Type 2 Diabetes and Exercise

Two of the biggest risk factors for Type 2 Diabetes (T2DM) are physical inactivity and poor diet, hence why T2DM is often called a lifestyle disease. Increasing your physical activity and eating a balanced diet will not only decrease your risk of developing T2DM, it is also frequently used as a treatment method (depending on the stage of T2DM – always seek medical advice).

What is T2DM?

Someone with T2DM has defects in their insulin pathway leading to hyperglycaemia (high blood sugar levels). Let’s look at a simplified version of the Insulin and Glucose pathway:
1. Levels of blood glucose increase; typically due to food consumption. The amount of blood glucose will depend on the type of food consumed.
2. The pancreas responds by releasing a corresponding amount of insulin into the blood stream. Higher blood glucose levels = more insulin. Lower blood glucose levels = less insulin.
3. Insulin receptors on the outer surface of muscles detect insulin and activate pathways within the muscle – the key substance we want to activate is GLUT4.
4. GLUT4 travels up to the surface of the muscle, it then ‘opens the door’ and allows glucose into the muscles.
5. The muscle cells can then use glucose as their energy source.

For most people with T2DM the problem lies at step #3. The insulin receptors are no longer reacting to the insulin that the pancreas is pumping out; if they don’t respond then GLUT4 can’t be activated and glucose can’t get into the cells – that means no energy for the muscles!

However, exercise has an amazing ability to bypass the need for insulin receptors, it can allow our bodies to jump straight to step #4 by activating GLUT4 and allowing glucose into cells. Whilst doing this, exercise also increases the rate at which we use glucose, thereby decreasing blood glucose levels further.

What sort of exercise is best?

To put it simply – the type you enjoy the most and will therefore stick to. If you’re new to exercise, start off simply and slowly. You might just aim to go for a short walk every day and gradually increase the duration and intensity. I would love to be able to write more in this section about what sort of exercise should be performed however there are considerable precautions that need to be taken when exercising and programs need to therefore be designed on a case-by-case basis. That’s not to say that people with T2DM should be scared of exercising, quite the opposite actually.

Precautions


People with T2DM need to work in consultation with their GP, dietitian and exercise physiologist to ensure they are engaging in the best and safest exercise program and diet.
When it comes to exercise, diabetics will often fatigue earlier and require longer recovery then those who are otherwise healthy. It’s also important to be aware of kidney and cardiovascular health as this can be affected by T2DM. There are also considerable risks due to hypertension (high blood pressure), retinopathy (the eyes), autonomic neuropathy (heart rate, body temperature regulation etc) and peripheral neuropathy (nerves at the feet).

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4 thoughts on “Type 2 Diabetes and Exercise

  1. Chris says:

    I have type one diabetes, which is quite different in terms of disease mechanism of course, but because my body doesn’t produce insulin and I have to inject it, it’s led me to some interesting observations (which I’m totally sharing) about my own sensitivity to insulin in relation to my training.

    I’m aware that a study size of one (me) does not make for anything properly scientific, but as to anecdotal evidence:

    I notice if I train with weights, in say a hypertrophy range (8 + reps), it seems to stimulate insulin sensitivity more than if I train in a typical strength range (3 – 6 reps). If I am training only once or twice per week, this increased insulin sensitivity seems to last indefinitely. I need to actually not be training for a couple of weeks before I notice my requirement for insulin increasing. So very little work seems to yield a great reward.

    Also, more than anything else I’ve done, tai chi practice seems to have a profound impact on my insulin sensitivity. There’s no clear reason for this, apart from the concept of harmonising your internal energy, which is a bit of an unfamiliar idea still in exercise-science circles I believe – the intensity is quite low, but the effect on my body is stronger than walking or gentle forms of yoga or other comparable activities in terms of simple perceived intensity.

    Both these training methods seem to be effective at increasing my insulin sensitivity – in that I don’t need to inject as much insulin when I’m pursuing these methods as I have to otherwise. Of course, if I’m training in a typical strength range I’m probably a bit hungrier than if I’m training in a hypertrophy range, so there’s a bunch of other variables to consider too…

    Also, I suspect there comes a point with increased muscle mass where even though you might have good insulin sensitivity – with more muscle you’ll need more insulin, because there’s simply more flesh and it requires more glucose? I’m not sure on this point… It would probably require a substantial increase in muscle mass and mightn’t apply to most exercisers…

    At any rate, it appears clear to me that exercise increases your body’s ability to metabolise sugars, both from what I’ve read and my own personal experiences, and it appears that the difference between no exercise and some exercise is much greater than the difference between one type of exercise and another. Which is totally what you already said! All training methods stimulate the muscles to uptake glucose more readily, so they’re all good if you’ve got any type of diabetes, and the exercise-benefit of increased circulation also helps to prevent against the typical problems diabetics can face – eye problems, kidney problems, limb and foot and gangrene problems, because they all relate to circulation. Yay exercise! Thank you!

    • jodieahp says:

      Hey Chris!

      Thanks so much for your comment – I always find it helpful to hear about people’s individual experiences as there can be differences from what scientific studies tell us. I’m especially intrigued by what you’ve said about tai chi. I’m a big fan of it myself but I know in the medical/scientific community they don’t really know how tai chi does the amazing things it does. Medicare, for example, won’t subsidise it as there’s no evidence to support it’s benefits (although there is anecdotal evidence).

      I wrote this article quite a while ago and there’s a bit of updating to be done I think. Might get on to that soon.

      • Chris says:

        Yeah, it’s a bit of a… unknown area to science? Of course, science is a Western thing, in the East they have different ways of verifying things – but recently the two have met! I saw a brief reference on a youtube clip – can’t remember where I’m afraid – where scientists in China used electro-something-video-imaging to watch a qigong master practicing, and they could “see the energy” with this equipment.

        But then again, the idea of being able to claim your gym membership against health insurance is only a fairly new one, and most of tai chi’s popularity in a medical-exercise-context is about falls prevention for the elderly… There are many things I would like to see Medicare cater for.

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