We all know that exercise is good for us, we hear it time and time again in the media, but never has it been more important than now. Especially as the rates of obesity are on the rise, and with it other associated lifestyle diseases. One lifestyle related disease, the focus of this blog, is type 2 diabetes mellitus. But what is type 2 diabetes? Why is exercise good? How much, and is there anything I need to consider?
Well…. I’m glad you asked!
What is Type 2 diabetes?
T2DM is a progressive disease where by the body over time develops a resistance to insulin.
Insulin is the major cellular mechanism for transport of glucose into skeletal muscle where it is stored as glycogen, or used to produce energy. As the body becomes resistant, more insulin is produced over time to facilitate this process until eventually the cells in the pancreas, responsible for insulin production, become exhausted. Not good! What is required at this point in time is an exogenous (external) source for this process to continue.
So my pancreas is exhausted. Now what do I do?
This is where exercise can assist. Muscle contraction also draws glucose into the muscle cell without the reliance on insulin. Using separate signalling pathways, these two processes eventually both lead to the same transporter protein, which transports the glucose into the muscle cell.
So think of it like this, the more you use your muscles, whether it be walking, riding, jumping, skipping, weights etc. the more you are pumping glucose into the muscle without working the pancreas into overtime. This assists in blood glucose/glycaemic control. A bout of exercise often has a carryover effect on blood sugars of 24hours.
How much exercise should I do?
Exercise and Sports Science Australia have released the following position statement when it comes to exercise recommendations for T2DM.
“Based on the evidence, it is recommended that patients with T2DM or pre-diabetes accumulate a minimum of 210 min per week of moderate-intensity exercise or 125 min per week of vigorous intensity exercise with no more than two consecutive days without training. Vigorous intensity exercise is more time efficient and may also result in greater benefits in appropriate individuals with consideration of complications and contraindications. It is further recommended that two or more resistance training sessions per week (2–4 sets of 8–10 repetitions) should be included in the total 210 or 125 min of moderate or vigorous exercise, respectively. It is also recommended that, due to the high prevalence and incidence of comorbid conditions in patients with T2DM, exercise training programs should be written and delivered by individuals with appropriate qualifications and experience to recognise and accommodate comorbidities and complications.”
Things to consider.
When exercising with diabetes, it is important that you check your blood sugars pre and post exercise, as well as monitor signs and symptoms of hypoglycaemia (a dropping of blood sugars below safe levels presenting in dizziness, confusion, slurred speech and nausea which can lead to a coma or death if unattended). A normal range is 4-8mmol. However, personally I prefer that a diabetic exercising in the movement room, has a post blood sugar reading higher than 6. This accommodates the consideration that the body is still working at a higher metabolic rate for a short time post exercise, and acts as a buffer from dangerously low levels until the body returns to its resting state.
Other comorbidities to which the ESSA guidelines refer are heart disease and hypertension to name a few. These also require close monitoring until a safe exercise capacity can be established without risk of causing a serious event. Complications associated with diabetes are things such as peripheral neuropathies, where an individual can experience altered sensation, more commonly in the lower limbs. This can affect balance and sensitivity. So it is important to consult your GP, as well as an exercise physiologist to establish a safe exercise program that will improve your quality of life.
B.ExSci&Nut, M.ClinExPhys, AEP, ESSAM
Michael is a masters qualified Exercise Physiologist with 5 years of clinical experience. During this time he has successfully applied exercise protocols to treat neurological, metabolic and cardiopulmonary disease.