// Personal training diabetic clients
by Melinda Cook
Diabetes affects everybody. Even if you do not fully understand the
nature of the condition, you will be familiar with the term. Diabetes
is a growing concern in our community with over 1.5 million Australians
living with this chronic and sometimes debilitating disease. This
number is growing steadily, with an additional 275 people being
diagnosed every day in Australia.
With these staggering figures, it is not surprising that a lot of personal trainers already have clients with diabetes, and if you haven’t already it is probable that you will train somebody with the disease in the near future.
WHAT EXACTLY IS DIABETES?
There are two main types of diabetes. Type I diabetes is an autoimmune disease, which means there is no particular reason why children, adolescents and young adults, the most commonly affected groups, are affected. It is the less common form of diabetes, representing only 10 to 15 per cent of all people with diabetes. There is no cure for type I diabetes and it cannot be prevented.
Type II diabetes, however, is much more common and is the type of diabetes often referred to in the media. It represents 85 to 90 per cent of all people with diabetes and is often diagnosed in those over 45 years of age. However, more and more young people are being diagnosed type II, a trend which is attributed to increasingly sedentary lifestyles among younger people. Sadly, people don’t seem to realise that type II diabetes can be prevented by leading a healthy lifestyle that includes regular exercise and healthy eating.
MANAGING DIABETES WITH TRAINING
Physical activity helps people maintain a healthy weight, increases their energy levels and generally makes them feel good about themselves. For those with diabetes, both type I and type II, exercise is essential in helping insulin, the hormone that controls blood glucose levels, to work better and to help improve overall diabetes management. Exercise can also be seen, therefore, to be one of the keys to preventing type II diabetes.
There is no wrong or right way to train people with diabetes, but there are certain things to look out for. The most important thing when training a diabetic client is understanding just how exercise affects people with the disease.
Grahame Jones, a personal trainer at Dare Fitness and Training in Brisbane, trains clients with type I, type II and pre-diabetes. Grahame, who has had type I diabetes for over 25 years, says the main difference when training people with diabetes is the awareness factor;
‘Just as with any client, close individual attention must be paid to any specific medical concerns the client may have. Exercise prescription is based on individual factors. The main difference between training regular clients and those with diabetes is that both the trainer and the client must be aware of the insulin-type effect that exercise can have on blood glucose levels, both during and after a training session.’
Exercise plays an important part in a daily routine for people with diabetes as it helps to keep blood glucose levels close to the ‘normal’ range of between four and eight millimoles per litre (mmol/L). Keeping the blood glucose levels within this range helps prevent short term effects of very low or high glucose levels as well as possible long term effects such as blindness, stroke and conditions resulting in amputations.
When people with diabetes exercise or participate in highly strenuous physical activity, however, their blood glucose levels are affected, increasing the possibility of negative short term effects such as hypoglycaemia.
‘It is good practice to test blood glucose before and after a session, even during, to help establish responses to a particular form of exercise. I personally always test before training, take in a small amount of carbs pre-workout, train for 30 to 45 minutes and then have a balanced meal within half an hour of the training session. This helps avoid hypoglycaemia and allows for adequate recovery from a training point of view’ Jones says.
DEALING WITH 'HYPOS'
Hypoglycaemia, commonly known as a ‘hypo’ can be common during exercise for people with diabetes. Hypos occur when blood glucose levels drop too low due to the muscles using more glucose as energy.
If a person with diabetes experiences a hypo during physical activity, it must be treated immediately with an easily absorbed carbohydrate food that is easy to consume, such as jelly beans or a soft drink (not diet varieties). Many of the early signs of a hypo are also ‘symptoms’ experienced by any individual during physical activity, and can therefore go unnoticed. When training a diabetic client, it is important to look out for signs, including:
• weakness, trembling or shaking
• lack of concentration or behaviour change
• numbness around the lips and fingers
As some of these symptoms are not necessarily visible, it’s always a good idea to ask your client how they are feeling if you suspect they may be having a hypo. If your client is experiencing any of the hypo symptoms, it’s important to stop the session and treat the hypo to stop blood glucose levels from dropping even lower.
Remember, it is important to have some form of glucose on hand both during and after exercise to treat hypoglycaemia if needed. Find out your client’s preferred choice and make sure you have a supply in your training bag (and try not to eat them yourself!).
Failure to treat a hypo quickly can result in loss of coordination, confusion, slurred speech and even loss of consciousness. In the case of unconsciousness, you must dial 000 for an ambulance and clearly state that it is a ‘diabetic emergency’.
FOCUS ON LIFESTYLE CHANGES, NOT DIABETES
As for ‘specific’ forms of exercise recommended for people with diabetes, Grahame Jones says he doesn’t put his clients through blitzes or challenges, focusing instead on lifestyle changes that will benefit a person’s diabetes and keep them training long term; ‘With the focus on good nutrition and regular exercise, I believe the ‘I have diabetes’ part of their lives can really take a back seat, enabling them to enjoy the benefits of their healthier lifestyle. Along with insulin or medications and blood glucose testing, nutrition and exercise help form the ‘tools of the trade’ for diabetes sufferers. For good diabetes control we need to learn to use ALL of them effectively.’
Personal trainers can make a huge contribution towards a person’s diabetes management by providing encouragement, support, motivation and advice in relation to following a healthy lifestyle, the rewards being better glycaemic control for your client, which will have them feeling great!
Melinda works for Diabetes Australia Queensland, a not-for-profit organisation dedicated to improving the lives of people living with diabetes. She promotes the work of the organisation and is involved in the Diabetes Preferred Trainer program. For more information on becoming a ‘diabetes preferred trainer’ visit www.trainerlocator.org or call 07 3239 5600.
NETWORK MAGAZINE • AUTUMN 2008 • PP73-74