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Diabetes Mellitus

I first became interested in diabetes when I was only three months into personal training and I took on my first Type I client, whose name was Sam. (It’s quite rare for someone to develop Type I at an older age – she was about thirty.)

Diabetes is not part of the syllabus when qualifying as a PT, so whatever I write here comes from what I have learned over the years since, and Phil Graham, who is a Type I educator, peer and friend in the fitness scene, has always answered any questions I have, so I’m very grateful for his input.

Here, I’m going to share what I think is a useful amount of knowledge on the subject and break it down in the best way I can. Whenever I break something down, I literally convey it in a way that I have communicated with myself in order to understand it.

I nearly left this section out of the book – I know it’s not light reading, but in the next few years (or maybe already), someone close to you may have some form of diabetes and you can have a positive impact on their life by understanding it. I do not wish to underestimate the seriousness of diabetes in any way by attempting to oversimplify it in this chapter. I am just trying to communicate the understanding I feel you may need at this stage.

So what is diabetes?

Diabetes is a group of metabolic diseases characterized by hyperglycaemia,* resulting from defects in insulin secretion, insulin action or both. The long-term hyperglycaemia of diabetes is associated with longterm damage, dysfunction and failure of different organs, especially the eyes, kidneys, nerves, heart and blood vessels.

Diabetes comes in several forms – four, to my knowledge, although I only really want to discuss two of them here: Type I and Type II. Type I – results from the pancreas failing to produce enough insulin. Type II – is a condition of defective insulin signalling. Gestastional – a condition where women without previously diagnosed diabetes exhibit high blood glucose (blood-sugar) levels during pregnancy, especially in the third trimester.

Please consult a doctor for more information on this. It’s estimated that right now over 400 million people are living with some form of diabetes, and most of us just don’t know enough about it. I spoke to a man on the Tube recently and he told me he was Type I diabetic.

I bombarded him with questions (I am fascinated by the complexity of it). I asked him what living with it was like, and he told me he often got judged by people around him for having it. This is because people jumped to the conclusion it was lifestyle or poor decisions that had led to his condition.

However, this isn’t always true, and I feel it’s largely unfair and unhelpful to tar everyone with the same brush when it comes to diabetes. It actually pissed me off that people are so quick to assume what type of diabetes he had, so I want to dedicate this part of the book to all those who have to live with diabetes and the unwarranted judgement that can come with it.

Type I

Typically known as the ‘insulin dependent’ form of diabetes. This is an autoimmune disease where the body attacks itself. Some of the other most common autoimmune diseases I’ve come across with clients include Crohn’s and rheumatoid arthritis.

Type I diabetes develops as the body attacks the cells in the pancreas responsible for producing insulin. If insulin can’t control blood-sugar levels and do its job in bringing glucose out of the blood, the glucose levels in the blood begin to rise, causing hyperglycaemia.

When someone with Type I continues to eat, especially carbohydrates, their blood-sugar levels are hiked high at the same time that cells in the body are not getting the fuel they need, or the glucose out of the bloodstream. The body will often start producing ketones. (If you remember, earlier in the book I spoke about ketosis occurring when glucose availability gets very low.)

Although there is a lot of glucose in the blood during hyperglycaemia, it’s not available, so the body begins producing ketones. Although ketosis isn’t immediately harmful, when excessive levels of ketones and glucose circulate the bloodstream for long periods, people can suffer the life-threatening state of ketoacidosis.

Type I can be managed with administration of insulin and using blood glucose monitors to check when blood sugar gets too high or too low. Over time, Type I diabetics can learn when they need to administer and how much during certain feedings. The cause of Type I diabetes is still not known fully, and I am sure you can see my frustration as to why many people don’t have a choice when it comes to Type I diabetes.

Type II

This is the most common type of diabetes. The fundamental issues seen with Type II are insulin resistance and reduced insulin production. Being pre-diabetic is a term often used to describe patients who are at risk of developing Type II if they do not change their lifestyle or habits. Family history, poor diet, being obese and sedentary put you at highest risk of developing Type II diabetes.

I believe it was called ‘adult-onset diabetes’, but unfortunately now we’re seeing it in younger populations, and even teenagers are developing Type II diabetes. The reason for the rise in obesity is complex, and I’d be misrepresenting it if I said it was just because we ‘eat too much and don’t move enough’, but our environment is growing evermore sedentary.

It’s deemed an effort by most to even meet their Deliveroo driver at the front door; at least not so long ago we had to walk to the chip shop to buy our fish and chips! And Uber means that we walk less, while some physical jobs are being replaced by technology, especially in the industrial sector worldwide. The key to reversing pre-diabetes or improving symptoms and effects of Type II must be to exercise as often as possible and to reduce body fat by implementing what you learn throughout this book. Increasing insulin sensitivity is the goal, and I’ll talk about it more below.

INSULIN RESISTANCE

Insulin resistance is primarily an acquired condition that is related to having too much body fat, although there are other causes linked to genetics and conditions like polycystic ovary syndrome (PCOS), which I’ll explain more about in the female fat loss section of the book.

What I often tell my clients is: ‘When there is an inability for your body to properly respond to insulin, you’re insulin resistant.’ The most common causes are obesity (which is having more fat than you need). Other factors can be age, lack of exercise or a sedentary lifestyle.

Training a muscle will increase insulin sensitivity at the muscle site; this is because even with insulin resistance there will be glucose (often stored as glycogen†) being ‘used’ as fuel at the muscle, meaning more demand for more fuel to re-enter the muscle to replenish it. Keto and Diabetes It’s quite easy to draw a conclusion that following a keto diet means lower levels of insulin and therefore a solution, right?

Although ketogenic diets are becoming more popular and some people are experiencing tremendous amounts of weight loss (with removal of many hedonic foods), I could therefore get behind a Type II using the protocol; however, the very low amounts of carbohydrates (often 20–50g per day) they could run the risk of a Type I experiencing a ‘hypo’, which would lead to issues with sustaining long term. Exercise not only means burning more calories, which is great, but it also increases insulin sensitivity to muscle tissue. Imagine on one end of the spectrum you have insulin resistance; what you want is to increase insulin sensitivity.

You’re not obese because you’re insulin resistant; you’re insulin resistant because you’re obese. Unfortunately, the daily habits that are formed over the years to make someone pre-Type II diabetic or even Type II cannot simply be undone by medical intervention.

Giving them a handful of pills isn’t going to change the habits that have been ingrained every day for years and sometimes decades. When setting goals for weight loss it’s hugely important to make them small. For instance, like I’ve said before, you don’t have 10kg to lose – you need to lose 1kg; that’s all your focus needs to be on – 1kg at a time and nothing more than that. When you’ve lost that 1kg, it’s time to set your sights on the next.

Treatment of Diabetes Mellitus

Treatment for diabetes aims to keep blood glucose levels as close to normal as possible to reduce the risk of developing complications. Treatment will vary depending on the type of diabetes. Lifestyle modifications in conjunction with medications like insulin are often needed.17 ‘Effective management of diabetes is a team effort between the person with diabetes and respected and suitably experienced health professionals.’ Phil Graham, The Diabetic Muscle and Fitness Guide.

James Smith-Personal Fitness Trainer