Earlier this month, I had the pleasure of attending the inaugural Sydney Diabetes Forum run by RPA Diabetes Centre and phn Central and Eastern Sydney. This was really to update health professionals on what’s happening in the world of diabetes. There was one part that really stood out.

In the past, if you were under a certain age and had diabetes it was almost certainly type 1 and if you were older, it was most certainly type 2. What they showed was that the rate of type 2 diabetes in our young people (15-25 years old) is rising, while type 2 diabetes in the middle and mature aged population is stable. What’s worse, when young people are diagnosed, progression is faster – almost like the condition is more aggressive. They showed that people with young onset type 2 diabetes were far worse than their type 1 counterparts with regard to development of diabetes related complications.

This trend is really concerning. It seems the message of looking after yourself has met the original target audience, but that audience has changed. I guess those of us who fall into the middle and more mature aged category can remember times when there weren’t computers, smartphones, ipads and the internet. We went out to ‘play’ outside and with our friends. This isn’t the same for those in the younger population.

A friend of ours who’s also an AEP (and used to work with us!) Dr Shelley Kay says ‘Parents often spend the first few years of children’s life trying to keep their children still, but then spend all of their teenage years trying to get them to move.” I think the statistics are now showing this is exactly what is happening. So if you have young people, make sure you keep them as active as you can and avoid that excessive screen time.

You are setting up their habits for life at those young years, which can be hard to undo as they get older. Sounds like an easy and simple message but if you‘re the parent of a young child – we assure you they’d say it’s not. Here’s our top 5 tips to avoid the screens and keep the young ones busy:

Go to the park a few times per week (after school for 30mins is fine)– it’s inexpensive and you can test out different parks near you. They are filled with all sorts of equipment – climbing especially that you don’t have at homeCycling or scooting along with you while you walk the dog, or even just going up and down the footpath at the front of your house if you are short of timeOur favorite - Dance while you’re waiting for dinner to cook. Kids waiting for dinner make THE most horrendous sound don’t they? Mix it up with some music and get dancing while the dinner finishes cooking on the stoveFresh Air – send them outside, they will come up with their own things to do when left to their own devices OR get into nature and do some bush walks, walks by the seaside or even just the local creek - show them the bugs and animalsIf they really need to rest – does it have to be with screens? Reading and audiobooks/kids podcasts are excellent ways to get them relaxed and using their imagination

As you may have seen last night, Christine was on The Project talking about injuries during exercise. In the case they were talking about, it was a gym injury that affected Ben Gilles’ ability to play drums for Silverchair.

It’s something that we’re passionate about as people can get the wrong idea about exercise and gyms too.

Let’s get real. Gyms are not the problem and neither is exercise. You can get hurt just going for a walk but it’s not that you have to lock yourself away! Here are some key tips to reduce your chances of getting hurt when you exercise.

Seek professional advice. Make sure they are qualified and experienced if they are helping you exercise. For anyone with a chronic condition, that means an Accredited Exercise Physiologist.Get someone who really listens. Having all the qualifications and experience in the world are of little use if they are not listening to you. You are THE MOST important part of the process and you’re experiences are paramount. Sure they should encourage you to challenge yourself, but not override you when you say ‘it’s enough’ or ‘ it hurts’.It’s not ‘No Pain, No Gain’. No Pain no gain is catchy I’ll grant you, but in reality it’s no effort no gain. Training intensity is based on what you feel and think – how you perceive how hard the exercise is. Not what someone else thinks is hard for you.Working hard is ok. In fact, it’s recommended that we do some higher intensity exercise and if we do, we can do it for a shorter amount of time. Resistance training is also recommended to be at moderate to hard intensity for there to be benefits. Working hard allows us to get fitter faster – and yes we will be sore afterwards but it’s that good kinda sore….Be patient. It takes time to build fitness. It can be that people over-do their exercise attempts – either to undo ‘damage from something they ate’ or in a hope to ‘catch up’ on a missed session. Remember - Exercise is a celebration of what your body can do, not punishment for something you ate.Do exercise for the right reasons. Do it to challenge yourself, to get yourself fitter, to allow you to do all the things you love to do (and for longer), to feel well and energized, to keep your mood up, to be there for your kids and grandkids. Do it – just to see if you can.Stretch. This is the most forgotten thing in exercise. Stretching can mean you can train more comfortably and effectively the next day. It allows you to identify when parts of you is a bit too stiff or sorer than it should be, indicating that you should train a little lighter that day. Stretch to maintain your joint happiness and range of motion. Stretch all the main joints and muscles you use when you exercise (NB: it can be later in the day after your session).Recover. If you don’t rest, your body can’t repair and adapt – that’s what getting fitter is. Make sure you get good sleep and that you have some rest days in your exercise plan.

Making New Year’s resolutions is either something you do or something you don’t. If you do then you love the challenge of seeing what you can bring into your life this new year and know that setting a resolution helps you to aim big. You’ve reassessed your life over the New Year’s break and think there are some things you could be doing better. If you don’t, maybe it’s not your thing. It might be that you share the main complaint we’ve heard about New Year’s resolutions - “People don’t stick to them so why set them? Or why do it at New Years – do it at any time of year?"

Well, whether you do or you don’t – it’s really all about setting goals. As we see people who are setting new goals every day, we’ve found that it’s best is to ‘KISS’. No, not keep it simple stupid but keep it short and specific. People often set goals that are large and unattainable and rather vague. Ever heard someone say – “This is it, this is my year. This year I’m going to get healthy”. The resolution or goal is excellent in theory, but notice how they don’t work in practice? They find every excuse under the sun to continue doing as they’ve been doing and think of some reason why it’s still ‘healthy’? That’s because the resolution doesn’t have a clear action or behavior they are going to change. When your goal is specific, you can see your progress and you know what to do to get there.

So rather than ‘I am going to get healthy this year’ make it really clear and really specific to ensure you’re successful.

“ I am going to walk three times per week – Monday, Wednesday and Saturdays”. This means you have chosen the activity, chosen when you’ll do it and the goal is clear.

It could be “I am going to drink 2 glasses of wine on Fridays and Saturdays and no other alcohol in the week”

Or “I am going to go to the gym two times per week – Tuesdays for Crossfit and Thursdays for the Yoga class”

So how do you make your resolution specific? Try these steps for a foolproof way to get specific:

Think about what activity you’d like to do – try something new or return to an activity you used to do. And then pick one!Consider joining a group for an activity – this can often inspire you to attend regularly and be more challenging than exercising alone. There are local swimming squads, dancing classes or a team sport where there is a set time to attend. Ask your friends if they are doing anything this year or if there is anything they would like to try and set up your own team! Do some recon and then choose the one that is best for you and fits into your timing.Make an ideal week plan. This is where you mark out the time you think you have to be active and assign it to an activity. We make plans to get married, in running our business, arrange our week at work and even for our next holiday. It’s the same for our health and fitness – being organised is the key.Reassess. Like any journey, sometimes we need to change direction. If the goal you’ve set is impractical, then reassess your goals and change them.Set one or two goals. ‘Getting healthy” as a resolution can mean so many things as there are so many parts to our health to consider. Set one or two goals tops, trial them and build upon them once you’ve got into a groove. Changing everything all at once can be overwhelming after the initial shine of excitement wears off. Make the changes gradual and you’re more likely to be successful.

Did you know that you are approximately 7 times more likely to eat “treat” food if it’s sitting in front of you, than if you had to go out and buy it?

Having treats is one of life’s great joys and provides food for the soul. However, if you are trying to keep them to a minimum over the festive season, then keeping them out of sight is going to make that whole process easier.

If we open the fridge or the pantry, and there’s nothing too high in sugar or salt or fat there, then we can stick to our plan. And on the flip side, if we stock the kitchen with lots of delicious fresh fruits and veggies, and healthy snacks (think nuts, wholegrain crackers, natural yoghurt and cheese), we’re more likely to satisfy our cravings with foods that are going to keep our tummies happy, as well as our waist lines and our BGLs.

At Christmas however, this can be really hard as there is often multiple Christmas parties to go to, let alone at home having all those left overs from Christmas day and all the hampers and food based presents. Some people manage these really well and self limit, but if it’s the kinda thing that you know means you’ll be tempted more than you want to be, try some of these suggestions:

For Christmas dinner, only order the amount you need. That’s right instead of the 5kg ham leg, can you get 2 kg instead? A turkey roll rather than a whole turkey?If it can last a while, put it away in an air tight container or the freezer for a treat laterTake the treats to the next visit or event you go to. Can save you cooking or buying something. Sharing is caring!Re-gift it. If it’s something you won’t or can’t eat – share the joy with someone else that can.Bin it. It’s not the most popular option going round, but if you don’t want to eat it and you have no one to give it to, it’s ok to simply throw it out.

Missing our physical activity is also a temptation over the festive season. We have more parties to go to and end of year festivities that take up more of our time and it can get hard to keep up your regular sessions. Keeping the habit is essential to ensure you don’t fall off the wagon. To keep yourself on track try these suggestions:

Go Late. If it’s a big event, it may not matter if you come a little later and still get in your after work exercise sessionKeep your regular session but make it shorter. The 20 min session is better than the 0 min session!

Move your regular session to another time of day. If you have an evening event straight from work, an early morning or lunchtime walk would keep your activity up for the day.

Summer and day light savings are always welcome aren’t they? They bring with them the promise of good times and memories - ‘fun in the sun’ as they say. And so many clients wanting to get more active say it’s easier in Summer than in Winter. However, while we welcome the hot days and sunny weather, they do bring some hidden dangers such as heat stress and skin damage. Exercising in hot conditions is vastly different to exercising in cool conditions and for people with diabetes can increase the fluctuation of the blood glucose readings, insulin they take and the effectiveness of the strips they use. When we exercise the body generates heat that it needs to get rid of, add hot weather to the mix and you can get a lot of heat building up in the body.

Heat stress occurs when our body is unable to cool itself enough to maintain a healthy temperature. Normally, the body cools itself by sweating, but sometimes sweating isn't enough and the body temperature keeps rising. Obviously when you exercise you increase that heat production and the signs can be confused with exercise itself.

Signs of heat stress:

Rapid pulse (hard to tell if you are already exercising!)Dry swollen tongueWeaknessLight-headednessConfusionClammy skinFatigue (hard to tell if you are exercising!)NauseaVomiting

If you suspect you or someone else has heat stress:

Move them to a cool areaRemove excess clothingIf conscious give them water to sipCool with cold compresses, rapid fanning and waterGet help if they deteriorate

In Australia, we have had much education and promotion of sun safety with the old ‘Slip Slop Slap’ campaign and sun protective policies in workplaces and schools. Often when we exercise in the sun, we wear less clothing to help us stay cool.

Tips to protect against heat stress and skin damage

Get your timing right: Avoid exercising in the hottest part of the day, this is between 11am and 3pm. Early morning or late afternoon is the best time to get active in summer.Wear the right gear: Exposing lots of your skin to the environment helps to maximise evaporation however it leaves you at risk of sunburn. Many clothing brands now that have SPF ratings and breathable fabrics that will protect you from the sun’s damaging rays while keeping you cool. You will be able to find them in any good sports store.Stay Hydrated: Prevention is better than cure! Keeping yourself hydrated is the most effective defense against heat stress. It maintains the right plasma volume in your blood to keep circulation and sweating at an optimal level (yes sweat is a good thing!). Before you head out to exercise its a great idea to consume 500ml of cold water 20 minutes (why cold water? Cold fluids are emptied from the stomach at a faster rate than fluids at body temperature). During exercise drink 250ml of water every 15 to 20 minutes. Don’t worry about drinking water while you are exercising, the absorption of water from the stomach is not slowed by exercise.Keep it simple: Water is the best way to stay hydrated. Consumption of drinks that contain concentrated simple sugars can actually slow down the rate at which fluid is absorbed from the stomach.

Remember that keeping your glucose levels stable when you exercise is helped by staying hydrated. If you take hypoglycemic treatments with you when you exercise, make sure you still do in summer.

And a line or two about your feet!

As we all know people with diabetes have to ensure that they look after their feet. When exercising in warmer temperatures there is a great chance of your feet sweating. Sweaty feet are more susceptible to the following:

Increased friction between your feet and the shoeCracking and splitting of the skin especially between the toesFungal infections like tinea, as these love warm, wet and dark areas

In addition, another hurdle is that in the heat feet tend to swell, especially as the day goes on. What this means is that in the summer months you are putting a larger foot in your shoes. This creates great rubbing and friction and more chance of foot damage.

Footwear tips for summer

Stay Dry: Regularly change your socks so that they stay dry during exercise. Also choose cotton rather than synthetic socksAir out: After wearing them make sure you air and dry out your shoesAllow for the swell: When buying shoes in summer, buy them in the afternoon when your feet are at their most swollenGet the best: The quality of your shoes is not something you should compromise on. Make sure they fit and if you have any doubts, see a podiatrist.

Travel is far more common now for business and families alike. And we are not immune! While Adam travels regularly, this month Christine’s travel has significantly increased as well. Business travel is not always fun – staying in hotel rooms, eating dinners alone or even having to attend dinners with clients – so even the most diligent person’s routine can be severely interrupted. Once that happens it can be really hard to stick to it. So what are the ways that you can stick to your exercise habit? And if it’s for business – how can you make it a short and sweet 20 minutes?

You can try to ensure that you have a gym in your hotel, but sometimes they are smaller than the average broom cupboard. And the pool – well it’s smaller than your bath at home! So what can you do if the weather is so bad that even going for a walk or run is out of the question?

The Answer? Resistance training!

Not only will resistance training maintain your fitness, your muscle mass and your glucose & energy levels – but it will also help you mange those aches and pains from sitting in planes, buses, trains and carrying luggage. Now if you are a regular exerciser – these exercises below will be familiar. If you feel like you need motivation, you can use an app like Zova on your iphone that sets you up to do a program of your choice. It can also sync with your music.

Now if that’s all too technical for you – here’s some exercises you can do while you travel.

Sit to stand

Select chair (higher is easier)Start by sitting on the chair with feet flat on the floorStand up fully and then sit back down again pushing your backside right back into the chairReturn to standing position and repeat with little or no rest between.

Note: You can hold dumbbells here to make it a little harder. Ensure your backside goes out behind you and there is no pressure on your knees. If this is too easy – try squats and squats with holds for 30 seconds at a time

Table press

Stand about 80cm (more if you are taller) from the tablePlace hands on the table, shoulder width apartGently lean in towards table by bending elbows, keeping body straight and ensuring table edge is in line with centre of chest.Press out from the table to your start position and repeat

Note: Ensure your shoulders stay back and down. Standing further out from the table will increase the intensity of this exercise.

Lunges

Standing with your feet shoulder-width apart, take a moderate step forwardLower yourself by bending both knees. Ensure that your back knee goes straight down towards the floor (imagine you are proposing!) and then rise up by straightening your legs. Repeat 10 times and change legs!

Note: the further down you go the harder it is!

Dips

Using a bench or chair, sit with hands on the edge and feet out in front of youMove your backside off the chair and lower it towards the groundRise to starting position and repeat

Note: The further down you go the harder it is!

Crunch

Lie on your back on the floor, knees bent, feet flat and deep abdominals turned on (this is drawing your belly button in towards your spine). Hands can be on your chest or resting lightly on your legsRaise your head and shoulders off the ground but only up to half wayLower yourself down to start position and repeat

Plank

Plank on knees (easiest)

Lie on floor on knees and bent elbowsSlowly raise your hips off the ground to make your body straight from knees to shouldersHead stays neutral and looking at the floor

Plank on toes (moderate)

Start by lying on stomach with toes on the ground and bent elbowsSlowly raise your hips off the ground to make your body straight from toes to shouldersHead stays in neutral and looking at the floor

Plank on toes (advanced)

Assume the plank position on toes and elbowsGently raise one leg 15cm off the ground – not very far – and then lower to the start position. Repeat with other legContinue alternating legs until you complete the time you set yourself (start with 15 seconds!)

Note: Do not rush. You do not have to hold your leg up for a long period – just a second or two. It is more important to have control in changing limbs.

Now, if you have a resistive cord (we have them for purchase on our website or in clinic) you can do many other exercises.

Bicep Curl (resistant cord)

1. Stand with feet shoulder-width apart, with trunk straight and holding resistant cord in your hands

2. Holding this position, raise cord by bending elbows until the cord reaches shoulder

3. Return to start position and repeat

Upright Row (resistant cord)

1. Stand with feet shoulder-width apart, with trunk straight and holding resistant cord in each hand

2. Holding this position, raise cord ends to chest with both hands, ensuring that elbows move backward and shoulders remain in the same position

3. Return to start position and repeat

Stretching

Quadricep/Hip Flexor (front of hip and thigh)

Sitting on the edge of a chair, place one foot under the chair and press backward with this heal until a stretch is felt in the front of that thigh. Ensure you remain sitting upright. The other foot is flat on the ground to stop you falling off the chair.

Hamstrings (back of thigh)

Standing, bring foot to your backside, holding it with your hand. Ensure knees are together, sitting on the edge of the chair, one foot flat on the ground for support. Place the other leg out straight with toes pointing up. Ensure back is straight, lean forward from hips as if curtseying to the queen! You should feel the stretch in the back of the thigh and knee.

Keeping the exercise habit is so much easier than having to start all over again – especially if your travel is frequent!

A final note: While resistance training is fantastic for you, you need to take care. Use good technique and make sure you can feel it in your muscles and not in your joints. If you are not sure, start gently and use a mirror to check your technique.

Spring has sprung! The birds are chirping, the flowers are blooming and the sun is now starting to be up before you are! There’s an extra spring in your step and this can make you think about a fresh start with your lifestyle before summer comes.

Having a little more sunshine and the warmth this brings can inspire people to get moving. Spring is all about new beginnings, so if you have been in hibernation for the last few months (where the doona, the couch and the heater have become your friends), how do you make this fresh start with physical activity without over doing it? Here are some suggestions:

1. Do something new. There are so many ways you can be active! Start by looking in your local area to see what’s nearby. Give them a call and ask how much it costs and can you come and have a look, or perhaps they will have a free trial. It’s often less daunting if you go with a friend or family member. If starting something new, ask the instructor what to expect and how much beginners should start with.

2. Get outside. There’s nothing like the feel of gentle sunshine on your back, the cool breeze and the sounds of nature surrounding you! Many people who exercise say that they love being able to loose themselves in where they are and what they are doing – leaving their cares behind them.

3. Get a view – a beautiful location can really inspire us to be consistent with exercise. Now you may not be able to go there everyday but going somewhere beautiful to walk, run, swim, ride or do your Tai Chi can be wonderfully inspiring.

4. Take a friend - good company often makes time fly (especially if they are furry & have four legs)! So whether it is a walk or ride, or a class with friends or simply walking your furry mate to the dog park – it’s all good physical activity.

5. When the weather warms up, people often think about doing more water-based activities – there’s hydrotherapy, water aerobics, learn to swim, learn to surf, and even swimming squads. The whole family loves a trip to the beach or pool where everyone can be active and enjoy the fun together.

6. Start back moderately! While you may be full of enthusiasm, your body may need a little time to warm up – so pace yourself! Start with every second day rather than everyday and do half or three quarters of what you did previously for the first week or so and see how your body responds.

Resistance training, or weight lifting, has been more extensively researched in the last 10 to 20 years and is now recognized as a scientifically proven way to improve our health. It is also part of physical activity guidelines around the world.

So what can you expect to gain for all the effort? Well, apart from the benefits of glucose control and diabetes prevention, resistance training has many other health rewards, such as:

Prevents Osteoporosis by increasing the strength of your bones. Your bones are one of the most reactive and changeable parts of your body, so are very responsive to their environment. A lack of loading on your bones puts you at risk of osteoporosis and can result in fractures. Lifting weights can help to prevent this as well as maintaining good posture, which can be a problem for people with Osteoporosis.Keeps you strong and able! As we age we lose muscle. Without resistance training your muscles will reduce in size and get weaker. If this continues for too long you’ll find simple things, like climbing stairs or walking up hills, more difficult. If this keeps going further, your ability to do daily tasks such as dressing yourself, washing, and straight-forward housework can be affected. Reduced muscle mass also puts you at greater risk of having a fall and is common in people with chronic diseases such as type 2 diabetes.More muscle increases the number of calories that you burn every minute of the day! This helps you to decrease your body fat levels.Improves the efficiency and strength of your heart.Increases the level of good cholesterol in the body – Oh yeah!Helps you lose body fat. Studies have shown that the fat loss from resistance training comes mostly from the visceral fat (it’s the fat around your intestinal organs). Visceral fat is a good thing to lose as it has been linked to increasing the chances of heart disease and metabolic diseases.Improves your mood! Recent studies revealed that high intensity resistance training can be as effective as medication in treating depressed people.

If this isn’t enough reason, we’re not sure what is!

Becoming pregnant catapults you into a whole new world. There are so many things to consider, what name to choose, nursery colour scheme, what pram will suit all your needs and the all-important one do you tough it out and have a natural birth or do you cruise through with chemical support. So many things to consider and such little time! One thing that is rarely on people’s pregnant radar is how are your blood glucose levels going?

Gestational diabetes is a very real concern for more and more women. Between 3 and 8% of pregnant women will go on to develop Gestational Diabetes in the second and third trimesters of pregnancy (around 24 to 28 weeks).

Gestational Diabetes is a temporary form of diabetes where women have difficulty managing their blood glucose levels. What causes it? Some of the hormones produced by the placenta are thought to interfere with the action of insulin (a hormone that carefully controls our glucose levels) so that the mother’s body becomes “resistant” to insulin. When the body becomes resistant to insulin, glucose levels no longer stay stable and tend to fluctuate.

It must be noted that Gestational Diabetes is very different to someone that had diabetes and then became pregnant. Gestational Diabetes is temporary and usually goes away after the baby is born.

Gestational Diabetes does leave you at risk of some other conditions. First of all women who develop Gestational Diabetes are at a greater risk (30 to 50%) of going on to develop Type 2 diabetes later in life. They are also thought to be of greater risk of developing pre-eclampsia (high blood pressure during pregnancy). In terms of the effect on the baby, babies are often born at a heavy birth weight and this is due to the high levels of insulin in the baby’s blood stream. High insulin levels turn the body into storage mode and leads to weight gain.

Who is at risk?

over the age of 35 yearsHave previously had Gestational DiabetesHave a family history of diabetesWomen who are overweightIndigenous Australians, Polynesian, Chinese, Indian and Middle Eastern ethnic backgrounds

One of the most important factors that can prevent or control Gestational Diabetes is physical activity. Regular exercise helps to control blood glucose levels by increasing insulin sensitivity. In other words following exercise insulin works much better in the body. A recent study of 22,000 pregnant women found that women who performed regular physical activity prior to pregnancy were far less likely to develop Gestational Diabetes. Interestingly the same study showed that women who spent 20 h/wk or more watching TV were at greater risk of developing Gestational Diabetes than women who spent less than 2h/wk watching TV.

Not only is it a great idea to exercise before you fall pregnant but it is also important to remain physically active during the pregnancy. The American College of Sports Medicine recently released a statement providing clear evidence for the benefits of physical activity for both baby and mother. They showed that in addition to controlling blood glucose levels exercise during pregnancy had the following benefits:

Improved recovery from the birth Improved postureStronger back muscles to reduce back painImproved sleep qualityStress relief Body weight managementImproved moodGreater ability to cope with the demands of motherhood

However when you are pregnant there are some guidelines you need to follow to ensure that you are exercising correctly and safely, they are:

In the later stages of pregnancy your body starts to release a hormone called relaxin. This softens ligaments and obviously puts them at greater risk of injury. So avoid high impact jarring exercise in the later stages of pregnancy.In the second trimester you often see changes in blood pressure, therefore avoid quick changes in body position, ie. Move slowly from lying/seated positions to standing.In the past it was generally considered unwise to exercise at a heart rate above 140 beats per minute. However this advice does not take into account a number of things. First, it does not consider the fitness level of individuals. For example people who are athletes or were very fit before the pregnancy can exercise at a higher intensity then someone who is not very active. Secondly, it does not take into consideration a woman’s age, should the heart rate target for an 18-year-old woman be the same as a 42 years old woman? The current advice around intensity is to go by how you feel. Women are recommended to work at a maximum intensity of somewhat hard, this means that you are working at an intensity that challenges you but is manageable. Of course always discuss and consult your medical professional before starting any exercise plan.After about 4 months of pregnancy avoid lying on your back for long periods as the weight of the baby can compress the veins and arteries going to the heart. Be aware that as the baby grows your centre of gravity is shifted and may affect your balance. Avoid letting yourself get too hot, don’t exercise in the heat or to the point where you are excessively sweating. Most of all listen to your body and when it is telling you that you need a rest, take it!

Zhang, C. Solomon, C.G. et. al A prospective study of pregravid physical activity and sedentary behaviours in relation to the risk of gestational diabetes mellitus. Arch Intern Med 2006 Mar 13; 166(5): 534-538.

Our three key messages are:

Know the diabetes risks and know the warning signs

Know how to respond to diabetes and who to turn to

Know how to manage diabetes and take control

So we've put together a little resource for each of these messages. Here's the first:

Know the diabetes risks and know the warning signs

These are the risk factors for type 2 diabetes: • Being overweight or obese • Being physically inactive • Poor diet • Increased age • Glucose intolerance (as diagnosed through a blood test) • Family history of diabetes • History of gestational diabetes • High blood pressure and high cholesterol • Ethnicity - higher rates of diabetes have been reported in Asians, Hispanics, Indigenous peoples (Australia, USA and Canada) and African Americans Unfortunately, your age, family history and ethnicity are well and truly out of your control! But there is a lot you can do to help get a hold on your physical activity and diet, which can have a great impact on your weight, glucose tolerance, risk of gestational diabetes, and blood pressure and cholesterol. Increasing your physical activity is such an important factor in improving your general health, as well as preventing and treating type 2 diabetes, and other chronic conditions.

3 things you want to try to include: 1. Be more active each day! Reduce the amount of time spent sitting, and move around as much as possible. Walk as a means of transport wherever possible, and break up activities such as watching TV by doing 10 laps of your hallway in the ad break!

2. Get huffy and puffy! Australian Physical Activity Guidelines recommend 30 minutes of moderate intensity physical activity on most if not all days! And if you can, also enjoy regular, vigorous activity for extra health and fitness benefits!

3. Build some muscle! This can be anything from a simple home-based resistance exercise program, to a gym-based one. You don’t need to look like Arnold Schwarzenegger to get benefits, but increasing your muscle mass helps to provide more sites for glucose storage (important for diabetes prevention and management), raises your metabolic rate (even when you’re at rest, you’re burning more kilojoules!), helps keep you fit and strong, and is important for the prevention and management of other chronic conditions, particularly osteoporosis. If you’re looking to improve your diet, don’t try to change everything all at once. Make small changes, one at a time. For example, start by ensuring you consume 2 serves of fruit and 5 serves of veggies each day. Replace beverages such as juice, cordial, soft drink and alcohol with water. These simple changes can make a big difference! Diabetes doesn’t necessarily give you a lot of warning – it can creep up on many people! We’ve previously discussed the “diabetes surprise” – the shock many people experience when they receive their diagnosis. So it’s important to be on the lookout for the following warning signs (though, be aware that these are sometimes mild, or completely absent in people with type 2 diabetes):

• Frequent urination • Excessive thirst • Increased hunger • Weight loss • Tiredness • Lack of interest and concentration • Vomiting and stomach pain (often mistaken as the flu) • A tingling sensation or numbness in the hands or feet • Blurred vision • Frequent infections • Slow-healing wounds The best thing you can do is to ensure you get regular blood tests through your GP, and if you notice any of the above warning signs, see your GP.

Check out The Glucose Club's very own Dr Adam Fraser in CLEO magazine discussing: How much exercise do you really need?

Receiving a diagnosis of diabetes can be shocking, surprising, overwhelming, upsetting, frustrating or maybe all of the above! It can be a stressful time in a person’s life, and sometimes gives a person the feeling of helplessness. While all of these reactions can be completely normal and are to be expected, it is important to know that you have the power to control your diabetes – your own decisions can play a big part in the management of your diabetes. It is important to have regular check-ups with your GP, and work with your GP in developing a management plan. Your GP may recommend you see other specialists to assist in the management of your diabetes. These may include:

- Endocrinologist - Accredited Exercise Physiologist - Dietitian - Diabetes nurse educator - Psychiatrist - Podiatrist - Optometrist You may see none, one or all of these specialists at various stages! They will be able to provide you with specialist advice in their area of expertise. While your GP can be a great source of information, it is not possible for them to be experts in all of these fields, so it can be a great opportunity for you to get expert information, which will help you manage your diabetes as effectively as possible!

Once you’ve been diagnosed with diabetes, it is important to know what you can do to manage it and gain control! The first thing to do is to work with your GP. If your GP has prescribed medication, or given you a referral to a specialist, it is important to follow your GP’s plan. Aside from medication, there are other things you can do to help manage your diabetes. Lifestyle modification – including increasing your activity levels, and improving your diet – is effective in assisting in the management of type 2 diabetes. Exercise improves glucose control in a number of ways. When you exercise, glucose is utilised as a source of energy. Glucose is stored in your blood, muscle and liver, so that after you exercise, the amount of glucose in your muscle and liver has been reduced. The next time you eat, glucose replenishes those diminished stores, rather than building up in your blood. If you build some muscle through resistance exercises (also known as “weight training”), this provides even more storage sites for glucose, which also help to reduce the amount of glucose building up in your blood. When you exercise, you also improve your insulin sensitivity – this means your cells respond better to insulin, so less of it is required to perform the same job. This also helps to improve your glucose control. On top of that though, it means your insulin levels tend to be lower – which is really important if you’re looking to lose weight, as high insulin levels signal your body to store fat from the food you eat, and prevent that fat being used as an energy source. When it comes to diet, stick to a few simple rules to help keep your glucose levels in control:

Slow & steady carbs! You’ve probably heard about low GI carbohydrates a lot! And it can be hard to know what to go for. Choose brown and grainy options over white options wherever possible! Except for rice – the best rices to go for are a couple of “white” options – doongara and basmati. These are even better than brown rice in terms of GI!

Go for green! Fill up your plate with veggies at every meal – these provide lots of vitamins and minerals, but also tend to be low GI, helping to keep you feel satiated for longer. Plant sources of fats also tend to be mono and polyunsaturated (which are the good kind!) – things like avocado, nuts and seeds.

Keep it lean! When it comes to animal sources of protein, trim all visible skin and fat prior to cooking, and keep portion sizes for meat to the size of the palm of your hand and fish up to the size of your whole hand. For ideas about what sort of exercise you should get into, and meal and nutrition ideas, check out book into see one of our accredited exercise physiologists in our clinics, or through one of our programs.

At TGC we were recently reminded of the importance of getting things checked with a close friend’s mum being diagnosed with Bowel Cancer. It’s such a shock when a vibrant, warm, active and life loving person gets this diagnosis. It makes us stop and think about what we can do to help, if anything.

In April at the Exercise and Sports Science Australia conference, so many of the presentations, posters and papers were all focusing on the role of exercise in cancer – both in regards to treatment and survivorship. There is mounting evidence that physical activity does more than simply keep people’s minds off the diagnosis. It’s safe and beneficial in both the treatment and post treatment phases, providing excellent results on survival.

Specifically for people with bowel cancer, one study in Melbourne found, “regular physical activity, even as little as once per week, was associated with an absolute improvement of 14% in overall survival and 12% in disease-specific survival at 5 years compared with no regular activity. This effect was greatest in survivors with right colon tumors and in survivors with stage II or III disease. They had a 39% reduction in all-cause mortality and 51% reduction in disease-specific mortality.”

Most encouragingly, starting physical activity after diagnosis also improves survival rates, no matter how active they were beforehand.

How does exercise do this? Research is ongoing into exactly how exercise impacts on cancer. Some current schools of thought are around immune function, oxidative damage, and the insulin axis as well as exerts anti-inflammatory and anti-proliferative effects on tumors.

This month is Bowel Cancer Awareness month so go to their website. There’s loads of information on bowel cancer, signs and symptoms as well as information for those with bowel cancer.

Check with your doctor on your bowel health and of course – start some exercise! If you need some help with how to do that, give us a call!

It’s Exercise Right week and the focus is on individualisation of people’s exercise. Everyone is different, we have different genetics, different needs as well as different likes and dislikes. All of these need to be considered if your exercise plan is to be successful. There are so many different types of exercise. There is no one exercise or exercise program that will last you all your life. Your exercise program will change as your life and your needs change. That’s why I love these images from ESSA. It clarifies that it’s not that they have failed at exercise – it’s just that they have outgrown their old exercise plan or it simply doesn’t fit into their life anymore. There are so many common reasons people stop exercising or find it hard to start. Moving into fulltime work for the first time, becoming a parent (that’s a big one!), changing job or moving house are all common reasons that our exercise programs may need to change. It’s also if your body changes – an injury or illness may need to be considered and a new program written to maximize the benefits of exercise for your recovery and minimize the impact of this change on your life. From personal experience over the course of my life, I have gone from exercising in the evening with friends, to the mornings in squad sessions, to afternoons on my own, back to mornings, to scheduling it in with children and a travelling husband while working myself and now getting myself set up in a home and gym program to ensure I’m regularly active. If I had tried to keep my old style of training, it simply wouldn’t have fitted into my life and I wouldn't be active anymore. I have needed different programs through a knee injury, pregnancy with pelvic girdle pain and also when I wanted to achieve different things. With exercise you get what you train for. Exercise helps in so many ways, so let’s not say ‘Exercise doesn’t work’ just ‘I haven’t found the exercise for me’. We’re happy to help you do that at TGC, so give us a call and let us help you find the right exercise for you.

"There is only one of you,

you are the only you that there is"

Jenna Marbles