1. Diabetes and Exercise

2. “Adding more physical activity to your day is one of the most important things you can do to help manage your diabetes and improve your health”
Diabetes Canada

3. Some Definitions Diabetes Insulin Pancreas
A disease in which the body cannot produce insulin, or cannot properly use the insulin it produces.
Insulin
A hormone which controls the amount of glucose (sugar) in the blood
Pancreas
An organ which releases hormones, such as insulin, into the digestive system

4. The Blood Sugar Response
^ review of how insulin regulates blood glucose
Source:

5. Types of Diabetes Type 1 (10% of diabetics)
Autoimmune disorder where the body attacks the beta cells of the pancreas. As a result, little or no insulin is produced. Treated with insulin.
Type 2 (90% of diabetics)
Body cannot use the insulin that is produced, or not enough insulin is produced. Typically occurs in adults. Can sometimes be managed with through diet and physical activity.
Gestational (5-20% of pregnant women)
Temporary condition which may occur during pregnancy. Increase the risk of developing Type 2 diabetes later on for both the mother and child.
Prediabetes
Blood sugar levels are higher than normal, but not high enough to be diagnosed as a diabetic. Treatable with diet and exercise.

6. Complications Heart attack Stroke Kidney failure Blindness Amputation
Impotence
Nerve damage
Hearing impairment
Alzheimer’s

7. How Does Exercise Help? Improved blood sugar control
Improves sensitivity to insulin
Improves uptake of blood sugar independent of insulin
Lower blood pressure
Reduces complications of diabetes
Eye, heart, kidney disease
Source: effect-exercise-blood-sugar/

8. For the science geeks out there …
“Exercise training is the most potent stimulus to increase skeletal muscle GLUT4 expression, an effect that may partly contribute to improved insulin action and glucose disposal and enhanced muscle glycogen storage following exercise training in health and disease.”

10. How much exercise do I need?
Diabetes Canada recommends 150 minutes of aerobic activity per week
Can be 10 minutes at a time
Don’t go for more than 2 days in a row without exercise
Add in resistance exercise
8-10 exercises, large muscle groups, 2-3x/wk

11. What about intensity?
Moderate intensity, 4-5 RPE, for cardiovascular training
Heart rate may not be reliable measure
High intensity has mixed results
10-15 reps until near exhaustion for resistance training
Avoid breath holding
Source: e:RPE_Training_(chart).gif

12. Progressing
Increase your frequency, then duration, and lastly intensity
Individuals with diabetes may not be able exercise at a high intensity (relative to healthy individuals)

13. Exercising for Weight Loss
It is unlikely that individuals with Type 2 diabetes will be able to exercise at a high enough intensity for weight loss. However, exercise is key for long-term weight maintenance.
Reduced oxygen uptake
Less Type II muscle fibres (fast twitch)
Reduced ability to store and use glycogen

14. Diabetes Prevention Highly effective for prevention of diabetes!
6 year study on pre-diabetic population. N=577
Incidence of diabetes with exercise = 41%
Without exercise = 68%
(diet and exercise) = 46%
Pan, X-P., G-W. Li, Y-H. Hu, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. Diabetes Care 20:537–544, 1997

15. Complications/Cautions
Avoid breath holding
Retinopathy
Foot neuropathy may affect ability to walk/run
Non-impact aerobic activities
Use RPE instead of HR
Autonomic neuropathy can effect HR
Monitor blood glucose closely when first starting exercise
Hypoglycemia from exercise rare in Type II

16. Resources Websites Diabetes Canada Endocrine Web Scientific articles
ACSM Position Stand
Exercise, Glut4 and Skeletal Muscle Glucose Uptake