In today’s segment on chronic or incurable disease, I’ll be discussing type 2 diabetes and the role of physical activity in its management. Type 2 diabetes is the fastest growing chronic condition and is predicted to affect 1 in 10 adults by 2040. Annually, 5 million deaths can be attributed to diabetes.
Before we begin, I want to clarify the difference between type 1 and 2 diabetes. Type 1 diabetes is due to an inability to PRODUCE insulin and is usually managed with supplemental insulin.
Type 2 diabetes is much more common and tends to present later in life but is becoming more and more common at younger ages. It is characterized by an inability to USE insulin within the body (although insulin production can also be affected in some people with type 2 diabetes).
Insulin function is essential within our body because it assists with the transport of glucose, a molecule responsible for providing energy to our cells and organs (most notably, our muscles and brain). Glucose is obtained from any form of carbohydrate that we eat, broken down in our digestive system, and deposited into our bloodstream to be shipped to various parts of the body. This is where insulin comes in: glucose isn’t able to move from blood to the cells where it is used on its own and needs the help of insulin to bind to the cell and “open the door”. In the case of type 2 diabetes, insulin is present but doesn’t communicate with the cell properly and glucose cannot be absorbed. This leads to an accumulation of glucose in the blood known as hyperglycemia and leads to all kinds of long term health issues classically associated with diabetes.
Fortunately, cell uptake of glucose can be stimulated by other means, without the reliance on insulin. A stretch or contraction of muscle fibers stimulates a pathway within the muscle that allows glucose to enter the cell without the help of insulin. This means that any time you move, the muscles that you use will begin to take in glucose and reduce the amount in the bloodstream. The more active you are and the more muscles involved in an activity will increase the amount of glucose moved into the muscle cells.
This mechanism highlights the importance of resistance training for diabetics. Resistance training is commonly used for to increase muscle size. Having more lean muscle is beneficial as there are more muscle cells being stimulated, contributing to increased glucose uptake and a decrease in blood glucose levels, even during normal daily activities. For people with diabetes, moderate to vigorous resistance training is recommended at least 2 times a week, on non-consecutive days to allow for optimal recovery. A comprehensive strength training program should target all the major muscle groups of the upper and lower body. For beginners, selecting a weight that can be lifted 10-15 times is a good starting point. As your strength, skill and experience increases, the weights you lift can also increase, progressing towards a weight that can only be lifted 8-10 times. Progress can also be made by increasing the number of sets per exercise and the number of days you partake in your resistance training program.
Physical activity can also help to increase the body’s sensitivity to insulin. This means that the cells that require glucose become more attuned to the presence of insulin and are more likely to allow the transport of glucose inside. This effect usually lasts for a few hours post exercise but can persist as long as 24 and even 72 hours. While this is only a temporary change, with repeated activity this effect becomes cumulative, helping to restore the body’s sensitivity to insulin and maintain better blood glucose control. Again, these positive effects must be maintained through regular activity. Once regular exercise is ceased, insulin sensitivity will decrease and blood glucose levels will begin to rise.
To maintain the positive effects of exercise, the American College of Sports Medicine and American Diabetes Association recommend a MINIMUM of 150 minutes per week of moderate to vigorous aerobic activity. The 150 minutes can be broken into smaller chunks and sessions as short as 10 minutes have still been found to be beneficial. Aerobic training should take place 3 days per week, with no more than 2 days off between exercising days. A moderate level of aerobic activity can be anything requiring an exertion similar to a brisk walk. This can accomplished through other forms of exercise such as running, cycling, dancing, rowing and swimming. More vigorous levels of activity will contribute further benefits to diabetes control but the intensity should be gradually increased to keep the exercise safe.
Lastly, both aerobic and resistance training will contribute to fat loss when performed regularly and consistently. Obesity is a huge risk factor in the development of Type 2 diabetes and maintaining a healthy body weight is an important step for those managing diabetes. Furthermore, regular exercise (and dietary changes) in pre-diabetic and obese populations has been found to prevent the onset of diabetes in 60% of cases! A preemptive approach to avoiding diabetes is much better than having to manage it!
All of the above information is intended as a helpful resource and not as medical advice. If you would like to begin a regular exercise program please consult with a medical professional to determine a safe and effective plan.
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