Episode Details

Episode 135: Exercise in Diabetes    

Kishan and Princess explain how exercise lowers or raises blood glucose levels in diabetes. Dr. Arreaza adds some comments about insulin resistance.  

Written by Kishan Ghadiya, MSIV, Ross University School of Medicine. Comments by Princess Enuka, MSIV, Ross University School of Medicine; and Hector Arreaza, MD.

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Today is April 7, 2023. Ep. 135.

Intro:

It is widely known exercise is paramount for all individuals. The American Heart Association recommends at least 150 minutes of moderate-intensity exercise weekly for general health. Exercise is particularly important in patients with diabetes, who require extensive lifestyle modification to manage their sugar levels. However, it is not well known how glucose metabolism changes when patients with diabetes exercise.

My patient in the clinic.

I recently saw in the clinic a young patient newly diagnosed with type 2 diabetes who asked about how his exercise was helping his sugar levels. He was confused because he heard that exercising allows for better glucose control but complained that his sugar levels were higher after exercising.

To understand what is going on in this patient, it is important to understand the underlying pathophysiology of diabetes. First off, the two most common types of diabetes are type 1 and type 2. Type 1 occurs when the pancreas stops producing insulin altogether. Type 2 occurs when the insulin secreted by the pancreas is no longer effective in normalizing blood sugar levels; the body is not able to utilize glucose efficiently, the number of calories consumed exceeds the body’s demands, and thus increasing body weight, which leads to insulin resistance and eventually pancreatic beta-cell exhaustion. Diabetes is thus a disease state of prolonged hyperglycemia and confers many long-term complications such as accelerated cardiovascular disease, neuropathy, nephropathy, and retinopathy.

How does exercise lower blood glucose? 

Once patients are diagnosed with diabetes, management is lifelong, and it takes considerable mental and physical effort to manage this change in health. Exercise is a key metric in diabetic management because lowering blood sugar is as simple as using excess glucose to create energy in our muscles. There are two main mechanisms in how exercise has a positive effect on diabetes. 

1. The first mechanism is that exercise directly increases insulin sensitivity by enhancing the muscles’ ability to effectively respond to insulin, thus allowing for better use of insulin on board (IOB). This benefit is not only seen during exercise itself but also up to 24 hours after exercise is complete. This means many patients with controlled diabetes can see a euglycemic effect up to 1 day after exercise.
2. The second mechanism is that increased glucose uptake into muscle does not require insulin secretion. In other words, active muscle use during exercise allows for glucose uptake even without the use of any insulin and is very effective in lowering blood sugar levels. Muscles have a higher metabolic rate than fat tissue. It means that even without exercising, a person with a higher muscle mass has a higher basal metabolic rate.

What type of exercise would be the most effective in controlling blood sugar? 

The data is very clear that there is no relationship between exercise technique and glucose level, but there is a relationship between exercise intens