Diabetes mellitus is a group of endocrine diseases that develop as a result of absolute or relative (violation of interaction with target cells) insufficiency of the hormone insulin, as a result of which hyperglycemia develops – a persistent increase in blood glucose. The disease is characterized by a chronic course and a violation of all types of metabolism: carbohydrate, fat, protein, mineral and water-salt.In diabetes mellitus, the formation of glycogen in the liver and muscles decreases, as a result, the sugar content in the blood (hyperglycemia) increases and it begins to be excreted in the urine ( glycosuria ).The development of diabetes mellitus is promoted by a violation of the central nervous regulation (often after mental trauma), eating disorders, excessive carbohydrate consumption, infectious diseases, hereditary predisposition and other factors. The causes of the disease can be tumors, inflammation and sclerotic changes in the pancreas.
With significant hyperglycemia, the tissues of the body are dehydrated, patients experience a constant feeling of thirst, consume large amounts of fluid, and excrete a lot of urine. Disorder of fat metabolism on the background of diabetes leads to a flood of blood fat. Increased blood levels of cholesterol. Patients have reduced skin turgor, dry skin and mucous membranes, decreased body resistance to infections, various associated diseases and complications (pustular skin lesions, hypertension, atherosclerosis, diseases of the kidneys, blood, etc.). In old age, diabetes can produce complications in the form of lower extremity gangrene.
Often, diabetics suffer from disorders of the protein and fat metabolism. As a result, toxic substances accumulate in the body that can cause the most dangerous complication – hypoglycemic shock and diabetic coma. Hypoglycemic shock is observed with a sharp drop in blood sugar levels under the influence of therapeutic drugs and is characterized by the appearance of a feeling of weakness, heart palpitations, hunger, increased motor excitability, seizures and loss of consciousness. Diabetic coma is caused by poisoning the body with products of incomplete fat burning. It is characterized by vomiting, drowsiness and a profound loss of consciousness.
Diabetes mellitus is a rapidly spreading disease worldwide. According to the WHO forecast, the number of patients with diabetes on earth by 2010 has doubled and amounts to 211 million people.
Briefly about the main thing:
1) people of average working age are ill .
2) diabetes is a risk factor for CHD.
3) complications of diabetes associated with damage to the cardiovascular system, kidneys, eyes, lower extremities, caused early disability and mortality of patients.
One faktovov, causing a significant increase in the incidence of diabetes, is an inadequate inflammatory activity.
The use of therapeutic physical culture in the complex treatment of patients with diabetes.
Treatment of diabetes depends on the severity of the disease. In the mild form, its leveling of carbohydrate metabolism is achieved by a carbohydrate-restricting diet. Diabetes is moderately compensated by insulin or antidiabetic drugs on the background of a diet. In severe form, large doses of insulin and a strict diet are prescribed.
The use of therapeutic physical culture in the complex treatment of patients with diabetes mellitus is due to the stimulating effect of physical exercises on tissue metabolism, sugar utilization in the body and its deposition in muscles.
It is clinically established that, under the influence of exercise, the blood sugar level sometimes decreases to normal values. Dosed physical exercise, enhancing the action of insulin, in some cases, allow to reduce its dose. In patients with overweight under the influence of exercise, fat metabolism normalizes and decreases in fat deposition.
The main tasks of physical therapy:
1) General strengthening and rejuvenation of the body.
2) Promoting the reduction of hyperglycemia, and in insulin-dependent patients, increased insulin action.
3) Improving cardiovascular and respiratory function system, prevention of progression of atherosclerosis.
4) Enhance overall physical performance.
5) Prevention of macro and microangiopathy .
6) Stimulation of intestinal and tissue metabolism.
7) Reduced body weight and improved digestive function.
8) Normalization of the emotional and mental sphere.
Indications for prescribing physical therapy:
– all forms of diabetes.
– in case of complications of diabetes mellitus ischemic heart disease, infarction myocardial gymnastics is built taking into account these diseases.
-micro and macroangiopathy .
Contraindications to the appointment of physical therapy:
– glycemia 16.6 mmol \ l and above
– availability of acetone in urine
– precoma
– a severe form of diabetes, accompanied by the accumulation in the blood of acetone, acetone acetic acid.
Physical training.
Physical training helps fight adynamia and muscle weakness that appear in patients with diabetes, increases the body’s resistance to adverse factors.
In the mild form of diabetes mellitus, exercises for all muscle groups are used in medical physical training. The movements are performed with a large amplitude, at a slow and medium pace, and for small muscle groups – at a fast pace. Gradually, more complex exercises of coordination are introduced, exercises with objects, on projectiles (gymnastic wall, bench) and with weights. The duration of the lesson is 30–45 minutes, the density is rather high. In addition to therapeutic exercises, it is necessary to use dosed walking, gradually increasing the distance from 5 to 10-12 km, sports exercises (walking on skis, skating, swimming, rowing, running), games (volleyball, badminton, tennis) with strict medical and pedagogical control in process of employment.
In case of moderate diabetes, the practice of physical therapy and the regulation of the motor regimen contribute to the stabilization of the dosage of drugs. Apply exercises of moderate and low intensity for all muscle groups. The duration of the class is 25-30 minutes, the density is low. In addition to therapeutic exercises, one should widely apply dosed walking for 2-7 km 1 .
In severe form of the disease, as well as with concomitant diseases of the cardiovascular system in people of middle and old age, the first classes should be conducted according to the method characteristic of diseases of the cardiovascular system. The overall load on the body is small or moderate. Exercises for small and medium muscle groups are widely used. Exercises for large muscle groups are included gradually and carefully as the body adapts to the load.
When dosing the load, it is necessary to take into account that long-term exercise at a slow pace reduces the sugar content in the blood, since diabetes mellitus consumes not only muscle glycogen, but also blood sugar.
Medical physical culture classes should be held no earlier than one hour after the injection of insulin and a light breakfast. Otherwise, hypoglycemia may occur.
Alimentary dystrophy develops with insufficient intake of the disease are carried out in the interictal period. In the chronic course of the disease, moderate pain in the joints is not a contraindication to practice, since rest provokes attacks of pain.
In exercises against the background of a variety of general tonic exercises, passive and active movements in the affected joints are used with the maximum possible volume, muscle relaxation exercises, and dynamic breathing exercises.
At the beginning of the course of treatment, starting positions are more often lying and sitting, then standing.
In the initial forms of the disease, when the patient has no special complaints, along with exercises in gymnastics, wide use should be made of sports exercises and games, and metered walking.
When combined therapeutic gymnastics with thermal procedures and massage classes should be carried out after them.
Diabetes mellitus is often complicated (especially in patients of middle and old age) with diseases of the cardiovascular system (atherosclerosis and hypertension). Classes with these patients are carried out in relation to the technique characteristic of the adhering disease. The load should be determined by both the degree of adaptation of the cardiovascular system and the indicators of blood sugar and urine.
In the case of a severe form of the disease, therapeutic physical training should be started after removing patients from a serious condition in order to prevent complications associated with physical inactivity and metabolic disorders. Adaptation of the patient to physical exertion should be gradual.
The first classes are conducted according to the method used for diseases of the cardiovascular system, depending on the duration of the prescribed stationary mode. Before the onset of compensation (lowering the level of sugar in the blood and urine under the influence of diet and medicines) in patients of young and middle age, the overall load on the body is small or moderate. Exercises for small and medium muscle groups are widely used. Exercises for large muscle groups are included gradually and carefully as the body adapts to the load. Further dosed walking from 500 m to 2 km and sedentary games (croquet, bowling alley) are added.
In mild diabetes, the leveling of carbohydrate metabolism is achieved by a carbohydrate-restricted diet. Diabetes is moderately compensated by insulin or antidiabetic drugs on the background of a diet.In severe cases with acidosis, high glucosuria , hyperglycemia, and ketonemia, large doses of insulin and a strict diet are used.
The use of therapeutic physical culture in the complex treatment of patients with diabetes mellitus is due to the stimulating effect of physical exercises on tissue metabolism, sugar utilization in the body and its increased deposition in muscles. Physical training helps fight adynamia and muscle weakness, characteristic of patients with diabetes.
Observations in the experiment and the clinic found that under the influence of exercise, blood sugar levels sometimes drop to normal. Dosed physical exercise, enhancing the effect of injected insulin, in some cases, allow to reduce its dose. In patients with overweight under the influence of exercise, fat metabolism normalizes and decreases in fat deposition.
The therapeutic role of physical exercises is also in their positive influence on all organs and systems suffering from diabetes, and in increasing the body’s resistance to adverse factors.
In the mild form of diabetes, therapeutic physical culture contributes to the normalization of metabolism by increasing the glycogen-forming function of the muscles and, when combined with a diet, makes it possible to abandon the use of drugs.
The healing and prophylactic effect of exercise is greatly increased when combined with hardening.
Hardening is understood as a set of systematic repeated effects on the body of natural factors in order to increase resistance to adverse climatic conditions.
The main tempering factors of nature are the sun, air and water. The use of these factors should be subject to certain principles:
1) gradualness
2) systematic and regular
3) complexity
4) individuality.
Conclusion
The tasks of therapeutic gymnastics are to help reduce hyperglycemia, and in insulin-dependent patients to contribute to enhancing its action; improve the function of the cardiovascular and respiratory systems; increase physical performance; prevent the development of micro-and macroangiopathy .
Therapeutic gymnastics in patients after the elimination of decompensation, but being on bed rest, is carried out in the initial prone position. Later in sitting and standing. Begin therapeutic gymnastics with elementary exercises for the muscles of the arms, legs and torso without burdening. In the future, include exercises with resistance and burdening, use expanders, dumbbells, medical . Breathing exercises are widely used. In addition to therapeutic gymnastics, dosed walking, cycling, rowing, physical exercises in the pool, and skis are shown.
It is important that the patient, being engaged independently in various forms of exercise therapy, knows that when a feeling of hunger, weakness, hand tremors appears, it is necessary to eat 1–2 pieces of sugar and stop exercising. After the disappearance of the state of hypoglycemia, the next day you can resume classes, but reduce their dosage.