Diabetes – Why Exercising is Essential

Let me start by explaining the different types of Diabetes. There are 4 types of Diabetes.
The two most common forms of diabetes are Type 1 and Type 2. In fact approximately 85% of all diabetics fall in the Type 2 category. The other 2 types are Secondary Diabetes and Gestational Diabetes. Secondary diabetes can be triggered by destruction of beta cells in the pancreas and/ or development of insulin resistance by an acquired disease. Gestational Diabetes is a form of high sugar in the blood that occurs during pregnancy. Today we will go in detail into Type 1 and Type 2 which covers approximately 95% of the Diabetic population.

Type 1

Type 1 diabetes or juvenile diabetes, as the name suggests is generally diagnosed early in life. It is caused by faulty pancreatic beta cells which leads to deficiency in the production of the hormone Insulin. As we know the role of insulin is to keep the blood sugar level in check to prevent Hyperglycemia (high) or Hypoglycemia (low). It is assumed that insulin production shuts down completely which is not true. In most cases around 15% or more is produced but it is not sufficient and hence there is a dependency on artificial insulin to compensate for the big deficit. They struggle to store body fat unless the insulin administered is not well balanced.

Type 2

This condition generally develops in mid-life though increasingly its common to see individuals in their 20’s being diagnosed for the same. Unlike Type 1, they produce normal insulin levels but are unable to move the glucose from the blood into the cells due to resistance from the cells. This term is referred to as Insulin Resistance. To overcome this challenge more insulin is produced to force absorption in the cells. To counter the additional insulin the cells build up a greater resistance to insulin and the cycle continues. Eventually the individual is not able to control the sugar level in the blood and they are diagnosed with Type 2 Diabetes.
As weight increases and insulin resistance disturbs the metabolism, muscle tissue is more prone to developing greater insulin resistance than the adipose tissue. Since the body is now unable to utilize the glucose and fatty acids in the muscles effectively, it shifts towards fat storage. This explains why people with Type 2 Diabetes gain weight very easily.

According to International Diabetes Federation, Diabetes currently affects 425 million adults worldwide. Stroke, coronary heart disease and peripheral heart disease is the leading cause of disability and death in people with Type 2 Diabetes. According to their global survey of people with Type 2 Diabetes, 2 in 3 people had CVD risk factors such as high BP, uncontrolled blood glucose levels and high cholesterol and/or had experienced a CVD event like angina, heart attack, stroke or heart failure.
The increasing prevalence of Diabetes only emphasis the fact that just medicines are not enough to control the spread of a Diabetes. There has to be a conscious effort to improve our lifestyle and reduce the risk of Diabetes related complications.

It therefore makes it essential to control the diet and also follow a structured exercise program. Exercise program should be a mix of aerobic and resistance training. A growing volume of evidence indicates justifiable gains are to be had in diabetics that train with weights.

Aerobic exercise benefits for the Type 2 diabetic include:

 Increases in both insulin sensitivity and non-insulin dependent muscle glucose
uptake
 Increases in muscle concentration of glut 4 transporter proteins that draw glucose
into muscle cells
 Increased oxidation rates of muscle glucose
 Increased insulin sensitivity and glucose uptake persist long after aerobic exercise,
even after pre-exercise glycogen levels have been restored
 Increased intramuscular lipid accumulation/storage to help fuel aerobically trained
muscle tissue
 Increased insulin sensitivity after a single bout of exercise may last between 24-72
hours, dependent on intensity and duration
 There is a strong dose response relationship between exercise intensity and improvements in glycemic control
(Sigal et al, 2004)

The benefits of including weight training for the Type 2 diabetic are:

 Improving Insulin sensitivity in the cells
 Reduction in plasma free fatty acids
 Arterial blood pressure reduces over time, despite commonly held views that resistance training may increase pressure
 Reduction in glycosylated hemoglobin levels, therefore indicating lower average
blood glucose levels

Benefits for Type 1

 Improved metabolic control in subjects with regular exercise frequency and
adherence (Guelfi, 2005)
 Reduction in post exercise blood glucose levels
 Improved endothelial function*and blood flow in a variety of vascular beds including
ocular (eyes)(Fuchsjager-Mayrl, 2002)
 Reduction in the need of taking insulin prior to an exercise program,therefore exercising consistently serves as a form of reducing hyperglycemia and aiding daily management.

*Endothelial function is to control vascular relaxation and contraction and release enzymes that control blood clotting, immune function and platelet adhesion.

Diet induced weight loss without exercise does have positive effects on insulin sensitivity but it fails to influence muscle oxidative capacity and improve glucose and fatty acid use. This will increase the chances of relapse and future weight gain, which is common after calorie restriction.
(Simoneau, 1999)

Research on obese men and women has shown that exercise induced weight loss has much more significant effects on reducing fasting insulin levels than diet alone. Regular exercise that does not result in any weight loss still reduces fasting insulin as effectively as
a dietary restricted weight reduction of between 6.5 – 7.4kg
(Ross et al, 2000, Ross et al, 2004).

Another important reason to exercise is that there are several markers of cardiovascular health that are influenced significantly by regular exercise. Many of these health markers are included as part of metabolic syndrome such as blood pressure, plasma cholesterol and abdominal obesity. There is sufficient evidence to demonstrate that exercise lowers each of these different risk factors.

‘Physical inactivity is the most common cardio-metabolic risk factor and the easiest one to eliminate.’ (ICCR, 2010)

Word of caution: The safe range for exercise is currently deemed between 5.5 – 13.8mmol/L(100mg/dL-250mg/dL). It is contraindicated to exercise when levels are below or above these markers. It is always advisable to take clearance from your Doctor before you start an exercise program.

My next blog will be about following diet guidelines for diabetics. But before I conclude I will leave with one diet tip;

Avoid all food marked “specially for diabetics”

If you are Diabetic and /or struggling with losing fat and are planning to start an exercise program, you can contact me for consultation on how to plan and progress on an individualized exercise program.

Jino Joseph Kavalamthara
Focus Awards UK Level 4 Exercise specialist in Physical Activity and Weight Management for Obese and Diabetic Clients (RQF)
Focus Awards UK Level 3 Certified in Designing Pre and Postnatal Exercise Programs
YMCA UK Level 3 Diploma in Personal Training
ACSM Certified Personal Trainer
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