The Effect Of Exercise On Diabetes Mellitus

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The Effect Of Exercise On Diabetes Mellitus

• Presented by
• Carol V. R. De Costa M.D. M.S.
• Rehabilitation Medicine And Sports Services P.C.
• 189 Montague Street Suite 700
• Brooklyn New York 11201
• [phone]
• www.remass.org

2
Disclosures

• None

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Objectives

• Discuss definition of exercise
• Review the physiologic effects of exercise on
  Diabetes Mellitus
• Highlight the benefits of exercise in Diabetes
  type 1 and 2
• Acknowledge Research studies on exercise and
  Diabetes
• Understand the risks associated with DM
• Learn tips for avoiding complications

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What is exercise

• Definition Performance of physical exertion for
  improvement of health or correction of a physical
  deformity.
• (Dorlands Medical Dictionary)

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Types of Exercise

• Aerobic- Affects the cardiovascular system.
  Increases oxygenation throughout the body and
  increases conditioning (exercise tolerance).
• Predominance of Slow twitch (Type 1 Muscle)
• walking running swimming cycling etc.
• Anaerobic- Affects the muscular system by
  increasing strength and muscle bulk
• Predominance of fast twitch (type II muscle)
• Strengthening exercises short duration
  activities

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Types of exercise (contd)

• Isometric No change in fiber length with
  contractions
• Isotonic Contractions without movement of the
  joint but with a change in muscle length.
• Isokinetic Performed with a machine which makes
  contractions possible with movement against a
  constant speed with variable resistance

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Isokinetic machine
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The Effect Of Exercise On Insulin And Glucose

• Decreased blood glucose
• Uptake of glucose into the muscles
• Stored as glycogen
• Decreased insulin level via use of insulin
  dependent glucose transfer to muscle.
• Increased Insulin Sensitivity ( type 2)
• May be blunted in Type I Diabetics dependent upon
  injection site
• Increased glucose via glycogenolysis and
  gluconeogenesis

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Effects of exercise in Type I Diabetics.

• Overall good response to exercise in diabetes
• Injection site can affect the availability of
  glucose
• Sub-cutaneous abdominal injection best
• Exogenous insulin is not modulated by the changes
  in glucose level due to glucagon or epinephrine.
  ( As with endogenous insulin)
• High risk of post exercise hypoglycemia

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Research Diabetes and Activities

• Classic Harvard study 1992
• 21 271 US male physician
• Prospective randomized
• Followed for 5 years
• Revealed those exercising 1X weekly or less had
  higher prevalence of Type 2 DM compared with
  physicians exercising 5X weekly (369/100k vs.
  214/100k)

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Italian Diabetes and Exercise Study 2008

• 606 subjects with type 2 Diabetes and Metabolic
  syndrome
• Randomized controlled multi-center
• Found that patients who received intensive
  exercise treatment decreased modifiable risk
  factors compared to those who received exercise
  counseling

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Effects of Exercise on Type 2 Diabetics

• Long term effects greater in Type 2 compared to
  type 1
• (Anish EJ Klenck CA. )
• Decreases HbA1C in Type 2 DM
• Increased insulin sensitivity in muscles liver
  and fat cells
• (Wallberg-Henrikson 1992)
• One exercise session can increase insulin
  sensitivity for 16 hours
• (Landry and Allen)

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Exercise effects on HbA1c

• 30-60 Minutes aerobic exercise at 50-80 VO2 max
  3-4 times per week reduces HbA1c by 10-20 from
  baseline (ADA 2004)
• Resistance training can decrease HbA1c
• Increase muscle mass and muscle glycogen stores
  (Erikson et al Casteneda et al)
• Circuit resistance training can have positive
  effects on HbA1c.
• 2X weekly decreases HbA1c from 8.8-8.2
• (Erikson et al)

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Benefits of Reduced HbA1cEnhanced by exercise

• 35 decrease risk of micro-vascular complications
• 25 decrease in diabetes-related deaths
• 18 decrease in combined fatal and non fatal MI
• 7 decrease in all cause Mortality
• UK Prospective Diabetes Study group Lancet 1998

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Overall Benefits of exercise in Diabetes

• Improved insulin sensitivity (type 2)
• Improved cardio-respiratory function
• Lowers risk in cardiac death
• (Blair et al 1989)
• Improved lipid profiles blood pressure and body
  fat percentage
• Decreased abdominal fat content
• ( Lehman et al 1997)
• Decreased mortality and lower incidence of
  macro-vascular disease (La Porte et al 1986
• Improved mood (endorphins)
• FBG or HbA1C in Type 1 diabetics not consistently
  improved

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Preparation Strategies For Exercise

• Pre-exercise estimate intensity an duration of
  exercise session
• Eat 1-3 hours prior to exercising
• Inject insulin one hour before starting exercise
  activity
• If blood glucose lt100mg/dl take a light snack
  directly before exercising
• If blood glucose is gt250 do not exercise and
  check ketones( may need to add insulin)
• Inject away from exercising muscle

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Maximize benefits and limit risks of exercise

• Supplement CHO every 30 minutes of exercise
  (30g/30 minute)
• Replace fluids ( .5L H20 Q 15 -20 mins)
• Monitor blood glucose (delayed hypoglycemia)
• Increase caloric intake for 12-24 hours after
  activity.
• Proper foot care
• Avoid blisters
• Check shoes for pebbles
• Avoid weight lifting
• retinal injury/ glaucoma

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Special consideration for CSII Insulin Pump

• Remove pump 30 minutes prior to short duration
  events
• For long duration events gt1hr
• Small boluses of insulin to decrease
  hyperglycemia
• Avoid displacement of the unit
• Use adhesive preparation to keep unit in place
  after increased sweating
• Remove before participating in contact /
  collision sports

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Recommendation for modification of Life style for
patients with DM

• Fold exercise into your day - EVERY DAY
• Get off the bus one stop before your home
• Put the exercise bike in front of the television
  or in the room where you spend most of your time
• Perform exercises while in the bed (straight leg
  raising stretching) upon awakening and before
  going to sleep
• Park the car in the far end of the parking lot
• Join the Gym or play a sport (Tennis Basketball)
  with a partner

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References

• American Diabetes Association. Physical
  activity/exercise and diabetes. Diabetes Care
  200427(Suppl 1)S58-S62
• Anish Ej Klenck CA. Exercise as Medicine The
  role of exercise in treating chronic disease. In
  McKeag DB Moeller JL eds. ACSMs Primary Care
  Sprots Medicine 2nd ed. Lippincott Williams and
  Wilkins 2007
• Balducci S Zanuso S et al. Design and Methods
  for a prospective Italian multicentre trial of
  intensive lifestyle intervention in people with
  type 2 diabetes mellitus and metabolic syndrome.
  NMCD18 Nov 2008(9)585-595
• Castenada C Layne JE Munoz-Orians L et al. A
  randomized controlled trial of resistance
  training to improve glycemic control in older
  adults with type 2 diabetes. Diabetes Care
  200225(12)2335-2341
• ErikssonJ TaimelaS ErickssonK et al.
  Resistance training in the treatment of
  non-insulin dependent diabetes mellitus. Int J
  Sports Med 199718242-246
• Kreisman SH Ah Mew N Halter JB et al.
  Norepinephrine infusion during moderate intensity
  exercise reproduces the glucoregulatory response
  to intense exercise Diabetes 52(6)1347-1354
  2003
• Lesle DK Trojian TH. Managing the Athlete with
  Type 1 Diabetes . Current Sports Med rep 2006
  50 93-98
• Landry GL Allen DB Diabetes mellitus and
  exercise. Lin Sports Med 11 (2) 403-418 1992
• Laporte RE Dorman JS Tajima N et al
  Pittsburg insulin dependent diabetes mellitus
  morbidity and mortality study Physical activity
  and diabetic complications. Pediatrics
  781027-1033 1986
• Mason J Nathan D et al. A prospective study of
  exercise and incidence of Diabetes Among US male
  physicians. JAMA 1992268(1)63-68

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• Thank you