[Prescription of exercise in the diabetic patient]. / Acerca de la prescripción de ejercicio en el paciente diabético.

There is a broad epidemiologic evidence related with the increase of the incidence and prevalence of diabetes mellitus type 2 throughout the world, especially in Western populations, at rates considered epidemic. Cerebrovascular disease and myocardial infarction are two of the most important complications of this disease and they have very high social and economic consequences. Treatment of this disease is directed good metabolic control, diminishing toward obtain co-morbidity, and reducing acute and chronic diabetic complications. Diet, hypoglycemic drugs or insulin, and programs of physical activity are used for this purpose. This document presents some thoughts on the difficulties related with the prescription of physical exercise in the diabetic patient and a brief proposal to solve those problems in the clinical practice.

[Reflexions on some dilemmas in bioethics for the millennium]. / Reflexiones acerca de algunos dilemas en bioética para el próximo milenio.

With the end of the millennium, several proposals or propositions have been made about politics, culture, and economics for the world society. Science cannot be isolated from this well-recognized globalization process. Information through the Internet allows the spread of scientific data and knowledge among professional and no professional users to be exchanged and non shared, with the possibility of storing that information in a very fast manner. However, there are important differences in the availability and quality the information, especially in developing countries. On the other hand, it is clear that advances in technology in recent years are higher and faster than development in humanistic and philosophical areas. This situation points to the necessity of using some basic bioethical principles to deal with very important dilemmas such as euthanasia, assisted suicide, and new bioethical dilemmas such as technified death, restriction of economic resources in health care institutions, cloning and genetic manipulation, among others.

Oxidative stress, acute and regular exercise: are they really harmful in the diabetic patient?

Oxidative stress has been involved in the pathogenic process of a variety of diseases including diabetes mellitus. The production of oxidative reactive products has been involved in biochemical changes in bio-molecules that might produce tissue damage directly related to some of the main vascular complications in the diabetic patient. On the other hand, exercise, paradoxically, is a well-recognized model of oxidative stress and also an important therapeutic tool in diabetes management. Therefore, the relationship between oxidative stress and exercise in diabetic patients implies an interesting biochemical paradox due to some of the negative effects of exercise principally by the increase of oxidative species in plasma. The effect of oxidative stress during an acute exercise and after an aerobic training period on those patients remains unknown and needs to be studied.

[Oxidative stress. Should it be measured in the diabetic patient?]. / El estrés oxidativo. Es necesario medirlo en el paciente diabético?

Oxidative stress has been defined as a loss of counterbalance between free radical or reactive oxygen species production and the antioxidant systems, with negative effects on carbohydrates, lipids, and proteins. It is also involved in the progression of different chronic diseases and apoptosis. Diabetes mellitus is associated to a high oxidative stress level through different biochemical pathways, i.e. protein glycosylation, glucose auto-oxidation, and the polyol pathway, mainly induced by hyperglycemia. Oxidative stress could also be involved in the pathogenesis of atherosclerotic lesions and other chronic diabetic complications. Measurement of oxidative stress could be useful to investigate its role in the initiation and development processes of chronic diabetic complications and also to evaluate preventive actions, including antioxidative therapy. Different attempts have been made to obtain a practical, accurate, specific, and sensitive method to evaluate oxidative stress in clinical practice. However, this ideal method is not currently available to date and the usefulness of the current methods needs to be confirmed in daily practice. We suggest quantifying oxidated and reduced glutation (GSSG/GSH) and the thiobarbituric reactive substances (TBARS) with currently alternatives. Currently available alternative methods while we await better options.