Diabete e esercizio fisico
L’ esercizio fisico, specie se aerobico, è parte integrante del piano di trattamento del diabete mellito. L’attività fisica deve essere gestita dai pazienti in modo da evitare i rischi derivanti da esso.
Nel diabetico mellito tipo I per esempio i livelli di insulina esogena non possono essere regolati automaticamente dagli ormoni della controregolazione, pertanto se sono troppo elevati, l’esercizio fisico può provocare ipoglicemia durante, al termine e anche nelle 48 ore successive. Nei pazienti con DM tipo 1, la risposta glicemica all’esercizio dipende dal: controllo glicemico, dalle condizioni generali del paziente, dell’integrità del sistema nervoso autonomo, dall’intensità, dal tipo e dalla durata dell’attività fisica e dal tempo di picco dell’ insulina somministrata. Il paziente deve essere a conoscenza di tutte queste variabili. Le linee guida raccomandano la misurazione della glicemia prima, durante e al termine dell’esercizio:
Se la glicemia fosse:
- 250 mg/dl in presenza di chetoni, è consigliabile non effettuare alcune attività, per il rischio di chetoacidosi;
- 100 mg/dl è necessario introdurre 20 g di carboidrati prima e dopo lo svolgimento dell’attività fisica.
Un allenamento costante può determinare una riduzione del
20% -30% del fabbisogno giornaliero di insulina.
Nel diabete mellito di tipo 2 è stato dimostrato che l’esercizio fisico riduce:
- l’insulinoresistenza periferica
- i livelli plasmatici di trigliceridi e delle VLDL
- migliora la glicemia, poiché determina il calo ponderale, il suo mantenimento nel tempo e la riduzione dell’insulinoresistenza.
L’aumentata sensibilità all’insulina derivante dall’ aumentata utilizzazione periferica del glucosio avviene non solo durante l’attività fisica ma permane nelle 48 ore successive.
La durata dell’esercizio dovrebbe essere di 30 minuti al giorno, di intensità pari al 50-75% della massima capacità aerobica individuale. Tale durata deve essere raggiunta gradualmente nel tempo e far parte integrante dell’attività fisica quotidiana.
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