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The Effect Of Exercise On Diabetes Mellitus


Review the physiologic effects of ... High risk of post exercise hypoglycemia. Research Diabetes and Activities ... Monitor blood glucose (delayed hypoglycemia) ... – PowerPoint PPT presentation

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Title: The Effect Of Exercise On Diabetes Mellitus

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
  • (718) 852-6949

  • None

  • 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
  • Understand the risks associated with DM
  • Learn tips for avoiding complications

What is exercise?
  • Definition Performance of physical exertion for
    improvement of health or correction of a physical
  • (Dorlands Medical Dictionary)

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

Types of exercise (contd)
  • Isometric No change in fiber length with
  • 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

Isokinetic machine
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

Effects of exercise in Type I Diabetics.
  • Overall good response to exercise in diabetes
  • Injection site can affect the availability of
  • 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

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.

Italian Diabetes and Exercise Study 2008
  • 606 subjects with type 2 Diabetes and Metabolic
  • Randomized controlled multi-center
  • Found that patients who received intensive
    exercise treatment decreased modifiable risk
    factors compared to those who received exercise

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)

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)

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

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

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
  • 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

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
  • Proper foot care
  • Avoid blisters
  • Check shoes for pebbles
  • Avoid weight lifting
  • retinal injury/ glaucoma

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

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

  • 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
  • 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,
  • 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

  • Thank you