Turkiye Klinikleri Journal of Sports Sciences

.: REVIEW
Tip 1 Diyabet, Egzersiz ve Beslenme
Type 1 Diabetes, Exercise and Nutrition
Emre Batuhan KENGERa, Can ERGÜNa
aBeslenme ve Diyetetik Bölümü, Bahçeşehir Üniversitesi Sağlık Bilimleri Fakültesi, İstanbul, TÜRKİYE
Turkiye Klinikleri J Sports Sci. 2019;11(3):164-70
doi: 10.5336/sportsci.2019-70286
Article Language: TR
Full Text
ÖZET
 Diyabetli bireylerin tedavisinde tıbbi beslenme tedavisi ve egzersiz, yaşam tarzı değişikliklerinin temelini oluşturmaktadır. Egzersizin olası komplikasyonlarının önlenmesi için egzersiz öncesi, sırası ve sonrasında egzersizin tipi, süresi ve yoğunluğuna göre beslenme planının yapılması gerekmektedir. Egzersiz, fiziksel uygunluğu artırmak için yapılandırılmış ve tasarlanmış daha spesifik bir fiziksel aktivite şeklidir. Egzersizin kan şekeri kontrolünü iyileştirdiği, kardiyovasküler risk faktörlerini azalttığı, kilo kaybına katkıda bulunduğu ve kişilerin daha iyi hissetmesini sağladığı gösterilmiştir. Tip 1 diyabetli kişiler tarafından yapılan çeşitli egzersiz türlerine metabolik ve nöroendokrin tepkilerinin anlaşılması, uygun beslenme ve insülin yönetimi stratejilerinin belirlenmesi için gereklidir. Tip 1 diyabette, egzersize verilen glisemik cevaplar, insülinin uygulandığı yer, dolaşımdaki insülin miktarı, egzersiz öncesi kan glukoz konsantrasyonu, son öğün veya atıştırmanın bileşimi ve yoğunluğu ile faaliyetin süresi ile ilişkilidir. Egzersiz sırasında dolaşımdaki artan insülin konsantrasyonları, hepatik glukoz üretimine göre artan glukoz atılımını teşvik eder ve lipolizi geciktirebilir. Kasların bir yakıt olarak glukoza bağımlılığını artırmaktadır. Hipoglisemi çoğu hastada aerobik egzersize başladıktan yaklaşık 45 dk içerisinde gelişmektedir. Tip 1 diyabetli hem antrenmanlı hem de antrenmansız bireylerin, aerobik egzersize başlamadan önce karbonhidrat alımını arttırmaları veya insülin dozunu azaltmaları veya her ikisini de uygulamaları gerekmektedir. Diyabetli birçok birey için, tedavi planının en zor olan kısmı ne yiyeceğini belirlemek ve bir yemek planını takip etmektir. Beslenme tedavisinin genel diyabet yönetiminde ayrılmaz bir rolü vardır ve diyabetli her birey, kişiselleştirilmiş bir beslenme planının iş birliğine dayalı gelişimi de dâhil olmak üzere sağlık ekibiyle birlikte eğitim, öz yönetim ve tedavi planlaması ile aktif olarak ilgilenmelidir.

Anahtar Kelimeler: Tip 1 diabetes mellitus; egzersiz; beslenme
ABSTRACT
 Medical nutrition therapy and exercise form the basis of lifestyle changes in the treatment of people with diabetes. In order to prevent possible complications of exercise, nutrition plan should be prepared according to type, duration and intensity of exercise before, during and after exercise. Exercise has been shown to improve blood sugar control, reduce cardiovascular risk factors, contribute to weight loss, and make people feel better. Understanding metabolic and neuroendocrine responses to various types of exercise performed by people with Type 1 diabetes is essential to identify appropriate nutritional and insulin management strategies. In Type 1 diabetes, glycemic responses to exercise are associated with the location of insulin delivery, the amount of circulating insulin, blood glucose concentration before exercise, the composition and intensity of the last meal or snack, and the duration of the activity. Increased circulating insulin concentrations during exercise promote increased glucose excretion relative to hepatic glucose production and may delay lipolysis; this increases the dependence of muscles on glucose as a fuel. Individuals with Type 1 diabetes need to increase their carbohydrate intake or reduce their insulin dose or both before starting aerobic exercise. For many people with diabetes, the most difficult part of the treatment plan is to determine what to eat and follow a meal plan. Nutritional therapy has an integral role in overall diabetes management and every individual with diabetes should actively engage in education, self-management and treatment planning with the health care team, including the cooperative development of a personalized nutrition plan.

Keywords: Tip 1 diabetes mellitus; exercise; nutrition
REFERENCES:
  1. Horton WB, Subauste JS. Care of the athlete with type 1 diabetes mellitus: a clinical review. Int J Endocrinol Metab. 2016;14(2):e36091. [Crossref]  [PubMed]  [PMC] 
  2. Sadarangani KP, Hamer M, Mindell JS, Coombs NA, Stamatakis E. Physical activity and risk of all-cause and cardiovascular disease mortality in diabetic adults from Great Britain: pooled analysis of 10 population-based cohorts. Diabetes Care. 2014;37(4):1016-23. [Crossref]  [PubMed] 
  3. Batacan RB Jr, Duncan MJ, Dalbo VJ, Tucker PS, Fenning AS. Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies. Br J Sports Med. 2017;51(6):494-503. [Crossref]  [PubMed] 
  4. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-79. [Crossref]  [PubMed] 
  5. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-59. [Crossref]  [PubMed] 
  6. Sluik D, Buijsse B, Muckelbauer R, Kaaks R, Teucher B, Johnsen NF, et al. Physical activity and mortality in individuals with diabetes mellitus: a prospective study and meta-analysis. Arch Intern Med. 2012;172(17):1285-95. [Crossref]  [PubMed] 
  7. Chimen M, Kennedy A, Nirantharakumar K, Pang TT, Andrews R, Narendran P. What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia. 2012;55(3):542-51. [Crossref]  [PubMed] 
  8. Jelleyman C, Yates T, O'Donovan G, Gray LJ, King JA, Khunti K, et al. The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis. Obes Rev. 2015;16(11):942-61. [Crossref]  [PubMed] 
  9. Anton SD, Karabetian C, Naugle K, Buford TW. Obesity and diabetes as accelerators of functional decline: can lifestyle interventions maintain functional status in high risk older adults? Exp Gerontol. 2013;48(9):888-97. [Crossref]  [PubMed]  [PMC] 
  10. Yardley JE, Kenny GP, Perkins BA, Riddell MC, Balaa N, Malcolm J, et al. Resistance versus aerobic exercise: acute effects on glycemia in type 1 diabetes. Diabetes Care. 2013;36(3):537-42. [Crossref]  [PubMed]  [PMC] 
  11. Yardley JE, Kenny GP, Perkins BA, Riddell MC, Malcolm J, Boulay P, et al. Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Diabetes Care. 2012;35(4):669-75. [Crossref]  [PubMed]  [PMC] 
  12. Gordon BA, Benson AC, Bird SR, Fraser SF. Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res Clin Pract. 2009;83(2):157-75. [Crossref]  [PubMed] 
  13. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2014;37(1):S14-34. [Crossref]  [PubMed] 
  14. Riddell MC, Gallen IW, Smart CE, Taplin CE, Adolfsson P, Lumb AN, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. 2017;5(5):377-90. [Crossref] 
  15. Abdelhafiz AH, Sinclair AJ. Diabetes, nutrition, and exercise. Clin Geriatr Med. 2015;31(3):439-51. [Crossref]  [PubMed] 
  16. Mallad A, Hinshaw L, Schiavon M, Dalla Man C, Dadlani V, Basu R, et al. Exercise effects on postprandial glucose metabolism in type 1 diabetes: a triple tracer approach. Am J Physiol Endocrinol Metab. 2015;308(12):E1106-15. [Crossref]  [PubMed]  [PMC] 
  17. Singhvi A, Tansey MJ, Janz K, Zimmerman MB, Tsalikian E. Aerobic fitness and glycemic variability in adolescents with type 1 diabetes. Endocr Pract. 2014;20(6):566-70. [Crossref]  [PubMed] 
  18. Turner D, Luzio S, Gray BJ, Dunseath G, Rees ED, Kilduff LP, et al. Impact of single and multiple sets of resistance exercise in type 1 diabetes. Scand J Med Sci Sports. 2015;25(1):e99-109. [Crossref]  [PubMed] 
  19. Gomez AM, Gomez C, Aschner P, Veloza A, Mu-oz O, Rubio C, et al. Effects of performing morning versus afternoon exercise on glycemic control and hypoglycemia frequency in type 1 diabetes patients on sensor-augmented insulin pump therapy. J Diabetes Sci Technol. 2015;9(3):619-24. [Crossref]  [PubMed]  [PMC] 
  20. Smart CE, Annan F, Bruno LP, Higgins LA, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2014. Nutritional management in children and adolescents with diabetes. Pediatr Diabetes. 2014;15 Suppl 20:135-53.
  21. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37 Supll 1:S120-43. [Crossref]  [PubMed] 
  22. Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;61(12):2461-98. [Crossref]  [PubMed] 
  23. Thomas DT, Erdman KA, Burke LM. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: nutrition and athletic performance. J Acad Nutr Diet. 2016;116(3):501-28. [Crossref]  [PubMed] 
  24. Riddell MC, Milliken J. Preventing exercise-induced hypoglycemia in type 1 diabetes using real-time continuous glucose monitoring and a new carbohydrate intake algorithm: an observational field study. Diabetes Technol Ther. 2011;13(8):819-25. [Crossref]  [PubMed] 
  25. Francescato MP, Stel G, Stenner E, Geat M. Prolonged exercise in type 1 diabetes: performance of a customizable algorithm to estimate the carbohydrate supplements to minimize glycemic imbalances. PLoS One. 2015;10(4):e0125220. [Crossref]  [PubMed]  [PMC] 
  26. Turner G, Quigg S, Davoren P, Basile R, McAuley SA, Coombes JS. Resources to guide exercise specialists managing adults with diabetes. Sports Med Open. 2019;5(1):20. [Crossref]  [PubMed]  [PMC] 

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