Diabetes and electrostimulation

Diabetes and electrostimulation, healthy

Diabetes represents one of the most serious health problems, since 246 million people suffer from it worldwide. This disease can be caused by others, such as obesity and sedentary lifestyle, or it can be the cause of blindness, amputations, kidney disease, etc.

In Spain, 12% of the population has type 2 diabetes (8.1% known and 3.9 unknown). But it is not only necessary to pay attention to this data, since the risk factors are conditioning factors in the appearance of the disease: hypertension and obesity double the risk of diabetes, with the prevalence of the former being 41.2% and of the second of 28.2%.

Physical activity also plays an important role, since sedentary people are 50% more likely to be obese, and therefore more at risk of ultimately suffering from diabetes. 50.3% of the Spanish population is sedentary, a heartbreaking fact (Soriguer et al., 2012).

 Different types of Diabetes

• Type 1 diabetes , insulin-dependent due to the destruction of beta cells.
• Type 2 diabetes , insulin-resistant, although depending on the evolution, you may need insulin. The first phase is characterized by glucose intolerance.
• Gestational diabetes . Pregnancy cells are believed to be able to reduce their ability to respond to insulin.

Glycemia is the marker that indicates the levels of free glucose in blood, serum or blood plasma. Normal values ​​are considered fasting between 70 and 100 mg / dl, and in postprandial situation (after eating) less than 140 mg / dl. In diabetes it is very important since hyperglycemia is the most common indicator, it occurs as follows at different levels:

Blood glucose levels

• In the pancreas there is a deterioration of insulin secretion, producing an insulin deficiency.
• In the liver, the hepatic production of glucose increases.
• In the muscle , glucose uptake decreases due to insulin resistance.
• Dysfunction of cell ß.

In diabetes, the ß cell presents dysfunction, and this may be due to glycolipotoxicity, which is characterized by high concentrations of glucose and fatty acids. “The ß cell plays a central role in the homeostasis of the nutrients that reach the body through the diet, not only for being able to manufacture and secrete insulin, but also for making said secretion at the right time and at the right time. adequate amount.

For this, the ß cell is capable, through a sensor system, of being able to measure the extracellular concentrations of glucose, the main nutrient that induces the secretory process. On the other hand, fatty acids are also capable of inducing the release of insulin, but mechanically the presence of glucose is necessary to induce this secretory effect ”(Roche Collado, 2007).

 What can physical exercise do to regulate diabetes symptoms and prevent other consequences?

“Various studies have shown that physical activity promotes adaptations of various kinds in the muscle fiber. Thus, a greater vascularization can be appreciated, glucose or GLUT4 transporters are increased, mitochondrial density is higher, hormone-sensitive lipase activity is enhanced, the size of glycogen deposits is increased, etc. ” (Lorenzo, 2009)

In fact, exercise regulates different intracellular signaling pathways in skeletal muscle:

1. Decreases GSK3 by improving glycogen synthesis, gene transcription, and protein synthesis. In a chronic way, glycogen stores improve, gene regulation and hypertrophy occur.
2. Improving the oxidation of fatty acids Increases AMPK , gene transcription, glucose uptake and insulin sensitivity. Chronically, oxidative capacity increases, gene regulation occurs, and insulin sensitivity improves.
3. Increases MAPK by improving gene transcription and glucose uptake. Gene regulation occurs chronically.
4. Glycogen synthesis, gene transcription, protein synthesis, and insulin sensitivity can be improved by increasing Akt . Chronically improve glycogen stores, insulin sensitivity, gene regulation and hypertrophy occur.
5. Increases p70s6k by enhancing glycogen synthesis and protein synthesis. Chronically, glycogen stores improve and hypertrophy occurs.

Regarding physical exercise with electrostimulation, the basis of the programs will consist of slow fiber training, since they have a greater capacity to capture glucose than fast fibers (Gómez-Zorita and Urdampilleta, 2012).

In some studies in rats it has been observed that “the greater the decrease in muscle glycogen after exercise, fasting, electrostimulation or a low-carbohydrate diet, the GLUT4 concentration found in the sarcolemma was greater, and therefore greater glucose uptake after food intake ”(Ramos-Jimenez et al. 2009).

Recently, in March 2015, an article was published on the effects of a comprehensive electrostimulation program in people with type 2 diabetes. The intervention consisted of 20-minute training sessions for 15 subjects aged 61.7 (14.8) years 2 times a week for 10 weeks. Fasting blood glucose decreased significantly, as did the HbA1c level. The authors conclude that Comprehensive EMS may be a new method to help patients overcome their sedentary lifestyle (van Buuren et al., 2015).

Another advantage of electrostimulation in diabetic people

Another advantage of the use of electrostimulation is that it stimulates muscle protein synthesis rates, so EMS can be an effective strategy to reduce muscle loss, for example in the elderly. The first study to demonstrate this took six men aged 70 (2) with type 2 diabetes as intervention subjects, since these patients usually have more exacerbated sarcopenia (Wall et al., 2012).

Still, consider case studies like the one Khan presented in 2012 in Singapore Medicine: an 80-year-old man with diabetes came to the hospital with back pain, and a TENS session was recommended ( transcutaneous nerve electrostimulation) every 24 hours. Upon observing the improvement, the dose was increased to 3 times every 24 hours, and then the man suffered hypoglycemia.

Withhold TENS treatment

When the TENS treatment was discontinued, hyperglycemia occurred, but when it was restarted the response was hypoglycemic. The authors’ conclusions are aimed at explaining these episodes by effective pain control, decreased sympathetic stimulation, increased insulin sensitivity, or altered muscle metabolism (Khan, 2012). This case is extreme, since it is an elderly person and the responses at a physiological level do not appear the same as in adulthood.

Furthermore, the TENS doses were not adequate to the conditions of this man, and the insulin doses were not initially adapted to the demand required by the electrostimulation treatment. In any case, physical education and sports professionals should take these cases into account to know that it is necessary to adapt the training doses with EMS, and even more so if it is a person with diabetes.

Conclusions

It should be borne in mind that, as in many cases, gender differences are also revealed when applying EMS in people with type 2 diabetes. A study concluded that diabetic women had less anaerobic glycolysis compared to those with diabetes. men (Miyamoto et al., 2015).

With diabetes you have to move, there are multiple benefits of physical exercise. But, above all, under the guidelines of qualified professionals, specialist trainers who take into account all the factors that affect this disease.