Physical activity – an important element in the treatment of diabetes

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Glucose homeostasis is the resultant of glucose in the blood and its consumption in cells, an important role in its maintenance is played by metabolic processes in skeletal muscles. Many factors influence the course of metabolic processes in the muscle tissue, among them are genetic factors, hormonal regulation and the concentration of substrates. Among the hormones involved in this regulation, one of the most important is insulin.

All types of muscle fibers are sensitive to insulin, although red fibers have a greater number of insulin receptors and glucose transporters (GLUT4) than white fibers. The glucose consumption in red muscles is particularly dependent on insulin, which is why during the physical training there is a clear increase in the number of glucose transporters – GLUT4.

In humans, exercise stimulates the transport of glucose in skeletal muscles. An accumulating effect of insulin and physical exercise on this transport was found.
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The addition of insulin effects and contraction to glucose transport in mammalian skeletal muscle suggests the presence of more than one GLUT4 storage tank in muscle cells. Probably there are separate intracellular insulin sensitive and contraction tanks.

In skeletal muscle in humans, the direct effect of exercise on muscular glucose transport is relatively short-lived (2-4 h), however, increased sensitivity to activation of glucose transport by insulin was observed> 48 h after exercise.

These observations have become the basis for the use of physical training in the treatment of diabetes

The GLUT4 glucose transporter plays the key role in the regulation of glucose transport. Therefore, physical training-induced GLUT4 expression can improve the transport of glucose in the muscles of diabetic patients. Muscle spasm improves the action of insulin and cellular glucose consumption throughout the body.

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The importance of physical exercise in the treatment of diabetes has been known for a very long time. The encyclopaedia of Aulus Cornelius Celsius, already from the 25th century BC-50th, recommends that people with diabetes should do physical exercise, and in the Polish version of the balneology textbook, published in the Polish language more than 100 years ago, we find such recommendations

… Since diabetes is an energetic activity of all the muscles of the body, then there are the most beneficial exercises that all the larger muscle groups in an equal way exert. For this reason, we recommend exercises on all instruments in the medical-gym … … Between other exercises the body works equally effectively fast horseback riding and fencing … ..In some cases you need to keep the muscles for later or completely forbid. In other cases it would be good again, replace active exercises with mechanical procedures (crease, pressing, chopping) … ..

Now the impact of physical training on the metabolic compensation of diabetic patients has found its scientific explanation

During physical exertion, there is an increased use of energy substrates, their release from tissue stores is increased and making available to changes. The main energetic substrate, especially in the first stage of muscle work, is glucose derived from glycogen, circulating in the blood and synthesized in the liver. However, glucose stores stored in the form of glycogen in the muscles and liver are not very large and when they last longer, they are quickly depleted. After completion of work, glycogen resynthesis occurs, which is stimulated by insulin.
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Here you can find more: Diabetes and physical exercise – contraindications. A post-training meal for a diabetics

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The use of glucose as an energy substrate during physical activity affects its blood level. The behavior of glycemia during exercise depends on the intensity and duration of exercise and on the treatment of diabetes.

As a result of the active burning of glucose in the muscles during exercise, lactates are formed, the concentration of which is higher the more intense the effort. In diabetic patients with insulin deficiency, the lactate concentration may not only be higher than in healthy people, but may also last longer in the blood serum.

The second important energetic substrate besides glucose are free fatty acids (WKT), which are released into the blood mainly from adipose tissue.

Physical effort increases lipolysis and release of PUFA, has a beneficial effect on the lipid profile of the blood. Under the influence of physical exercise, the concentration of total cholesterol and LDL cholesterol and triglycerides decreases, while the HDL cholesterol level is increased, especially the HDL2 fraction.

Physical effort also has a beneficial effect on the cardiovascular system, because it modifies the lipid metabolism, reduces insulin resistance, decreases catecholamine activity, increases plasma fibrinolytic activity, decreases clotting processes, increases the activity of the antioxidant system. During physical exertion, oxygen saturation increases significantly. In people with slight hypertension, the use of moderate physical training may result in normalization of blood pressure.

Physical training should be a very important element of the diabetes treatment program. Physical activity improves both the physical condition of the body and mental balance, facilitates environmental contacts.

In young, well-fed patients with well-balanced diabetes and no chronic complications, virtually any type of physical activity is possible. An effort is considered to be intense exercise, which in 60 minutes causes the heart rate to remain at 80-90% of the maximum (Table 1).

Sporting sport for people with diabetes is possible when the patient has adequate knowledge, is prudent and responsible. The appropriate modification of treatment, excellent self-control and constant cooperation with the treatment team allow to achieve good sports results and at the same time ensure the patient’s safety. Contraindications to competitive sports are late complications of diabetes and a tendency to acute complications.

The rules to prevent the occurrence of hypo – and hyperglycaemia depend on many factors. Each patient should have an individual treatment schedule, depending on their age, the insulin therapy model used, and the type of physical activity and its duration. In Poland, all juvenile patients remain under the care of specialist clinics, where patients and their carers should obtain the necessary instructions. In many countries, also in some Polish centers, trainings are also conducted for teachers and sport instructors.

General guidelines include the need for very careful glycemic monitoring. Testing blood glucose should be done before and after physical training, and with efforts lasting more than 1 hour, such markings should be made during such training. With long-term efforts (eg trips), it is important to determine blood glucose also within a few or even several hours after ending physical activity, to prevent late hypoglycaemia.

Posted on: January 18, 2019

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