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Exercise in diabetes - Strategies for managing BSL

Diabetes | December 3, 2014 | Author: The Super Pharmacist


Exercise in diabetes - Strategies for managing BSL

Diabetes is a condition in which excessive concentrations of dietary glucose may build up in the tissues of a patient, rather than be broken down as in the course of normal metabolism. This is due to the failure of insulin signalling, which should control the ability of cells to take in glucose to use for fuel. This increased exposure to high glucose concentrations may take the form of many illnesses and conditions, including

  • Diabetic neuropathy, in which damage to nervous tissue may result in chronic pain or numbness in the extremities
  • The increased risk of cardiovascular diseases, such as atherosclerosis or high blood pressure
  • Impaired hearing
  • Kidney damage and/or failure
  • The increased risk of the metabolic syndrome, which may lead to obesity

Diabetes may be associated with the increased risk of death due to diabetes-induced complications. Currently, both of the most prominent forms of the condition are being seen in rising numbers of younger people. 

The role of exercise in diabetesHowever, those with type 1 diabetes, a condition in which insulin release is impaired due to autoimmune damage to the pancreas, appear to be at decreasing risk of premature death. This may be due to advancements in type 1 diabetes management, such as the use of insulin pumps and monitors. 

Patients with type 2 diabetes are at significantly higher risk of mortality.

As it is estimated that the number of diabetes patients will increase to over 300 million in the next nine years, (up to 95% of whom will have type 2 diabetes) this is a global concern with need for even better treatment and management strategies than those available now. The development of diabetes is associated with many factors, including:

  • Genetic factors, particularly those concerning insulin and components of the body's insulin-producing mechanisms
  • Chronic commercially-produced sugar and/or carbohydrate intake, which are readily broken down to glucose in the gut
  • Pre-existing obesity and/or the metabolic syndrome
  • A mainly sedentary lifestyle

The role of exercise in diabetes

Physical inactivity is associated with impaired fasting glycaemia, or the increased inability to break down glucose in cells, which is an important factor of 'pre-diabetes', the precursor condition of type 2 diabetes. In addition, the accumulation of stored fat may further increase the risk of this condition, as increased abdominal fat and decreased muscle mass is also associated with insulin resistance.
Exercise and physical activity are regarded as crucial components of avoiding or controlling type 2 diabetes
and reducing the associated risks of cardiovascular disease and mortality for patients with this condition.

Large-scale clinical trials (approximately 500-3000 human subjects) of exercise in diabetes type 2 management or prevention have resulted in the significantly reduced incidence of the condition compared to placebo interventions. Exercise is also associated with improved control of blood sugar in those with established type 2 diabetes. The maintenance of cardio-respiratory fitness over time is associated with increased insulin release and decreased insulin resistance in general. It is also associated with the prevention of age-related decreases in insulin sensitivity. 

Therefore, diabetic patients may address their impaired insulin response with exercise.

Muscle cells require glucose for fuel, particularly when engaged in high volumes of work, as when undergoing exercise. The sugar is stored in the liver in a highly complex and concentrated form called glucagon, which can be broken back down into its constituent glucose in response to exercise. It is then released into the bloodstream, which is broken down in the cells in response to the signals of insulin. Insulin also promotes blood flow in muscles in response to exercise, so as to increase the availability of glucose to this tissue. 

However, in conditions where insulin is deficient (i.e. diabetes type 1) or ineffective (type 2), glucose concentrations may be abnormally high or low after exercise for patients in comparison to normal individuals.

High blood glucose levels may increase the risks of the complications as listed above, whilst abrupt reductions in this level (or hypoglycaemia) may also be dangerous. This is associated with adverse effects such as lethargy, confusion, seizures and the induction of a coma in severe cases. Therefore, despite the beneficial effects of exercise, diabetic people must often approach the activity with increased caution, adaptation and planning.

Blood glucose levels may be controlled in a variety of ways so that the benefits of exercise outweigh the risks. These include:

Medication adaptations

Those with diabetes who take daily insulin may find they are at higher risk of hypoglycaemia in response to exercise, as their natural insulin production (or endogenous insulin release) is better stimulated by this activity. Therefore, they may need to adjust their doses of insulin (with the aid of a health professional) if they plan to start exercising regularly, or enhance their existing programme. This may be done through personal blood glucose testing and testing at their clinic or healthcare facility.

Blood sugar monitoring

This may be done using a device that measures blood glucose from a small sample gained from a finger-prick test. Blood glucose monitoring is a convenient manner to test this level during the day. It may be done after meals, before, during or after exercise.

Blood sugar monitoringIf blood glucose is found to be very low or very high, exercise may be postponed until it returns to acceptable levels. If it is similarly altered after exercise, this may be addressed by consuming an appropriate amount of carbohydrate-containing food or drink (such as fruit, fruit juice or non-diet commercial beverages). These could be carried during exercise in case of hypoglycaemia, the onset of which may be detected by sensations of weakness or confusion.

Interval training

This is a type of exercise in which the individual works out or engages in high-impact activities for briefer periods of time than traditional exercise sessions (30 minutes or less). This has been shown to be effective in improving fasting glucose and the response to insulin, thus reducing the risk of pre-diabetes and potentially controlling diabetes type 2.

Other advantages of high-intensity interval exercise is that it is time-efficient, and gives ample opportunity to monitor blood sugar levels, and to take steps to correct them if need be.

  • Interval training may be more effective and suitable for patients with reduced fitness and complications such as neuropathy.
  • It is associated with improvements in cardiovascular health and even rehabilitations in those with disorders such as coronary artery disease.
  • Interval training has been found to result in improved lung function, exercise tolerance and quality of life in comparison with conventional aerobic exercise.  Australia’s best online discount chemist


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