type-2 diabetes

Physical Activity: Amazing Medicine

While the health challenges that face people with type-2 diabetes are numerous, so are the benefits of physical activity.

Source: American College of Sports Medicine / American Diabetes Association Joint Position Statement: Exercise and Type-2 Diabetes, Medicine & Science in Sports & Exercise 2010, 2282-2303.

Physical activity lowers blood glucose in multiple ways:

1. Through accelerated glucose utilization by working muscles

2. Through enhanced sensitivity to insulin, which may continue for several hours after completion of the exercise activity. This occurs due to the proliferation of insulin receptors (shown in red) on muscle cells and the use of GLUT4 (shown in orange), which transports glucose across the cell membrane in a non-insulin-mediated process.

Thus, for those at risk of hypoglycemia, it is important to accommodate for increased physical activity with either a reduction in their insulin/oral medication, or an increase in carbohydrate consumption.

Exercise/Physical Activity:

Effects of Insulin Sensitivity

Physical activity lowers blood glucose in multiple ways:

1.Through accelerated glucose utilization by working muscles

2.Through enhanced sensitivity to insulin, which may continue for several hours after completion of the exercise activity. This occurs due to the proliferation of insulin receptors (shown in red) on muscle cells and the use of GLUT4 (shown in orange), which transports glucose across the cell membrane in a non-insulin-mediated process.

Who Is At Risk for Hypogylcemia During Exercise?

It is important to note that only users of insulin or insulin secretagogues (sulfonylureas and meglitinides) are at risk of hypoglycemia. Those using only other medications are not at risk of hypoglycemia during exercise.

Adjustments for Exercise

Reducing mealtime insulin doses for post-meal exercise is an effective way to prevent exercise-induced hypoglycemia. The amount of the dosage reduction will need to be tailored to the type, duration, and intensity of activity.

Note that competitive/anaerobic activities may not require an insulin reduction, as they often lead to secretion of adrenal hormones which raise glucose levels.