So sport and walking can become a cure

Answer: Physical activity is one of the fundamental pillars in the management of diabetes mellitus, both type 1 and type 2. One of the main effects of physical activity is the increase in insulin sensitivity in skeletal muscles and peripheral tissues. This means that during and after exercise, muscle cells are more capable of absorbing glucose from the blood, thus contributing to lower blood glucose levels in both the short and long term. In type 2 diabetes in particular, physical activity can significantly improve glycaemic control, as shown by a reduction in glycated haemoglobin (HbA1c). In some cases, this improvement may allow a reduction in the dose or number of drugs required, in combination with a healthy diet. In type 1 diabetes, physical activity also improves insulin sensitivity, promoting better management of insulin therapy and reducing glycaemic fluctuations. In type 1 diabetes, it is crucial to carefully manage physical activity to prevent hypoglycaemic episodes during or after exercise. However, technologies have greatly simplified this management, making physical activity safe and accessible for these patients as well.

Regular physical activity has positive effects on blood pressure and lipid profile, helping to reduce the risk of cardiovascular disease, which is one of the main causes of mortality in people with diabetes. In particular, exercise increases HDL ('good') cholesterol levels, while reducing triglyceride and LDL ('bad') cholesterol levels. In addition, physical activity helps control body weight, a crucial factor especially in type 2 diabetes but more recently also in type 1 diabetes, where overweight and obesity are among the main risk factors and worsen insulin resistance. By reducing body weight, exercise further improves insulin sensitivity and counteracts the development of complications.

From an inflammatory point of view, regular physical activity reduces systemic inflammation and oxidative stress, two mechanisms that contribute to the onset and progression of microvascular complications (such as retinopathy, nephropathy and neuropathy) and macrovascular complications (such as heart attack and stroke). In addition to the metabolic and cardiovascular benefits, physical activity improves muscle strength, flexibility and balance, which are crucial in preventing falls and fractures especially in the elderly or those with neuropathic complications.

Despite its many benefits, physical activity in diabetes requires some caution, particularly because of the risk of hypoglycaemia. This is a frequent problem especially in people with type 1 diabetes on insulin therapy, but can also occur in some patients with type 2 diabetes being treated with hypoglycaemic drugs. Hypoglycaemia can occur during or up to several hours after exercise, and its symptoms include trembling, sweating, confusion, and in severe cases loss of consciousness. To prevent these episodes, careful monitoring of blood glucose before, during and after exercise, adjustment of insulin or drug therapy, and carbohydrate intake if necessary, is essential. Conversely, in some situations exercise can cause hyperglycaemia, especially if very intense or in the presence of marked insulin deficiency. This occurs due to the release of counter-regulatory hormones such as adrenalin and cortisol, which increase the production of glucose by the liver. This is why it is important to avoid excessive exertion without adequate preparation. Further precautions concern the environment in which the activity takes place: for example, in intense heat, the risk of dehydration and electrolyte imbalances increases, and special care must be taken.

Physical activity should always be prescribed in a customised manner, favouring a combination of aerobic exercises (such as walking, running, cycling, swimming) and muscle-strengthening exercises, carried out regularly, at least 150 minutes per week.