Regular exercise is an essential component of any treatment plan for people who have type 2 diabetes. The UK's National Service Framework for Diabetes Standards states: 'Regular physical activity lowers the risk of developing type 2 diabetes by increasing insulin sensitivity'. There are two main issues in implementing the recommended strategy: one is motivating patients to 'get moving' and 'stay active'. The other is dealing with the risks associated with exercise, especially the risk of hypoglycaemia in those who are treated with insulin. Thus some people with diabetes may be reluctant to undertake physical activity for fear of the consequences. This book contains valuable information for healthcare professionals who are managing patients with either type 1 or type 2 diabetes to enable them to provide help and support to those patients who wish to undertake regular activity, sporting or otherwise.
The book describes the physiological responses during exercise in patients with type 1 diabetes and discusses suitable nutritional strategies for these people. New chapters address the role of physical activity in the prevention and management of type 2 diabetes, as well as how to combine insulin pump therapy and exercise. Other chapters cover the role of the diabetes team in promoting exercise, encouraging patients to become and stay physically active.
The book will prove helpful to all members of the diabetes specialist team: clinicians, Diabetes Specialist Nurses, psychologists, GPs, sports scientists and patients.
"What is really useful about this book is the wealth of practical advice. ... This is an excellent book which should be on the shelves in every diabetic clinic." Robert Tattersall, Special Professor of Metabolic Medicine, University of Nottingham, UK

Dinesh Nagi is the author of Exercise and Sport in Diabetes, 2nd Edition, published by Wiley.

Foreword to the First Edition.

Preface to the First Edition.

Preface to the Second edition.

1 Physiological responses to exercise (Clyde Williams).

1.1 Introduction.

1.2 Maximal exercise.

1.3 Submaximal exercise.

1.4 Endurance training.

1.5 Muscle fibre composition.

1.6 Muscle metabolism during exercise.

1.7 Anaerobic and lactate thresholds.

1.8 Fatigue and carbohydrate metabolism.

1.9 Carbohydrate nutrition and exercise.

1.10  Fluid intake before exercise.

1.11 Summary.

References.

2 Exercise in type 1 diabetes (Jean-Jacques Grimm).

2.1 Introduction.

2.2 Exercise physiology.

2.3 Insulin absorption.

2.4 Hypoglycaemia.

2.5 Hyperglycaemia.

2.6 Strategy for treatment adjustments.

2.7 Evaluation of the intensity and duration of the effort.

2.8 Nutritional treatments and adaptations.

2.9 Insulin dose adjustment.

2.10 Conclusions.

References. 

3 Diet and nutritional strategies during sport and exercise in type 1 diabetes (Elaine Hibbert-Jones and Gill Regan).

3.1 What is exercise?.

3.2 The athlete with diabetes.

3.3 Nutritional principles for optimizing sports performance.

3.4 Puttting theory into practice.

3.5 Identifying nutritional goals.

3.6 Energy.

3.7 Carbohydrate.

3.8 Guidelines for carbohydrate intake before, during and after exercise.

3.9 Protein.

3.10 Fat.

3.11 Vitamins and minerals.

3.12 Fluid and hydration.

3.13 Pulling it all together.

References.

Appendices. 

4 The role of physical activity in the prevention of type 2 diabetes (Dinesh K. Nagi).

4.1 Exercise and prevention of type 2 diabetes.

References.

5 Exercise, metabolic syndrome and type 2 diabetes (Dinesh K. Nagi).

5.1 Physical activity in type 2 diabetes.

5.2 Type 2 diabetes, insulin resistance and the metabolic syndrome.

5.3 Effect of exercise on the metabolic syndrome of type 2 diabetes.

5.4 What kind of exercise, aerobic or resistance training.

5.5 Effects on cardiovascular risk factors.

5.6 Regulation of carbohydrate metabolism during exercise in type 2 diabetes.

5.7 Effect of physical activity on insulin sensitivity.

References. 

6 The role of exercise in the management of type 2 diabetes (Dinesh K. Nagi).

6.1 Introduction.

6.2 Benefits of regular physical activity in type 2 diabetes.

6.3 Effects on long-term mortality.

6.4 Risks of physical activity.

6.5 Conclusions.

References.

7 Exercise in children and adolescents (Diarmuid Smith, Alan Connacher, Ray Newton and Chris Thompson).

7.1 Introduction.

7.2 Metabolic effects of exercise.

7.3 Attitudes to exercise in young adults with type 1 diabetes.

7.4 The Firbush camp.

7.5 Precautions during exercise.

7.6 Summary.

References.

8  Insuling pump therapy and exercise (Peter Hammond and Sandra Dudley).

8.1 Introduction.

8.2 Potential advantages of CSII.

8.3 CSII usage.

8.4 Benefits of CSII over multiple daily injections.

8.5 Potential advantages for CSII use with exercise.

8.6 Studies of response to exercise in CSII users.

8.7 Practicalities for using CSII with exercise.

8.8 Cautions for using CSII with exercise.

References.

9  Diabetes and the marathon (Bill Burr).

9.1 Introduction.

9.2 Guidelines.

9.3 Personal views.

9.4 Summary.

Bibliography.

Useful Addresses.

10  Diabetes and specific sports (Mark Sherlock and Chris Thompson).

10.1   General principles.

10.2   Canoeing.

10.3   Golf.

10.4   Hillwalking.

10.5   Extreme altitude mountaineering.

10.6   Rowing.

10.7  Soccer and rugby.

10.8  Tennis.

10.9  Sub-aqua (scuba) diving.

10.10  Skiing.

10.11  Restrictions imposed by sports governing bodies.

10.12  Conclusions.

References.

11 Becoming and staying physically active (Elizabeth Marseden and Alison Kirk).

11.1   Recommendations for physical activity and exercise.

11.2   Essential attributes of a physical activity programme for people with diabetes.

11.3   Preparation for exercise.

11.4   Changing behaviour.

References.

Appendix 1: Stretching exercises.

Appendix 2: Muscular endurance exercises.

12 The role of the diabetes team in promoting physical activity (Dinesh Nagi and Bill Burr).

12.1 Introduction.

12.2 Educating the diabetes team.

12.3 Exercise therapist as part of the team.

12.4 Assessment of patients.

12.5 The exercise prescription.

12.6 Patient education.

12.7 Motivating patients and changing behaviour.

12.8 Conclusions.

References.

Index.