Role and Management of Exercise in Diabetes Mellitus

Abstract

As more is understood about the physiology of exercise, in both normal and diabetic subjects, its role in the treatment of diabetes is becoming better defined. Whereas people with diabetes may derive many benefits from regular physical exercise, there are also several hazards that make exercise difficult to manage. In type I (insulin-dependent) diabetes, there are risks of hypoglycemia during or after exercise or of worsening metabolic control if insulin deficiency is present. Type II (non-insulin-dependent) diabetic patients treated with sulfonylureas are also at some increased risk of developing hypoglycemia during or after exercise, although this poses less of a problem than with insulin treatment. In individuals treated by diet alone, regulation of blood glucose during exercise is usually not a significant problem and exercise can be used as an adjunct to diet to achieve weight loss and improved insulin sensitivity. When obese type II diabetic patients are treated with very low calorie diets, adequate amounts of carbohydrate must be provided to ensure maintenance of normal muscle glycogen content, particularly if individuals wish to participate in highintensity exercise that places a heavy workload on specific muscle groups. On the other hand, moderateintensity exercise such as vigorous walking can be tolerated by individuals on very low calorie, carbohydrate-restricted diets after an appropriate period of adaptation. A number of strategies can be employed to avoid hypoglycemia in type I diabetic patients, and both type I and II diabetic patients should be examined carefully for long-term complications of their disease, which may be made worse by exercise. These considerations have led many diabetologists to consider exercise beneficial in the management of diabetes for

Walking for exercise ? immediate effect on blood glucose levels in type 2 diabetes

“…However, there was a tendency towards greater decline with higher pre-walk blood glucose levels (Table II). DISCUSSION Regular intensive exercise in diabetes care is known to induce an immediate lowering of blood glucose levels, increased insulin sensitivity, and a decline of glycated haemoglobin (HbA1c) (8). The results from this study show that low-intensity exercise was sufcient to produce a signi cant acute reduction of blood glucose levels in elderly type 2 diabetes patients.…”

Habitual physical activity, aerobic capacity and metabolic control in patients with newly-diagnosed Type 2 (non-insulin-dependent) diabetes mellitus: effect of 1-year diet and exercise intervention

“…The blood glucose lowering effect of exercise is largely due to the cumulative effects of single exercise bouts [4,6,7,9]. The interaction between glycaemic control and aerobic capacity may, however, be more complex because it has been suggested that lowered VO2 at in diabetic subjects is due to a high HbA~ level through increased oxygen affinity [25].…”

“…Few studies have previously suggested that exercise improves serum lipid profile in Type 2 diabetes [10][11][12]. However, it has been speculated that the most important impact of exercise in Type 2 diabetes is the beneficial effect on cardiovascular risk factors [6,8]. Recently, a study on obese healthy subjects showed that combined diet and exercise training resulted in a significantly higher increase in HDLcholesterol than diet alone [30].…”

“…Recent reviews have pointed out the potential for exercise to improve insulin sensitivity, glucose tolerance and long-term glycaemic control measured by HbAlc in diabetic patients [3][4][5][6][7][8][9]. Furthermore, there are suggestive data showing that regular physical activity may induce favourable changes in serum lipid profile [10][11][12].…”

Make Your Diabetic Patients Walk

“…Many studies have shown that regular physical activity improves quality of life, reduces the risk of mortality from all causes (1)(2)(3)(4), and is particularly advantageous in subjects with impaired glucose tolerance (5,6) or type 2 diabetes (7)(8)(9)(10)(11)(12). Physical activity counseling can motivate most diabetic subjects to increase their levels of voluntary energy expenditure (9 -11), but, at present, the relationship between amounts of physical activity and longterm beneficial effects in type 2 diabetes care is unknown.…”