DIABETES AND PHYSICAL EXERCISE

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The exercise in general:

  • Improves the insulin sensitivity 
  • It’s helpful for weight loss and maintaining weight loss
  • Improves muscle strength
  • Improves bone density and strength
  • Reduces blood pressure
  • Protects the heart and blood vessels by increasing the “good” and reducing the “bad” cholesterol
  • Improves blood circulation and reduces the risk of cardiovascular disease
  • Increases the energy level
  • Helps relax and relieve anxiety

 

Exercise is essential for management of type 2 diabetes. It not only helps control blood glucose but also improves physical fitness and reduces the risk of cardiovascular disease.

 

Which types of exercise are recommended for people with diabetes

Any activity that increases your heart rate and keeps it, improves your aerobic capacity. Aerobic exercise helps prevent type 2 diabetes and in general, improves glucose control in people with diabetes. Apart from these, it boosts overall mood and fight anxiety. You do not feel anxious when walking or swimming. According to the latest research, resistance training such as weight exercises also can lead to better blood glucose control and the result is similar with this of anti-diabetic drugs. In addition, they improve muscle strength and mass, reduce fat, improve mood and self-confidence.

It is GOOD to exercise three to four times a week, 30 minutes a day. Exercise every day is ideal. A good exercise program includes 5 to 10-minute warm-up, at least 15-30 minutes of continuous aerobic exercise (fast walking or cycling) and 5-minute relaxation at the end. Add to this program muscular strength or resistance exercises 2 to 3 times a week.

However, you need to be careful! Do not forget to track your glucose prior to, during and after exercise. This recording will reveal how your body responds to exercise and will help you to avoid dangerous blood sugar fluctuations. The effect of exercise is the same either for people with diabetes or without diabetes. Under normal circumstances, insulin is released from the beta cells in the pancreas when blood glucose levels increase, for example after eating. Insulin is necessary for the use of glucose by the liver and muscles, which can cause lower blood sugar levels. When exercising, the body needs extra energy (in the form of glucose) for the muscles. For short bursts, such as a quick run to catch the bus, the muscles and liver release stores of glucose for fuel. With continued moderate exercising, though, your muscles take up glucose at almost 20 times the normal rate. This lowers blood glucose levels. In people who do not use insulin or anti-diabetic drugs, insulin levels is lower and thus the risk of hypoglycemia is reduced. In addition, in people with diabetes, intense exercise CAN transiently increase glucose sugar levels. That is why if you have diabetes you should definitely control your blood sugar levels after exercise.

 

Before exercise: check your blood sugar

Before starting any exercise program, you should consult your doctor, especially if you had previously reduced physical activity. Ask your doctor which activities and the duration of exercise are relevant and if any change in your medication is required. If you use insulin or drugs that can cause hypoglycemia, monitor your blood sugar 30 minutes before exercise and just before exercise. This will help you understand if your glucose level is stable, rising or falling and if exercise is safe for you.

 

Recognize hypoglycemia symptoms

During exercise, you should avoid hypoglycemia. During prolonged exercise, check your blood sugar every 30 minutes, especially if you start a new exercise program or if you change the exercise intensity or duration. It seems difficult when practicing in the open air or taking part in organized sports. However, it is necessary at least until you realize that your body responds to changes in an exercise program.

 

Stop exercising if:

  • The sugar is below 70 mg / dL
  • You feel scared, nervous or confused
  • -Take or drink something to raise your blood sugar levels (15-20 grams of carbohydrates), such as: Two to five glucose tablets, half a glass (125 ml) juice, half a glass of carbonated sugar drink, five or six candies with sugar
  • Check your sugar again in 15 minutes. If it is still low, consume the same food or drink with sugar and check it again in 15 minutes. Repeat these steps until your blood glucose is at least 70 mg/dL. You can continue the exercise if blood sugar levels are normal.

 

After an exercise: Check your blood sugar again

Check your blood sugar immediately after exercise and several times over the next few hours. An exercise depleted glucogen stores in the muscles and the liver. As your body replaces these stores, it takes the sugar from the blood. The more intent is an exercise, the greater is the effect on the blood sugar levels. Hypoglycemia can occur even many hours after exercise.

 

Exercise tips

  • To reduce the risk of hypoglycemia, people with diabetes should follow structured exercise and dietary program, and take medication at the same time each day.
  • An extended or very intense exercise can cause the production of adrenaline and other hormones that antagonize the effect of insulin and may increase blood sugar levels. If you follow an extended or very intense exercise (which lasts for several hours), it may be necessary to alter the insulin / antidiabetic tablet medication in your diet. Consult your doctor.
  • Be careful when you exercise while your medication has the greatest effect. Depending on the time of exercise, it may be necessary to reduce the dose of basal or nutritional insulin. Your doctor will give you the appropriate instructions.
  • Better to exercise with someone who knows that you has diabetes and what to do in case of hypoglycemia.
  • It is useful to have an ID with you with the details on your disorders and medications.
  • Measure the sugar before, during and after exercise and always have a snack with carbohydrates (fruit, juice) in case of hypoglycemia.
  • Ask your doctor what is the best type of exercise for you. Some complications of diabetes, such as advanced retinopathy or neuropathy, can make some exercises dangerous for you. Your doctor will make you a test to estimate your heart’s response to the exercise.
  • Do not start exercising if you have type 1 diabetes and your blood sugar is over 250 mg / dL and you have ketone bodies in your blood because you probably have insulin deficiency and exercise will increase even more sugar levels. Take fluids, adjust the dose of insulin and contact your doctor.
  • Start slowly and then gradually increase the intensity and duration. Choose an activity that you enjoy.  If you enjoy an exercise, it will become a lifestyle. If you need to lose some weight, a water aerobics is a good idea. Other choices are cycling or swimming. Put on comfortable shoes and take care of your feet. Drink water before, during and after exercise to avoid dehydration. Do not ignore the pain! Stop exercising if you feel an excessive pain in the muscles and joints.

If you pair regular exercise with a well-balanced diet and the medication, you are on a right way to achieve an optimal regulation of blood glucose level as well as to avoid chronic complications of diabetes.

Hyperthyroidism

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Hyperthyroidism occurs when your thyroid gland becomes overactive and produces more thyroid hormones than you need. This leads to an increased rate of metabolism and the appearance of various symptoms, which, depending on the condition severity, are more or less perceptible to the patient.

What is the thyroid gland?

 The thyroid gland is located in the anterior neck; it is a butterfly-shaped organ that is usually visible on inspection. It produces hormones, triiodothyronine (T3) and thyroxine (T4), which mostly controls how your body uses energy (metabolism). The thyroid is controlled by a gland located in the brain, the pituitary gland, which produces thyroid-stimulating hormone (TSH) to stimulate secretion of thyroid hormones (T4, T3). These two glands works together very closely and any functional thyroid disorder influences inversely the production of TSH.

What causes hyperthyroidism ?

  1. Graves’s disease. It is the most common cause of an overactive thyroid, especially in women of reproductive age (ages 20-40). It can occur at any age in men and women. As an autoimmune disease, ie our immune system produces an antibody that stimulates our thyroid, it may co-exist with other autoimmune diseases in the same patient (Crohn’s Disease, rheumatoid arthritis, celiac disease, type 1 diabetes, etc.). Also, as it is usually observed in autoimmune diseases, there is a family predisposition. Some patients may have eye problems (thyroid ophthalmopathy or Graves’ ophthalmopathy) with exophthalmia, dry eye syndrome, swelling, diplopia and loss of vision in the most severe forms. Smoking is one of the risk factors for the appearance and worsening of ophthalmopathy.
  2. One or more thyroid nodules that can become autonomous over the years, producing more thyroid hormones and thus causing hyperthyroidism. That is what Endocrinologists call toxic adenoma or toxic multinodular goiter, which can be detected by scan as “hot nodules”.
  3. In cases where hyperthyroidism is caused by inflammation and destruction of parenchyma, autoimmune etiology (postpartum thyroiditis) or potential viral etiology, usually after respiratory failure (hypoxia).
  4. Medications: amiodarone, interferon, lithium
  5. Excessive dosage of thyroxine

What are the symptoms of Hyperthyroidism?

  1. Weight loss with normal or increased appetite
  2. Tachycardia and even heart arrhythmia
  3. Leakage of stool
  4. Anxiety, irritability, sleeping difficulty
  5. Shaky hands, sweating, heat intolerance
  6. Fatigue, weakness
  7. Menstrual disorders

Diagnosis

Blood test help determine the diagnosis: TSH, Ft4, T3 (Ft3) and visualization by scintigraphy. It may also be necessary to measure antibodies (TSI, anti-TPO & anti-TG) and thyroid ultrasound with triplex to control the inferior thyroid artery.

Treatment

There are three choices

  1. Antithyroid Drugs
  2. Radioiodine
  3. Surgery

The age, severity, cause of hyperthyroidism and the patient’s preference play a role in choosing the right treatment.

Medication

There are two categories of drugs used in the treatment of hyperthyroidism.

Antithyroids such as metamazole (unimazole), carbimazole (Thyrostat) and propylthiouracil (prothuril), which reduce the excessive production of thyroid hormones. We usually prefer the first two because of fewer side effects, excepting the first trimester of pregnancy it is preferred to use propylthiouracil.

Antipyretics are prescribed: a) for a short time to make the patient euthyroid prior to surgery or radioactive iodine (usually in the second case the drugs should be discontinued a few days prior to iodine administration to increase the intake of the radiopharmaceutical and to make possible a thyroid destruction). b) for a longer period (1-2 years) as in Graves Disease in order to achieve to achieve a  therapeutic treatment (usually 30% up to 50-60% of patients in milder forms of the disease). After a discontinuation, there is a risk of relapse even after long-term sobriety. That is why we need to proceed to one of the two permanent treatment methods, thyroidectomy or radioactive iodine. All anti-thyroid medicines can cause side effects that your doctor should tell you and regularly measure some biochemical markers. During antithyroid medication, thyroid function should be checked, at least every 1-2 months.

Beta-blockers (mostly propranolol) are the second category of drugs, are prescribed in order to relieve symptoms (tachycardia, tremor, irritation) by gradually lowering the dose until the control of hyperthyroidism is achieved.

 

Radioactive iodine

Radioactive iodine is used in liquid form or in a capsule and can destroy the thyroid parenchyma, usually within 6-18 weeks. In people with severe symptoms, older patients and those with heart diseases, as previously mentioned, an antithyroid medication should be preceded, which will be interrupted a few days before a treatment. Most patients after radioactive iodine become hypothyroid and they should take a lifelong thyroxine therapy. On the other hand, 10-20% of the patients may need a second dose to see a result of a treatement, usually those with more severe hyperthyroidism and a large thyroid gland. Some patients with Graves’ disease, especially smokers, may experience a worsening of ophthalmopathy after a radioactive iodine. Patients that received a radioiodine should avoid close contact with children and pregnant women for 3 to 7 days after a treatment. A therapy is contraindicated during breastfeeding and pregnancy, while women of childbearing age should be delay any pregnancy for at least 6 months or more, after a radioactive iodine.

 

Thyroidectomy 

Suggested as the first option

  • To patients with large goiters (a large thyroid gland) with tracheal compression.
  • Abnormal antithyroid treatment due to serious side effects
  • The presence of suspected malignant thyroid nodules
  • Patient preference

After a surgery, the patient needs to pass regular thyroid function and blood calcium tests. When optimum tests’ results are achieved, monitoring is done 1-2 times a year. Patients should be aware that usually after a surgery a lifelong thyroxine replacement therapy is required.