. To purchase a medical aid, you need to contact a pharmacy or a company that has entered into an agreement with the Health Insurance Fund and present an identity document taken with you.

You can read more information about subsidized medicines and medical aids on the website.

Aids

Assistive products are a product or a means by which you can prevent emerging or congenital health defects or the progression of a disease, compensate for functional impairment caused by any damage or health defect, as well as maintain physical and social independence, performance and activity.

Assistive products can be purchased or rented on the basis of a personal assistive product card.

The basis for the application for a personal card of assistive products is a certificate from a doctor or the need for an assistive device, which has been identified by the rehabilitation team. The need for an assistive device should not be recorded in a doctor’s certificate or rehabilitation plan with the precision of the ISO code, but should be recorded in a form that is understandable to all.It should be clear from it what kind of auxiliary means a person needs. In the case of some assistive devices (for example, leg prostheses, wheelchairs, invarollers, etc.), only a specialist doctor or a rehabilitation team of specialists can determine the need.

You can find more detailed information on aids on the website.

Performance Assessment

Starting from January 1, 2017, the ability to work is assessed instead of incapacity for work.The ability to work and / or health defect is determined individually for each person, according to his state of health. The work capacity is assessed by the unemployment insurance fund and the health defect is determined by the Social Insurance Board.

Assessment of the working capacity is the final determination of the working capacity of a person, taking into account the state of health of the person and the assessment of his working capacity by the person himself. The unemployment insurance fund confirms partial or no work ability for a period of up to five years, up to no longer than a year of entering the retirement age.You can find more information about the assessment of the work ability on the website of the unemployment fund.

Definition of health defect

A defect, a lack of health is a handicap or deviation caused by a state of health, in which case a person has obstacles and problems with the ability to cope with daily activities and participation in the life of society.

It is possible to apply for the establishment of a health defect if:

• Health problems make it difficult for you to cope with daily activities and participate in community life
• You need more guidance, supervision and assistance than your peers

Health defect is established both for children and people of working age, and for old-age pensioners.Detailed information can be found on the website.

1. About Chronic Kidney Disease: a Guide for Patients. National Kidney Foundation. 2013–2014.
2. Chronic Kidney Disease (CKD). National Institute of Diabetes and Digestive and Kidney Diseases.
3. Description of High Blood Pressure.
4. Diabeet. Patsiendi infomaterjal. Ida-Tallinna Keskhaigla.
5. D-vitamiinist. Patsiendijuhend.TÜ Kliinikum 2014.
6. End Stage Renal Disease. New Patient Education Manual 2012. Carolinas HealthCare System Renal Services. Charlotte, North Carolina.
7. Kidney Disease Education. DaVita Inc.
8. Hidden Health Risks. Kidney Disease, Diabetes, and High Blood Pressure. National Kidney Foundation, 2014.
9. Kroonilise neeruhaiguse ennetus ja käsitlus, RJ-N / 16.1-2017 Ravijuhendite nõukoda. 2017.
10. Kuidas tervislikult toituda.
11. Living with Kidney Disease A comprehensive guide for coping with chronic kidney Disease. Second edition. Ministry of Health and Kidney Health New Zealand. 2014. Wellington: Ministry of Health.
12. National Kidney Foundation. A to Z Health Guide.
13. Rosenberg, M., Luman, M., Kõlvald, K., Telling, K., Lilienthal K., Teor, A., Vainumäe, I., Uhlinova, J., Järv, L. (2010). Krooniline neeruhaigus – vaikne ja salajane haigus. Tartu Ülikooli Kirjastus.
14. Sprague, S.M. (2012). The value of measuring Bone Mineral Density in CKD non-dialysis & dialysis patients. Compact Renal.
15. The Emotional Effects of Kidney Failure.
16. Täiskasvanute kõrgvererõhktõve patsiendijuhend, PJ-I / 4.1-2015 Ravijuhendite Nõukoda. 2015
17. Virtanen, J. Metaboolne atsidoos. Eesti Arst 2016; 95 (10): 650–655.

Diabetic Athlete’s Handbook (Part 11)

Strength sports

Strength sports require short, intense physical exertion.In baseball, you may need to hit the ball hard and run fast to first base. On the court, it can be a high jump or a discus throw. More recently, professional baseball players have emerged among the sugar sufferers. In addition, some people with diabetes mellitus are involved in bodybuilding and weightlifting. One such athlete with diabetes received the title of Mr. Universe, without the use of steroids and other chemicals that improve the result. This chapter covers several strength sports, including baseball, softball, bodybuilding, fencing, on-court athletics, powerlifting and Olympic weightlifting, sprint, and volleyball (indoor and beach).

General recommendations for strength sports

Most strength sports are characterized by short-term, less than 10 seconds, muscle contraction. The energy for such activity is provided by the phosphagen system (creatine phosphate and ATP). If the activity lasts longer (up to 2 minutes), then the body synthesizes energy for it in the form of ATP during the lactic acid cycle. you can feel this system working in the form of a burning sensation in the muscles.This burning sensation is due to the breakdown of glycogen and the synthesis of lactate as a byproduct. A decrease in pH (i.e. acidification) in the muscles creates a feeling of discomfort.

General guidelines for changing diabetes management

Mode changes depend on which strength sport you choose. Intense physical activity can increase, decrease, or have no effect on blood glucose levels. However, after a while, the level of glycemia may decrease, especially if the resistance load is repeated for an extended period.For example, hitting the ball, running fast, and shooting baseball can have a cumulative effect and reduce glycogen. You need to be on the lookout, as replenishing glycogen stores after play can lead to a drop in blood sugar, called late hypoglycemia.

Using an insulin pump

When engaging in recreational strength sports, insulin dose changes may vary by sport.For light or short-term play, you may not need to change the dose at all. When playing for a long time, such as in team workouts, you will need to lower your boluses and basal rapid-acting insulin rates by 10-50%, depending on the intensity and duration of your workout. You will need less dose reduction than with endurance sports. This is due to the fact that the load in power sports is more intense, but short-term.If exercising causes the release of hormones that increase glycemia, then you will need to add insulin. If you participate in strength sports for an hour or more, then you will need to eat 10-30g of carbohydrates, depending on the degree of change in the dose of insulin. In addition, you may need to lower your basal insulin rate by 10-25% after doing some sports, and eat more.

Basal bolus regimens

When doing strength sports, the changes in regimen will depend on the particular sport you have chosen.If the sessions are short-term, then regime changes may not be necessary. Before long sessions (for example, before a team workout), you need to reduce your fast-acting insulin by 10-50%. Strength sports require a relatively smaller dose reduction than aerobic ones, since intense and short-term physical activity often does not reduce, but increases glycemic levels (which means the need for some amount of insulin to bring sugars back to normal). With long-term involvement, you may need 10-30g of carbs per hour, depending on how much you have reduced your fast-acting insulin dose and what your current blood insulin level is.After exercising, you may need to reduce your nightly basal insulin dose by 10-15% and arrange an extra meal before bed to prevent hypo at night after a significant decrease in muscle glycogen.

Without insulin and on oral hypoglycemic agents (PSS)

The strength nature of these sports can increase glycemic levels (albeit briefly), which occurs even in non-diabetic athletes. If you exercise for a long period of time, the sugars return to normal.As in sports that require a combination of strength and endurance, an aerobic cool-down will reduce elevated glycemic levels more quickly. For about a day after the end of physical activity, the level of glycemia may remain slightly lower, as the body uses blood glucose to replenish depleted glycogen stores. you may be more sensitive to insulin within 24 to 48 hours. If you are taking any long-acting PSS (such as Diabinesis, DiaBeta, Micrones, or Glinaz), check your glycemic level for any signs you associate with the onset of hypoglycemia.

Intensity, duration and other factors

The intensity of the game, the duration and nature of the activity (play for relaxation or participation in a competition) all have an impact on sugar levels. Recreational play is usually less intense but longer than competition. More serious overall loading will reduce glycogen stores after repetitive strength movements while intense competition. such as pushing the nucleus can promote the release of hormones that increase glycemic levels.On the other hand, playing leisure softball may not have an effect on your sugar. If you play softball for 2-3 hours, your blood sugar may drop. Participation in strength sports for a long time can cause hypoglycemia after exercise or at night.

Baseball & Softball

These activities are inherently anaerobic because they only require short bursts of energy to shoot, hit the ball, and sprint.As a result, you may not expend a lot of energy in these sports, and you will not have to seriously change your diabetes treatment regimen. However, these activities help young athletes improve eye-hand coordination and overall motor development.

The glycemic response depends on the intensity of the game and whether you are competing or playing for recreation. For example, in baseball and softball, the catcher and reliever are more active than other players because they participate in the game almost all the time.Exercise during exercise, just like other frequent repetition exercise, lowers blood glucose levels. For further guidance on controlling blood glucose levels while playing baseball and softball, see Table 11.1.

Table 11.1 Baseball and Softball

Examples from the life of athletes

The following examples show that recreational play may require minimal changes in treatment regimen, while longer, more intense exercise can significantly lower blood glucose levels.

Insulin dose changes only

To control blood glucose when playing baseball, Jake Sheldon of Millersville, Maryland, lowers his pre-class insulin bolus by 10-15%. If required, he can set a lower basal rate of insulin delivery for a while after a game or workout. When playing baseball, J.P. DeLisio of Midlosian, Va. Leaves his pump on and doesn’t change anything except when he plays batter.If he has hypo, then he drinks 120 ml of juice.

Bailey Glass of Los Lunas, New Mexico reduces Lantus by 1 (from 12) on softball days. Usually, its sugars are stable during the game, and 2-5 hours after the end of the game, they fall.

Long Beach, California resident Kaylee Swenson usually does not turn off her pump when playing fast-pitch softball. Sometimes she still turns it off, but before that, she administers an hourly dose of basal in the form of a bolus.

Diet changes only

North Carolina resident John Elwood plays baseball in high school. At the same time, he does not remove the pump and does not change the scheme of insulin administration, unless he feels the approach of hypoglycemia. Usually, he just eats more carbohydrates to control glycemia during this physical activity.

An athlete with type 2 diabetes, Chris Simmonds from Abindon, Maryland, works as a baseball judge on weekends.He tries to eat more carbohydrates these days: despite the fact that he only uses metformin to treat diabetes, sugars often drop, especially if several games have to be tried.

Combination of changes

Keith Sonder of Enumclaw, Wash., Typically lowers her basal insulin rate when playing fastpitch softball by 50%, and sometimes removes her pump when the game is too intense. In addition, before starting the game, she eats a certain amount of carbohydrates and proteins and drinks Gatorade to prevent hypo during games.

Debbie Schiesler from Phoenix, Arizona, plays softball at her university in California. She believes that during the season of games she needs much less Novolog for food, because she plays as a pitcher and trains a lot. To prevent hypo while playing, she uses Oreos and orange juice. She usually injects Lantus in the morning and evening, but on especially active days she reduces the dose of Lantus in the evening.

Brendon Hunter usually turns off his insulin pump during training and playing baseball.He usually has a small “snack” before meals containing 15g of carbohydrates and often eats while playing. He checks his blood glucose levels while he is playing, and if the blood sugar starts to rise during the two-hour game, he plugs in his pump and delivers a bolus of insulin.

For cricket, Joel King of Bass, UK usually sets a temporary basal insulin rate that is 50% lower than usual 40-60 minutes before the game. In addition, he usually eats a cereal bar containing 15g of carbohydrates or a banana in advance, and also drinks about a bottle of Lucozade in two hours of play.

New Yorker Gail Brosnan plays softball during the spring and summer months and always turns off her insulin pump before playing. Before the start of the game, she tries to keep her glycemia at the level of 8.9 mmol / L and takes carbohydrates if the sugar drops by 7.2 mmol / L.

Bodybuilding

This type of physical activity relies on anaerobic energy sources for muscle building, but also includes an aerobic component in powerlifting and weight training.By itself, bodybuilding competition has no effect on blood glucose levels unless mental stress is taken into account. Continuing training for these competitions works in much the same way as weight training. The increase in muscle mass as a result of exercise leads to increased insulin sensitivity and a decrease in insulin requirements. Aerobic exercise aimed at lowering body fat can lead to lower blood sugar levels.

Heavy weight training releases hormones that increase blood glucose levels, so your sugar levels during this type of physical activity may go up rather than go down.On the other hand, prolonged weight training promotes the use of muscle glycogen and thus increases the risk of late hypoglycemia. To establish a specific regimen for intense training, see the section on weight training in Chapter 8. Combining weight training and cardio can effectively lower blood glucose levels. As for cardio workouts, the changes in the regime will depend mainly on their intensity and duration. See Chapter 8 for advice on using aerobic machines.Further bodybuilding instructions are in Table 11.2.

Examples from the life of athletes

Insulin dose changes only

Lisa Harlan, from Kettering, Ohio, follows a bodybuilding diet (high in protein) and mostly changes her insulin dosage. She regularly and intensively trains with weights and does cardio for one hour a week. The order of her classes does not change, so she only lowers insulin by 0.5-1 units during especially hard training. She finds bodybuilding competitions very difficult, although sugars usually drop during cardio.

Table 11.2 Bodybuilding

Combination of mode changes

A resident of Kansas City, Missouri, Kim Seeley is a professional fitness competitor at the International Federation of Bodybuilding (IFBB). She says vigorous weight lifting raises her glycemic levels, and cardio lowers them. In addition, if she is on a diet for 9-12 weeks before a performance, then the amount of fat in her body is greatly reduced and the total daily dose of insulin is reduced by at least 30%.Despite this, she must monitor the calorie intake in order to continue to lose weight. In preparation for the competition, she switches from an insulin pump to Lantus and Humalog, because with a strong thinning of the subcutaneous fat layer, she has nowhere to connect the pump. She increases the dose of Humalog (and does not lower it) only on days when she does sets of exercises for the legs and during competitions, when sugar rises against the background of psychological stress.

Dow Burns, a Mr.Universe title holder from Menlo Park, California, agrees with Kim’s view of insulin requirements as a function of body fat.He believes there is a huge difference in training plan between training to maintain overall health and preparing for competition. He changes the dose of insulin based on his weight and body fat. He also notes that the less body fat, the less insulin he needs. He changes his diet when he lowers fat for competition and this also affects his insulin needs.

Auckland, New Zealand resident Nev Rines says that during heavy weight training and bodybuilding, he reduces the dose of Novorapid by 2-3 units (about 25% of the usual dose) to prevent hypo.Despite some amount of insulin in the body during exercise, glucose levels do not drop, but rise. To prevent hypo, he drinks a little fruit juices during his workouts. On days of increased activity, he sometimes reduces the dose of Protafan (medium-acting insulin) in the evening injection to prevent nighttime hypo.

Fencing

One of only four sports that have been featured in all of the modern Olympic Games, fencing involves short, hard kicks and lunges, as well as constant leg movements throughout the allotted time (round) of competition.

Workouts in this sport include both strength training and endurance exercises. In order to achieve high results in fencing, it is necessary to have a good general physical level. This level can be achieved by combining yoga with weightlifting, as well as cardio and endurance exercises, including rope and plyometric exercises. The glycemic effect depends on the intensity and duration of the activity. With prolonged intensive work, there is a greater likelihood of a decrease in glycemic levels.During competition, blood glucose levels can rise due to the intensity of the match and psychological stress.

Examples from the life of athletes

Combination of mode changes

Adrian Conard, from Victoria, Australia, administers half of his usual bolus if he eats less than 2 hours before the start of fencing, but the doses of Novorapid and Protafan (medium-acting insulin) are usually not changed. During the competition, he cannot eat anything, so he replaces water with sports drinks.

Technical types of athletics (long jump, high jump, javelin, discus, shot, hammer throw)

Most of these sports require short-term, near-maximum muscle contractions (such as javelin or discus throwing or long jump). Basically, anaerobic energy sources are used. The intensity and short duration of the competition makes it easier to control glycemia, although glucose levels may subsequently drop due to the replenishment of muscle glycogen stores.During and after training, in contrast to competitions, more serious changes in the insulin administration scheme are required, because physical activity in training is longer. See table 11.3 for further guidance.

Table 11.3 Technical types of athletics

Powerlifting and Olympic Weightlifting

Physical activities such as lifting weights lasting up to 10 seconds are provided by short-term energy sources — ATP and CP. Powerlifting and Olympic weightlifting are different sports; Powerlifting includes the maximum number of squat lifts, bench press and deadlift, while in Olympic weightlifting there are only two moves: snatch and clean and jerk.Both of these types of physical activity can initially raise blood glucose levels, but later on, sugar levels can drop. Long-term training in these types of glycemic effects is similar to the effects of high-resistance strength machines. The increase in muscle volume resulting from these exercises increases the body’s sensitivity to insulin, which means that you will have to reduce your insulin doses. See Chapter 8 for advice on changing your regimen for intense weight training.

Examples from the life of athletes

Insulin dose changes

Keith Knight from Aloha, Oregon, an Olympic weightlifter with diabetes 1.Type 5, turns off its pump completely for weight training sessions that last 45 to 60 minutes. He usually turns on the pump no earlier than 2-3 hours after the end of the workout. He does not start working with weight until the glycemia exceeds 7.8 mmol / L.

Diet changes only

Bob Duncan of Richmond, Virginia, with type 2 diabetes, believes that regular powerlifting keeps his sugar levels in the normal range better than aerobic exercise.Before class at lunchtime, he eats a banana, dried fruit, and drinks a protein shake.

Sprint

Although a full-strength sprint (i.e. when you can no longer increase your pace) can usually run for no longer than 5-10 seconds, a sprint (not at full strength) can be run at different distances, as well as intervals. For example, an 800m run requires more energy from the lactic acid system and is mostly anaerobic, while a run longer than 2 minutes draws more energy from aerobic sources.After a single sprint, glycemic levels may rise (thus increasing glycemia at the end of aerobic exercise, see discussion in Chapter 2). Repeated sprints will initially increase glycemic levels and then decline as the body replenishes glycogen and other used “Fuel”. Thus, when sprinting, you should not worry about immediate sugar reduction, but about the prevention of late hypoglycemic conditions. For further guidance on sprinting glycemic control, see Table 11.4.

Table 11.4 Sprint

Examples from the life of athletes

These examples show that the main effect of sprint running, at least in training, is to increase, not decrease, glycemia.

Insulin dose changes only

When Felix Kazha of Redmond, Wash. Sprints at top speed, he injects an additional 1-1.5 units of insulin per hour.

David Walton of Newton, PA, believes sprinting at the end of a long run boosts his sugar. For example, when he briskly runs 3 miles (4.8km) and then sprints the last 800m, his sugar rises by 1.7mmol / L, although without this sprint they would have fallen.

Doretta Reilly of Atlanta, Georgia, sprints at least once a week and does not change her diet on that day. Instead, she usually lowers her insulin doses on food before her interval training. On days like this, she drinks more orange juice than she does when weights.

Volleyball and Beach Volleyball

This activity involves short, strong movements (catching and serving the ball) and is by nature anaerobic.The total energy expenditure can be relatively low, depending on the length and intensity of the game, but beach volleyball requires a lot of effort due to the fact that you have to walk and run on loose sand. Workouts usually require more strength as they last longer. Moving and hitting the ball when playing volleyball requires short bursts of muscle activity and you do not need to change the dose as much as in more active games on the court (eg basketball). If you play for relaxation, the intensity of the game is usually low and you do not have to take part in every serve.Playing at a high level can raise your glycemic levels in the beginning, but if you play intensely and for long periods, beware of late hypo. See Table 11.5 for further guidance.

Table 11.5 Volleyball and Beach Volleyball

Examples from the life of athletes

Insulin dose changes only

Jenny Vandevelde from California lowers her pump basal insulin rate to 20% of her normal when playing volleyball. With hypo, he takes carbohydrate bars.

Julia Majurin of Indeanapolis, Indiana, lowers her basal volleyball to 25% of her normal.

Richard Feifer from California lowers his basal intake to 10% of his norm 30 minutes before the start of the game and returns to the previous regime 30 minutes before the end of the class.

Canadian resident Tanya Knappich from Brampton, Ontario turns off her pump during the game, as does Leanny Lauzonis from Albuquerque, New Mexico. Leanny usually plays for two hours, after which the sugar drops.

Combination of mode changes

Taylor Tenton (Ashland, Virginia) plays volleyball for her varsity team.On those days when the load is heavy, she reduces the dose of Novolog, but does not change the dose of Lantus. She drinks Gatorade while playing to prevent hypo.

Christa, a teenager from Palm Springs. The state of California plays volleyball throughout the year. If she eats before the game, then she reduces the dose of Humalog for food by 1-2 units.Sometimes she introduces 1 unit after the game. If she feels hypo while playing, then she eats a carbohydrate-protein bar.

Athlete Portrait

Doug Burns

Redwood City, California, USA

Type 1 diabetes mellitus diagnosed at age 7 (1972)

Powerlifting & Bodybuilding

Set America’s record for bench press, won Natural Mr.USA (2004) and Natural Mr. Universe Tall Class (2006).

Current treatment: Novolog with insulin pump Animas.

Training Features First, define your goals, what you have achieved and what you are going to do. Then your workouts make sense. Second: do what you do the worst, what is the hardest for you to achieve those goals. If I succeed, then you will succeed.Allow yourself to make mistakes and laugh at them, even at serious mistakes. All of us with diabetes make mistakes sometimes: in training, in competition, or on days when we have terrible sugars.

Typical daily and weekly training and diabetes management regimen: My training is very different if I exercise for my health or prepare for a competition. I slightly change the dose, but I do it purposefully, depending on the amount of fat in the body (the less fat, the less insulin I need).

Here is my regimen for practicing “for health”

Monday: Cardio workout early in the morning, usually 30-45 minutes and lifting weights for the chest, shoulders, triceps and abdomen (3-5 sets of 2-4 exercises per part of the body

Tuesday: Run the hills in the evening (outdoor cardio 50 minutes) and leg workout (4-5 sets of 3-5 exercises per part of the body, including squats and leg curls)

Wednesday: Cardio early in the morning, usually 35-40 minutes and lifting weights in the evening using the back and triceps muscles (3-5 sets of 2-4 exercises per part of the body)

Thursday: Cardio workout 40 minutes and workout for legs (5 sets of 3 exercises on a part of the body)

Friday: Cardio 30 minutes and upper body (combined exercises)

Saturday: Normal activity only

Sunday: Rest day

Other interests and hobbies I enjoy reading and visiting new places.I am always looking for ways to improve myself.

Diabetes Story and Exercise I was born in Washington and grew up in Long Beach, Mississippi and was diagnosed with diabetes at age 7. Before the advent of blood glucose meters and effective ways to control diabetes, I was often hospitalized for several years due to decompensation. When I was 10 years old, I entered the intensive care unit of the Johns Hopkins Medical Center with a weight of 24 kg and a glycemic level of 64.1 (!) Mmol / L. Due to constant hospitalizations and poor condition, other guys did not communicate with me much and I was not allowed to participate in team games.

I saw a drawing of Samson, who is fighting with a lion and decided to become strong, began to do weightlifting on his own. At first I took just heavy stones and various homemade weights for this. At first, nothing worked, but I trained hard for several years and gradually turned from a guy who was called a “bag of bones” in school to a state champion, and then won the title of American powerlifting champion, without the use of chemicals. Then I felt the benefits of aerobic exercise and shifted the emphasis of training to physical development.So far I have won the Southern States Championships, Mr. California and Mr. USA titles, and Natural Mr. Universe Tall.

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Detachment of the retina is a severe disease of the organ of vision, in which the retina is separated from the choroid (choroid).
Today it is the main cause of blindness, and 70% of patients are of working age.
The severity of this eye disease depends on the area of ​​retinal detachment and the age of the process.

According to the pathogenesis of retinal detachment, they are divided into 3 types:

• Rheumatogenic (primary) retinal detachment

• Traction retinal detachment

• Exudative (secondary) retinal detachment

Causes of retinal detachment

The development of rhegmatogenous retinal detachment is associated with the rupture of the retina and the ingress of fluid from the vitreous under it.This condition develops with thinning of the retina in the zones of peripheral dystrophies. With various types of retinal dystrophies (lattice, “snail trace”, etc.), a rupture in a degeneratively changed area can be triggered by sudden movements, excessive physical exertion, traumatic brain injury, falls, or occur spontaneously.
The occurrence of tractional retinal detachment is associated with pronounced tension from the vitreous body in the region of vitreoretinal adhesions, even without the formation of a rupture.This condition occurs in the complicated course of diabetes mellitus.
Exudative retinal detachment is a consequence of the course of various eye diseases (inflammatory processes of the choroid, tumors of the retina and choroid, etc.), in which fluid accumulates under the retina.

Signs of retinal detachment

– There is a flickering of black dots before the eyes, which interfere with concentrating on the object in question, do not disappear after rest or sleep.
– At the very beginning of detachment, the patient may pay attention to the appearance of flashes (photopsies) in the eyes, which appear in the form of light glare, lightning, and spots of light.
– Also at this stage, patients note the curvature of straight lines, the size and shape of the objects under consideration (metamorphopsia).
– There is a progressive decrease in visual acuity. With massive detachment, a person can lose their eyesight in just a few hours.

– A black spot appears, a shroud, a curtain.This blackness is the area of ​​the detachment that no longer receives or transmits light pulses. This process progresses up to a complete loss of vision, with an untimely visit to an ophthalmologist.

If you experience these symptoms, you should immediately consult a doctor. If the disease is started, there may be a danger of chronic inflammation, complete loss of vision. Especially vigilant should be those people who have already had a retinal detachment in one eye.They should be checked periodically by an ophthalmologist.

Modern diagnostic methods

– Determination of visual acuity (this will assess the state of the central region of the retina).

– Computer perimetry – examination of the visual field to determine the state of the retinal periphery.

– Measurement of intraocular pressure (tonometry).

– Electrophysiological study – will assess the safety and viability of cells of the retina and optic nerve.

– Ultrasound examination to determine the size of retinal detachment and the state of the vitreous body. This study is especially important in the presence of opacities in the optical media, in which fundus ophthalmoscopy is difficult.

– Examination of the fundus (direct and indirect ophthalmoscopy), which will determine the localization of retinal breaks, their number, assess the condition of the detached retina and its relationship with the vitreous body, identify thinned areas that require increased attention during surgical treatment.

Treatment

Retinal detachment treatment requires an individual approach. The choice of treatment method depends on the type, form, and severity of the pathology.

Retinal detachment cannot be cured with any drops, pills or injections. The only effective method of treatment is surgery, and the earlier it is performed, the more chances the patient has in the hope of stabilizing the process and preserving vision.

In the early stages of retinal detachment, with the localization of the process at the periphery, it is possible to carry out laser coagulation of the retina to stabilize the process and prevent further progression.

In all other cases, surgical treatment is performed:

– Ectrascleral filling (ballooning, meridional or circular filling). The purpose of extrascleral filling is to bring the detached retinal area closer to the surface of the pigment epithelium, which requires determining the exact localization of detachment and breaks.

– Intraocular (vitrectomy). Removal of the altered vitreous body and endolaser coagulation around the ruptures is performed.Then, instead of the vitreous body, an air-gas mixture, or silicone oil, or saline solution is injected into the vitreous cavity in order to straighten and press the retina to the underlying membranes of the eye.

With a different course of retinal detachment, it is possible to combine different methods of treatment.

Prevention of retinal detachment

Retinal detachment can be prevented. For this purpose, patients, especially those with myopia, retinal dystrophy, diabetes mellitus, head and eye injuries and during pregnancy, need regular preventive examination by an ophthalmologist with a Goldmann lens and timely retinal laser coagulation.Patients at risk for retinal detachment are contraindicated in heavy physical exertion, heavy lifting, and some sports.

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90,000 Prostatitis – a threat to men’s health

Almost every man throughout his life becomes a victim of a prostate gland disease – prostatitis, by far the most common urological disease in men.

The prostate gland (prostate) is a very important glandular-muscular organ.The glandular part of the prostate produces a secret that, mixing with the sperm, maintains the viability of the sperm. The muscle part regulates the flow of semen and urine so that they do not mix. In addition, the prostate is involved in the production of male sex hormones, which not only ensure normal male sexual function, but also affect all metabolic processes in the body. In this regard, the performance of the male body largely depends on the state of this small organ.The prostate gland is located just below the bladder, surrounding the urinary canal.
The channel that excretes urine and semen through the penis is called the urethra.

Unfortunately, not all men manage to keep the prostate intact. Inflammation of the prostate gland, known as prostatitis, is quite common today. At the same time, if earlier prostatitis attacked mainly elderly men, today the disease occurs even in young men.

Why does prostatitis occur?

Previously, it was believed that the main cause of prostatitis is genitourinary infections, however, doctors often meet with a non-infectious form of prostatitis. Therefore, today other factors are considered that contribute to the development of this disease, including:

• Low physical activity. A sedentary lifestyle leads to the development of congestion in the pelvic organs. If the blood supply is disturbed, the local metabolism worsens, which can lead to the development of inflammatory processes.
• Sexual abstinence. It has been noted that irregular sexual activity, in particular prolonged abstinence, negatively affects the condition of the prostate gland.
• Hypothermia. With hypothermia of the pelvic organs, local immune defenses are reduced, which makes the prostate gland more vulnerable to infection.

The insidiousness of chronic prostatitis is that it often develops asymptomatically for a long time.Therefore, most men seek help only with the development of various complications. Exacerbations of chronic prostatitis, when symptoms become severe, are often the reason for seeking medical attention.

Symptoms of prostatitis can be conditionally divided into three groups:

• Disruption of the urinary apparatus. A man experiences frequent urge to urinate, a feeling of incomplete emptying of the bladder, and painful sensations (often a burning sensation) when urinating.Typically, these symptoms are also accompanied by pain in the lower abdomen.
• Disorders of sexual function. Prostatitis may cause pain in the urethra and rectum during ejaculation. In addition, there may be a weakening of erection, premature ejaculation and “wear” orgasm (or lack thereof).
• Nervous disorders associated with a man’s concern for his health.

If prostatitis is left untreated, the disease progresses, causing more and more harm to the man.In the future, the course of the inflammatory process is aggravated, which can lead to scarring of a part of the prostate and even the appearance of stones in the organ.

Take Action

If you notice one or more of the symptoms described above, then immediately consult a doctor so as not to start the disease.

Treatment of chronic prostatitis can be very diverse, and depends on the complexity and neglect of the disease itself. And when the doctor, at the next routine examination after digital rectal examination and ultrasound, confirms the presence of chronic prostatitis, you should not despair – these are only traces of exacerbations.

The main goal of prostatitis treatment is to achieve the longest possible remission, as a result of which the patient can forget about unpleasant symptoms for several years.

It is advisable to carry out the treatment of chronic prostatitis in a comprehensive manner and to select a treatment regimen individually, taking into account the characteristics of the disease in a particular patient. It can be antibiotics and anti-inflammatory drugs – if the cause of inflammation of the infection, or vitamins, biostimulants and physiotherapy with prostate massage – if the cause of prostatitis is congestion and impaired local circulation.If the cause of the disease is mixed, then the methods of treating prostatitis can be combined to obtain the highest possible results from the treatment. Very good results are obtained by spa treatment, where it is possible to combine all the necessary therapeutic factors under the supervision of a specialist doctor.

Prevention of chronic prostatitis consists in following simple but very important recommendations:

• Have a regular sex life.
• Avoid strong alcoholic drinks and beer, spicy food, smoked meats and seasonings (spices).
• Do not overcool, remember that even a short stay in cold water or in wet swimming trunks in the wind can exacerbate the disease.
• Lifting weights, squatting with a barbell, riding a bicycle with a narrow seat – harm the prostate!
• Remember that sedentary work and long periods of time behind the wheel of a car contributes to the congestion of blood in the prostate gland and rectum, increasing the risk of prostatitis and hemorrhoids.
• Patients who have had an exacerbation of prostatitis know that it is advisable to see a doctor every 6 months, and once a year in case of prolonged remission (quiet period).

You can get advice from an experienced urologist, undergo the necessary examination and treatment on the basis of our sanatorium, in the General Resort Urological Center. At your service are ultrasound and laboratory diagnostics, modern physiotherapy equipment, including laser, radio wave, shock wave therapy.

There are contraindications. A specialist consultation is required.

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