Diabetes is the result of a lowered secretion of insulin with a bigger or smaller peripheral resistance to insulin with consequent hyperglycemia. The elementary counterparts of this disease are the malfunction in the transport of glucose from blood to tissue and organ cells.

Glucose is a sugar which is a product of degradation of carbohydrates during digestion and which ends up in blood. The hormone that enables glucose to come from blood to the cells is called insulin. Insulin is secreted by beta- cells in the pancreas. We can simplify it this way: a lot of glucose in blood is the signal to insulin to "run" into blood and start to "knock" on the doors of the cells. They, in turn, open and glucose comes in the cells through the open doors thanks to insulin. When there is no or not enough of insulin, glucose then stays "homeless" and circulates through blood because there isn't anybody who would open the door. Diabetics have an increased level of glucose in their blood for two reasons: their body does not produce enough insulin or their body is not using the insulin in a satisfactory manner.

There are two basic types of the illness: diabetes mellitus type 1 or diabetes dependent on insulin and diabetes mellitus type 2 or an insulin-independent diabetes.

The first type occurs in younger people, oftentimes children, whose beta- cells of the pancreas lose their ability to secrete insulin and the only effective therapy is the one where insulin is taken additionally, via shots. If the illness appears before a person's 30^th birthday, we are referring to diabetes mellitus type 1.

The second type appears in later life, after 30 years of age. It is directly connected to a person's lifestyle and diet. In time, the beta- cells of the pancreas become exhausted and there isn't enough insulin. Why is that so? Consuming a large amount of simple sugars (sugars that are made by industrial manufacture and are used as consumption sugars in foods; in comparison to natural sugars in fruits, vegetables and cereal) leads to a constant circulation of large concentrations of glucose. That requires a lot of insulin which is produces by beta- cells, however, they become exhausted after some time and their production is decreased. On the other hand, we become insensitive to insulin in other cells (for example, in muscle cells). To explain in more simply, when insulin reaches the cells and the knocks on the door so that glucose could enter, the door cannot open anymore.

There are oral medications that serve as therapy for diabetes, meaning pills or artificially- produced insulin which is transferred via a syringe under the skin. There are two ways to do this: the first is by means of a pen syringe (a special kind of syringe that transmits the insulin under the skin) or by a means of a so- called insulin pump.

Physical activity and diabetes

Although physical activity is more important as a preventive aid to stop diabetes from occurring, persons who already suffer from this illness can have multiple benefits from physical activity.

The reasons are the following: 

Physical activity has a large importance in curing diabetes because it improves blood circulation, increases the consumption of glucose in muscles up to 20 times more in comparison to muscles while resting. Also, it increases the number of receptors for using glucose in cells as well as the usage of fat which, in turn, decreases the level of fat in blood and prevents the occurrence of atherosclerosis. Physical activity increases cell sensitivity to insulin in a way that tissue cells increase their ability to tie insulin (enables the "door opening" in the cell) so that a person with diabetes who trains can increase glucose intake (food) at the same level of insulin concentration. Also, he or she can gradually decrease the doses of insulin or oral antidiabetic (pills).

By means of physical activity, we control our body weight. Losing weight can, in a person with type 2 diabetes, increase the control of their glucose blood levels. When starting to take up a training programme, many patients are compelled to control their diet in more detail and track their blood sugar levels (glucose).

Controlling glucose is the key factor in preventing complications in diabetes. Those who have controlled their blood sugar 4 or more times a day had 50 - 70% less complications that the ones who haven't.

Physical activity lowers cardiovascular risk factors which, in combination with diabetes, lead to atherosclerotic cardiovascular diseases of the heart and blood vessels, decreases the levels of serum lipids (cholesterol) and lowers stress. Diabetics are at a larger risk of arterial obstructions which can cause a heart attack. Training can help in preventing this state because it regulates the levels of cholesterol in blood and, in general, makes a good effect on health. Physical exercise, in this way, regulates our blood pressure, stimulates weight loss, increases the levels of good cholesterol, builds and strengthens muscles and bones, increases the levels of energy, improves our mood and quality of sleep and lowers our stress levels.

Exercize has a great influence on the patient's psychological state. Having control over diabetes reflects on other aspects of life. An increase in self- confidence and a decrease in one's dependency on medication is apparent. Actually, having control over your illness means having control over an important part of everyday life.

So, why do diabetic patients need to choose martial arts as physical activity?

The basic reason lies in the fact that, by practicing a martial art, the patient does three basic exercizes: aerobic exercize, strength training and flexibility. A well- balanced and adjusted training is something that is highly advised to patients who suffer from diabetes. Also, practicing certain martial arts techniques, for example, tai chi, ko budo (moderate practice with weapons), karate (katas), tae kwon do (hyung), kung fu (quen), boxing (exercize with a boxing bag) as well as any other moderate contactless training, are ideal for patients who use an insulin pump. The reason is that these kinds of exercizes are performed without close contact and there is virtually no chance that the tube could be pulled out from the pump.

Aerobic exercizes are very often performed in various martial arts and they are an integral part of particular martial arts trainings. These include: race walking or jogging, moderate running, kata performance, practicing of certain techniques (combinations of performing different punches with the hand or foot), moderate exercize with a boxing bag, practices by using weapons (nunchaku, sai, kama, bo, bokken, katana etc.), rope jumping, swimming, cycling as well as some sports (e.g. basketball, volleyball). Aerobic exercize are an important counterpart in martial arts training, namely boxing, karate, tae kwon do, kung fu, kick boxing, judo, ju jutsu, muay thai, aikido, UFC (MMA), fencing, wrestling, and so on.

Patients who suffer from diabetes are advised to do some moderate strength training which they should perform daily, usually in 30- minute intervals. Strength training is also a very important part of martial arts. By training some martial arts such as boxing, karate, tae kwon do, judo, wrestling, ju jutsu, kickboxing, muay thai, kung fu, UFC (MMA) and many other, the patient will also train various exercizes to build up strength. It is important to emphasize that, by working with an instructor, the patient will make sure that the performance of the exercizes is always optimal, i.e. properly and moderately adjusted.

Strength training is useful for patients who suffer from diabetes because it helps them increase their muscle mass and build strong and solid bones. An increase in muscle mass is very important for diabetics because muscles consume glucose. If the patient is not able to perform strength training exercizes on a daily basis, which is advisable, he or she should perform them at least three times a week, in 30– minute intervals. It should be enough in order to reap all the benefits of strength training. It is important that, while exercizing, the patient covers all muscle groups in the body, especially the muscles that take care of our posture (stomach, i.e. abdominal, back and legs). This is why choosing a martial art (karate, tae kwon do, kung fu, judo, wrestling, ju jutsu, aikido, boxing, kickboxing, MMA etc.) is ideal. Also, patients can perform most strength training exercizes without many problems by using only their body weight, by using some lighter weights (or a certain weapon in their hands) or by using a resistance (stretch) band etc. This makes martial arts exercizes an excellent choice.

Exercizes that increase flexibility are also an important counterpart in various martial arts trainings, namely karate, tae kwon do, capoeira, kung fu, kickboxing, as well as skills such as judo, aikido, ju jutsu, boxing, wrestling, fencing, and so on. Flexibility training is very important in order to gain a better functioning of muscles and joints. Patients with diabetes should regularly stretch before and after each training so that their muscles could relax and get rid of any tension.

A patient with diabetes should definitely take into consideration that, if blood sugar levels are not controlled regularly, duly and properly, he or she should avoid physical exercize. This is exactly why it is good that the patient exercizes a martial arts skills such as tae kwon do, karate, judo, kung fu, aikido, ju jutsu, kickboxing sambo, muay thai, boxing, wrestling, fencing etc. Because, in training, a lot of attention is given to the athlete's self-control which is, in turn, a very important trait for diabetic patients.

The best time to exercize is in the morning because the daily rhythm of other hormonal secretion (which are in interaction with insulin) is such that mornings make the best possible time and evening the worst. The patient should do the entire training in the morning and it should consist of aerobic exercizes, strength training and flexibility, with an intensity of around 80%. It is advisable that moderate exercize is done in the evening, such as some katas, tai chi, stretching, yoga, walking or jogging, weapon practice (sai, bo, nunchaku, kama, katana), certain breathing exercizes, kung fu on a wooden dummy etc.

Regular martial arts exercize where the trainees are barefoot (tae kwon do, karate, judo, aikido, ju jutsu, capoeira, muay thai, kick boxing, MMA etc.) carries multiple benefits. This kind of exercize strengthens the muscles of the foot and shins which regulates blood circulation in the ulterior parts of the body, i.e. feet. Also, it adds to a larger flexibility and improves the sensitivity of peripheral nerves, i.e. improves overall sensitivity of the feet which increases stability while walking.

Persons who have diabetic retinopathy (the damage of blood vessels inside the eye) need to avoid physical activity which increases systolic blood pressure beyond 180 mm HG. Weightlifting falls within this category as well as certain exercize where a brief, but powerful straining of the muscles takes place (e.g. push- ups, rope climbing, pull- ups, training with weights etc.). During workout, the patient should drink water and carry some sweets so that, in case their blood sugar level drops under a recommended amount, they could increase it instantly.

Patients should increase the amount of exercize gradually until they reach a level of physical activity that they can still endure. Determining factors that come into play include one's age and the current physical state in which the patient is in. Patients who during physical activity enter hypoglycemia need to check their blood sugar levels more often, take in carbohydrates or lower their insulin doses so that, immediately before they strain their bodies, they become slightly hyperglycemic. Under a large exertion, hypoglycemia dictates simultaneous carbohydrate consumption, typically 5- 15 g of glucose or some other simple sugar.

Patients who have some sort of diabetic complications such as neuropathy or retinopathy need to lower the amount of exertion and adapt the given goal. Those who have high blood pressure need to avoid strenght training where you keep a certain position (e.g. squats, long- term hanging etc.). This kind of patient should be moving at a light pace and this is another argument why martial arts are an ideal choice (tae kwon do, karate, kung fu, judo, wrestling, boxing, ju jutsu, capoeira, fencing, MMA, kickboxing etc.). The patient should avoid exercizing during heat and higher temperatures in general (take care not to dehydrate – an increased intake of liquid is necessary) as well as during low temperatures, i.e. below 0 (zero) degrees Celsius.

Some experts believe that, in order to lose body weight and avoid changes in the blood vessels, aerobic load is proven to be the best for the patients. Every exertion, i.e. physical activity improves glycemic control and all types of exercize are beneficial. However, some physical activities, e.g. certain martial arts, are the most adjustable for diabetic patients. As an example, a mention can be given to the most adjustable exercize - practicing katas (forms, hyung), especially some breathing katas, for example, sanchin, tensho, tai chi, chi gong etc. By practicing these katas accompanied by a light aerobic physical activity, patients can even lower their stress levels and relax which will regulate their blood sugar levels. This is the reason why this kind of exercize is ideal for patients who suffer from diabetes.

Fighting, i.e. sparing exercizes (kumite) as well as sports competitions can be allowed to those patients whose health permits it, but still needs to be regularly controlled. It is certainly more appropriate for younger trainees, but it can also be taken up by older patients whose health stats are good and who are in a better condition. Sparing as well as sports competitions can cause a lot of stress which is connected to a high emotional charge (because of large excitement). During this state, the adrenal gland secretes the hormone adrenaline (stress causes a severe adrenalin reaction).

A lot of stress and the secretion of adrenaline, i.e. its increase can have a very negative effect on a diabetic patient because the blood sugar (glucose) levels drastically increase (hyperglycemia). This is why the patient needs to control his/her blood sugar levels regularly before the competition and sometimes even during it (in a pause between two fight) and certainly after the competition.

A diabetic diet, i.e. a special regime can have a key role in treating all types of diabetes. The diet should be divided into 3 meal courses and 2-3- snacks which shouldn't be left out or connected into one. When picking groceries, keep in mind that the total daily intake of food comes to 50- 60% of carbohydrates (food items that do not cause sudden and long- lasting glucose peaks in the blood, i.e. legumes, some types of pasta, rice; concentrated sugars are not recommended), 30% of fats (around 10% of fat are of animal origin - butter, fat, dairy, eggs, meat and around 20% are of plant origin - olive, soy, pumpkin, corn oil, margarine, almonds, hazelnuts, peanuts - contain essential fatty acids which are necessary for our metabolism) and 15- 20% of protein (of animal origin - meat, fish, milk, eggs and plant origin - beans, peas, broad beans, soy, mushrooms).

Mango and cinnamon are foods that are especially appreciated because of their antioxidative and anti- inflammatory effect. They prevent activity of enzimes that break down carbohydrates from food and, in turn, lower the concentration of sugars in blood.

The daily intake of calories should be done by every diabetic patient so that their goals could be personally defined, depending on their body mass index (the ratio of a person's weight in kilograms and his/her height in meters). When choosing food, as well as many questions when it comes to a particular diet regime, you should most definitely consult with your instructor. Various martial arts instructors have a lot of knowledge on a correct diet as well as a correct regime. When taking on a martial art, a lot of attention is given to it and they will be happy to give you advice.

All of the ways in which diabetes is treated have only one goal - healthy blood sugar level regulation and prevention of complications that it may cause. Living with diabetes is not easy and patients are forced to make many sacrifices and change their lifestyles. Complications can lead to permanent disability and can increase mortality which, thanks to an increase in the number of new patients, is currently a worldwide health problem.

Special type of diet, different medicine and equipment needed to treat diabetes (pills, insulin, pen- injections, measuring strips, blood sugar meters, insulin pumps etc.) can be very costly and can burden the patient financially. This is also one of the reasons to take up a martial arts as a physical activity and, thus, lower one's need to take medicaments and drop therapy expenses.

Martial arts training is surely the cheapest solution for diabetic patients, in comparison to everything else (diet, medicine) in the process of treatment and it has a very big effect.