Situations in which diabetics should avoid vigorous physical activities

Physical activities cannot be the same for every one all the time, in some special cases especially In type 1 diabetes, exercise can worsens hyperglycemia (>300mg/dl) and ketosis. Vigorous activities are best avoided.
Things to be noted in:
Hypoglycemia
Patients on insulin are at risk, added carbohydrate consumption is required if pre-exercise glucose levels are less than 100mg/dl and for patients on other medicines, preventive measures are not required
Retinopathy
Vigorous aerobic or resistance exercises- contraindicated and there is a risk of developing vitreous hemorrhage or retinal detachment.
Peripheral neuropathy
Excess physical activities may lead to loss of protective sensation; also there is a high risk of skin break down, infection and Charcot joint destruction. It is best advised to go for non- weight bearing exercises like Swimming, bicycling, arm exercises etc.
Autonomic neuropathy
Physical activities here can increase the exercise induced injury and also it can decrease cardiac responsiveness, postural hypotension, impaired thermoregulation, impaired night vision due to impaired pupillary reaction and unpredicted carbohydrate delivery from gastroparesis.
The best solution is to individualize the physical activity according to the cardiac status.
Some Special precaution to be kept in mind
**Feet should be inspected for any cuts blisters and infection
**Avoid exercises in extreme hot and cold climates
**Avoid exercises during periods of poor metabolic control
Benefits of exercise
**Improvement in insulin sensitivity
**Reduction of height
**Reduction in weight
**Improvement in lipid profile
**Improvement in cardiovascular function
**Sense of well being

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Significance of exercise for healthy life

It is a well known fact that regular physical activity improves health and wellbeing. So what does physical activity mean? Bodily movement produced by the contraction of skeletal muscle that requires energy expenditure in excess of resting energy expenditure. Whereas exercise is a subset of physical activity: planned, structured, and repetitive bodily movement performed to improve or maintain one or more component of physical fitness.
Exercises are of two types:
Aerobic
Anaerobic
Aerobic exercise consists of rhythmic, repeated and continuous movements of the same large muscle groups like walking, cycling, jogging, swimming etc…
Resistance exercise are activities that use muscular strength to move a weight or work against a resistive load like weight lifting, exercises using weight machines.
The American Diabetes Associations has recommended a minimum of 150 min moderate intense aerobic physical activity every week. And in the absence of contraindication, resistance exercises three times a week.
Frequency and type of exercise
At least 30 min of moderate intensity exercise daily.
90 min/week of vigorous exercise.
Should be distributed over at least 3 days/week, with no more than 2 consecutive days
without physical activity.

ENERGY EXPENDITURE ON VARIOUS PHYSICAL ACTIVITIES
ACTIVITY :KCAL/HR
Cleaning/mopping : 210
Gardening: 300
Watching TV: 86
Cycling(15km/hr) : 360
Running : 12km/hr : 750
10km/hr : 655
8km/hr : 522
6km/hr : 353
Walking(4km/hr) :160
Shuttle :348
Table tennis :245
Tennis : 392
Volley ball :180
Dancing :372
Fishing :222
Shopping :204
Typing :108
Sleeping :57
Standing :132
Sitting :86
Some of the general principles to be followed while exercising:
Daily exercise preferred
Start slow- have a warming up and cooling down period
Chest pain during exercise- stop exercise
Well fitting sports shoes
Carry sweets/sugar
Individualize exercise prescription
Reduce dose of insulin
Several well-planned studies have confirmed the benefits of yoga practices among diabetics.
And some of the best practiced Yogasanas are:
Ardha baddhapadma paschimoottasana
Eka pada galavasana
Shalabasana
Padahasthasana
Suptaveerasana
Adomukha matsyasana
Urdhwa prasarita padasana
Chatushpadasana
Mahamudhra
Urdhwa dhanurasana
Bhujangasana

Will buccal insulin succeed in the market…..?

Oral Recosulin is a rapid mist technology which allows precise insulin dose delivered via simple, cosmetically acceptable metered dose inhaler in form of fine aerosolized droplets directly into the mouth. This technology utilizes the formation of micro fine thin membranes to encapsulate and protect the insulin molecule. The system introduces fine particulate aerosol at high velocity (100 miles per hour) into the patient’s breath. The mouth deposition is dramatically increased compared with conventional technology. This oral aerosol formulation is rapidly absorbed through the bucal mucosal lining and in the oropharynx region. It provides the plasma insulin levels necessary to control postprandial glucose rise in diabetic patients.

This novel, pain free, oral insulin formulation has a critical series of attributes:
1. Rapid absorption
2. Simple (user-friendly) administration technique
3. Precise dosing control
4. Bolus delivery of drug

Dosage and administration:
One puff of oral-recosulin delivers 10 units of regular insulin. Approximately 1 unit of regular insulin is absorbed into systemic circulation of patient after taking 1 puff of oral-recosulin.
The patient should be relaxed and breathing normally. The mouth piece of the device placed in mouth at the end of normal exhalation. The patient sprays oral-recosulin into the mouth. Patient is asked to hold breath for 5 second (by counting slowly to 5)
This procedure is repeated until correct numbers of puffs are administered.
It is recommended that oral-recosulin be given in divided doses with 50% of the dose before the meal and remaining after the meal.

The indications of oral-recosulin are:
1. Oral-recosulin is indicated depending on the type of diabetes.
2. It is recommended as bolus insulin for use with basal insulin for better compliance and control of postprandial glucose rise.
3. It can be used in combination with sulfonylureas, metformin and pioglitazone and other anti-diabetic agents for glycemic control in patients who do not achieve satisfactory glycemic control with oral therapy alone.
4. It can be used for insulin initiation in patients needing insulin for diabetes control.
5. It can be used for control of postprandial hyperglycemia in igt patients not adequately managed with standard treatment protocol.
6. It can be used for achieving glycemic control in ifg patients not adequately managed with standard treatment protocol.

Unique features:
It has been shown to be fast, flexible, safe and simple. Most important it is well accepted by both patients as well as doctors
1. Needle free, pain free therapy: intensive diabetes therapy requires at least 3-4 injections per day. Oral-recosulin provides needle free administration of insulin for treatment of diabetes
2. Rapid insulin absorption: oral-recosulin is absorbed in blood stream faster than injected insulin
3. Short duration of action: acts similar to rapid acting insulin analogue for control of postprandial glucose rise.
4. No risk of hypoglycemia: rapid absorption avoids prolonged tail exceeding postprandial state as common with subcutaneous insulin.
5. Higher patient compliance: needle free, pain free insulin therapy should increase compliance
6. Better quality of life: the small size of device makes it convenient to carry anywhere and to use comfortably in public. Since dosing time before meal is greatly reduced this offers a more flexible lifestyle. The improved compliance, which leads to a better quality of life.

The Debate
--> Though the main advantage of Oral Buccal insulin is to avoid injection prick, a long acting/intermediate insulin has to be injected anyway. So injection cannot be completely avoided.
--> Moreover when only 1 unit of insulin is systemically absorbed with 1 puff, it will be cumbersome for a patient requiring >10 units of insulin. So its difficult for patients who need >20 units of insulin
--> The droplets may not be deposited in the lung parenchyma but there is no literature to explain their deposition elsewhere in the respiratory tract during accidental inhalation.
--> As insulin treatment has to be continued for years together, the long term effect particularly carcinogenic effect on the buccal mucosa is unknown.
--> It’s bioavailability while taking hot or cold food is not known
--> The cost of a single puff is more than rs.1000. A patient may need at least 20-25 puffs/day minimum. So the daily expenditure for insulin is very high
--> In a country like USA where insurance covers a patient’s expenditure on hospitalization & medicine, exubera (nasal insulin) was not affordable. Similarly buccal insulin which carries same disadvantages like exubera may have to struggle in the market to establish its place
--> Probably the time will give us the result.

Onset of action - 10 minutes
Peak level - 50 minutes
Duration of action - 150 minutes
Bioeffectiveness - 7-10% of s.c. injected insulin when given in same dose