Pre & Postprandial  Brief(5 minutes!) Muscle Training for Management of Blood Glucose   Kathleen Broomall, Ph.D.
Postprandial hyperglycemic spike Glycemic index, postprandial glycemia, and the shape of the curve in healthy subjects: an...
Types of Diabetes <ul><li>Type 1 diabetes, formerly called juvenile diabetes, is usually first diagnosed in children, teen...
Diagnostic Criteria for Diabetes <ul><li>Fasting Plasma Glucose Result (mg/dL) Diagnosis  </li></ul><ul><ul><ul><li>99 or ...
Diagnostic Criteria for Diabetes <ul><ul><ul><li>2-Hour Postprandial Plasma Glucose Result (mg/dL) Diagnosis  </li></ul></...
Pre-Diabetes <ul><li>Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough ...
Metabolic Syndrome <ul><li>Metabolic syndrome is defined as the presence of any three of the following conditions: </li></...
Role of postprandial spike in Cardiovascular Disease Review article doi: 10.1111/j.1742-1241.2006.01168.x
Abnormal Glucose Metabolism may be underestimated in Heart Patients <ul><li>Conclusions: Abnormal Glucose Metabolism is pr...
Exercise and Diabetes: Current Recommendations <ul><li>Various recommendations  </li></ul><ul><ul><ul><li>30 minutes exerc...
Exercise and Muscle Glut 4 Sugar Receptor <ul><li>GLUT4: a key player regulating glucose homeostasis?   ( Molecular Membra...
Can exercise minimize postprandial damage ? <ul><li>“ Can exercise minimize postprandial oxidative stress in patients with...
“ Can exercise minimize postprandial oxidative stress in patients with Type II Diabetes? “ Curr Diabetes Rev 2008, Nov 4(4...
Muscle Absorption of Sugar Occurs within Minutes of Contraction <ul><li>“ Acute exercise has two separate effects on skele...
Method of Postprandial Muscle Training <ul><li>Brief muscle activity done within 60 minutes of meal, geared toward efficie...
Control of postprandial spike with 5-10 minutes exercise Before postprandial muscle training, used 20-30 minutes long dura...
Control of Fasting Blood Glucose Fasting Blood Sugar Postprandial short interval muscle training provided better control o...
Overall Improvement of Glucose Homeostasis Fasting, postprandial and random blood sugars Postprandial short interval muscl...
Improvement in A1C <ul><li>A1C reflects average blood sugar over past 90 days </li></ul><ul><ul><ul><li>Normal: 5-6% </li>...
Uses/Advantages of Pre & Postprandial Muscle Training:  DISEASE PREVENTION, and SLOW PROGRESSION! <ul><li>Very safe for us...
Advantages of Pre & Postprandial Muscle Training <ul><li>Pre & Postprandial muscle training is what nature intended   –  o...
Interested Parties <ul><li>Individuals </li></ul><ul><li>Companies wanting to cut health care costs can incentivize behavi...
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Pre & Postprandial Brief Muscle Training for Prevention and Management of Diabetes

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Description of short interval muscle training technique to help diabetics and pre-diabetics maintain good glycemic control to prevent disease progression. This technique also seems to prevent weight regain, which will lead to recovery with enough weight loss.

The technique could be used also for dieters who easily regain their weight, it selectively puts carbohydrates into muscle rather than fat cells.

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Pre & Postprandial Brief Muscle Training for Prevention and Management of Diabetes

  1. 1. Pre & Postprandial Brief(5 minutes!) Muscle Training for Management of Blood Glucose Kathleen Broomall, Ph.D.
  2. 2. Postprandial hyperglycemic spike Glycemic index, postprandial glycemia, and the shape of the curve in healthy subjects: analysis of a database of more than 1000 foods1,2 Brand-Miller et al_ 89 (1) 97 -- American Journal of Clinical Nutrition
  3. 3. Types of Diabetes <ul><li>Type 1 diabetes, formerly called juvenile diabetes, is usually first diagnosed in children, teenagers, and young adults. In this form of diabetes, the pancreas no longer makes insulin because the body’s immune system has attacked and destroyed the pancreatic cells specialized to make insulin. These insulin-producing cells are called beta cells. </li></ul><ul><li>Type 2 diabetes, formerly called adult-onset diabetes, is the most common form. People can develop type 2 diabetes at any age, even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin properly. As a result, the body needs more insulin to help glucose enter cells to be used for energy. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, the pancreas loses its ability to secrete enough insulin in response to meals. </li></ul>
  4. 4. Diagnostic Criteria for Diabetes <ul><li>Fasting Plasma Glucose Result (mg/dL) Diagnosis </li></ul><ul><ul><ul><li>99 or below Normal </li></ul></ul></ul><ul><ul><ul><li>100 to 125 Pre-diabetes (Impaired Fasting Glucose) </li></ul></ul></ul><ul><ul><ul><li>126 or above Diabetes </li></ul></ul></ul>
  5. 5. Diagnostic Criteria for Diabetes <ul><ul><ul><li>2-Hour Postprandial Plasma Glucose Result (mg/dL) Diagnosis </li></ul></ul></ul><ul><ul><ul><ul><ul><li>139 and below Normal </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>140 to 199 Pre-diabetes (Impaired Glucose Tolerance) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>200 and above Diabetes </li></ul></ul></ul></ul></ul>
  6. 6. Pre-Diabetes <ul><li>Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. This condition is sometimes called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. The U.S. Department of Health and Human Services estimates that about one in four U.S. adults aged 20 years or older—or 57 million people—had pre-diabetes in 2007. </li></ul>
  7. 7. Metabolic Syndrome <ul><li>Metabolic syndrome is defined as the presence of any three of the following conditions: </li></ul><ul><ul><li>waist measurement of 40 inches or more for men and 35 inches or more for women </li></ul></ul><ul><ul><li>triglyceride levels of 150 milligrams per deciliter (mg/dL) or above, or taking medication for elevated triglyceride levels </li></ul></ul><ul><ul><li>HDL, or “good,” cholesterol level below 40 mg/dL for men and below 50 mg/dL for women, or taking medication for low HDL levels </li></ul></ul><ul><ul><li>blood pressure levels of 130/85 or above, or taking medication for elevated blood pressure levels </li></ul></ul><ul><ul><li>fasting blood glucose levels of 100 mg/dL or above, or taking medication for elevated blood glucose levels </li></ul></ul>
  8. 8. Role of postprandial spike in Cardiovascular Disease Review article doi: 10.1111/j.1742-1241.2006.01168.x
  9. 9. Abnormal Glucose Metabolism may be underestimated in Heart Patients <ul><li>Conclusions: Abnormal Glucose Metabolism is prevalent (found in >28% of patients tested) and underestimated in Primary Hypertension Coronary Heart Disease patients with normal Fasting Blood Glucose, and it will develop even if therapeutic life-style changes are adopted. Except for FBG, more attention should be paid to postprandial blood glucose . Oral Glucose Tolerance Test should be a routine procedure for PH patients, especially in-hospital PH patients, regardless of normal FBG, and active drug intervention for Impaired Glucose Tolerance patients with PH may be recommended. </li></ul><ul><ul><li>“ Glucometabolic state of in-hospital primary hypertension patients with normal fasting blood glucose in a sub-population in China”  Diabetes Metab Res Rev 2009, Mar 6 (epub) </li></ul></ul>
  10. 10. Exercise and Diabetes: Current Recommendations <ul><li>Various recommendations </li></ul><ul><ul><ul><li>30 minutes exercise 5 days a week </li></ul></ul></ul><ul><ul><ul><li>By Borg scale: 12/13 is a brisk walk for 15-20 minutes 4-7 days a week (breathing through mouth, feeling warm, starting to perspire, but able to continue activity) </li></ul></ul></ul><ul><ul><ul><li>Thought to improve insulin sensitivity, improves overall glucose homeostasis </li></ul></ul></ul>
  11. 11. Exercise and Muscle Glut 4 Sugar Receptor <ul><li>GLUT4: a key player regulating glucose homeostasis? ( Molecular Membrane Biology, 2001, 18, 205- 211) </li></ul><ul><ul><ul><li>In patients with Type II diabetes mellitus, reduced glucose transport in skeletal muscle is a major factor responsible for reduced whole body glucose uptake. </li></ul></ul></ul><ul><ul><ul><li>Thus, GLUT4 is an attractive target for pharmacological intervention strategies to control glucose homeostasis. </li></ul></ul></ul><ul><li>There are at least two separate pathways by which glucose transport and GLUT4 translocation can be activated in skeletal muscle; one stimulated by insulin or insulin mimicking agents and one activated by muscle contractions or hypoxia (Douen et al. 1990, Cartee et al. 1991, Lund et al. 1995, Zierath et al. 1997). </li></ul><ul><li>When the two pathways are stimulated concurrently, glucose transport and GLUT4 translocation are increased in an additive manner </li></ul><ul><li>( Wallberg-Henriksson and Hollosz y 1985, Lund et al. 1995). </li></ul>
  12. 12. Can exercise minimize postprandial damage ? <ul><li>“ Can exercise minimize postprandial oxidative stress in patients with TypeII Diabetes? “ </li></ul><ul><li>Curr Diabetes Rev 2008, Nov 4(4) 309-19 </li></ul><ul><li>Acute and chronic exercise can: </li></ul><ul><li>1. Cause an increase in endogenous antioxidant enzyme activity. </li></ul><ul><li>2. Improve blood glucose clearance via enhanced </li></ul><ul><li>Glut 4 ( contraction stimulated uptake of sugar into muscles is still effective in Type II diabetics, while insulin receptors are ineffective – insulin resistant.) </li></ul><ul><li>3. Improves blood triglyceride and lipoprotein lipase activity. </li></ul>
  13. 13. “ Can exercise minimize postprandial oxidative stress in patients with Type II Diabetes? “ Curr Diabetes Rev 2008, Nov 4(4) 309-19
  14. 14. Muscle Absorption of Sugar Occurs within Minutes of Contraction <ul><li>“ Acute exercise has two separate effects on skeletal muscle glucose transport. One effect, which is observed during and shortly after exercise, is an insulin-independent stimulation of glucose transport.” “Can exercise minimize postprandial oxidative stress in patients with TypeII Diabetes? “ Curr Diabetes Rev 2008, Nov 4(4) 309-19 </li></ul>
  15. 15. Method of Postprandial Muscle Training <ul><li>Brief muscle activity done within 60 minutes of meal, geared toward efficient contractile activity with light cardio, with ease of accessibility for the average person (5-7 minutes, depending on individual needs). The most effective method is to do some work just before the meal, then test blood sugar at 90 minutes, then do additional work if necessary, according to personal preference. Some examples are: </li></ul><ul><ul><li>Climbing stairs, walking between flights </li></ul></ul><ul><ul><li>Walking on slight incline </li></ul></ul><ul><ul><li>Resistance training, with walking between </li></ul></ul><ul><ul><li>Optimally, would like to randomly sample postprandial blood sugar to check effectiveness for individual (return to 100-120) </li></ul></ul>
  16. 16. Control of postprandial spike with 5-10 minutes exercise Before postprandial muscle training, used 20-30 minutes long duration exercise, 7 days per week Blood sugar at 2 hrs postprandial Postprandial short interval muscle training suppresses blood sugar spike in reliable and predictable way. (N=1)
  17. 17. Control of Fasting Blood Glucose Fasting Blood Sugar Postprandial short interval muscle training provided better control of fasting blood glucose. (N=1)
  18. 18. Overall Improvement of Glucose Homeostasis Fasting, postprandial and random blood sugars Postprandial short interval muscle training provided better overall control of glucose homeostasis (exercise on stairs or treadmill, with a sprained ankle!). (N=1)
  19. 19. Improvement in A1C <ul><li>A1C reflects average blood sugar over past 90 days </li></ul><ul><ul><ul><li>Normal: 5-6% </li></ul></ul></ul><ul><ul><ul><li>Diabetic: 7% </li></ul></ul></ul><ul><ul><ul><li>Spring 2008: 6.5% </li></ul></ul></ul><ul><ul><ul><li>Spring 2009: 5.8% (Even with increase in BMI) </li></ul></ul></ul>
  20. 20. Uses/Advantages of Pre & Postprandial Muscle Training: DISEASE PREVENTION, and SLOW PROGRESSION! <ul><li>Very safe for use in pre-diabetic, decreases their cardiovascular risk and slows or prevents progression of disease. </li></ul><ul><li>Builds optimal amount of muscle, because muscle fibers are benefitting from increased frequency of glucose absorption. (Type II diabetics’ muscles atrophy faster than normal, and have abnormal histology.) </li></ul><ul><li>Better muscle health equals greater ease of compliance. </li></ul><ul><li>May help prevent weight regain because sugar actively absorbed into muscles, not into adipose tissues. </li></ul>
  21. 21. Advantages of Pre & Postprandial Muscle Training <ul><li>Pre & Postprandial muscle training is what nature intended – our glucose homeostasis was never intended to rely solely on our insulin receptor system. Instead, we are meant to use our muscles as a secondary regulatory system, in conjunction with our insulin receptor system. Apparently, this secondary system in our muscles operates with amazing efficiency, such that we can easily and quickly activate this muscle based (insulin independent) blood sugar regulatory system with a few simple muscle contraction events, then continue with our busy, however sedentary, lifestyles. </li></ul><ul><li>“ Resistance exercise increases postprandial muscle protein synthesis in humans”, Med Sci Sports Exerc 2009 Jan; 41 (1): 144-54. </li></ul><ul><ul><li>Postprandial exercise may be a very efficient way to build new muscle fiber, which helps regulate blood sugar even at rest. </li></ul></ul>
  22. 22. Interested Parties <ul><li>Individuals </li></ul><ul><li>Companies wanting to cut health care costs can incentivize behavior </li></ul><ul><li>Parents and schools </li></ul><ul><li>Exercise equipment sellers </li></ul><ul><li>Blood glucose meter producers, especially bloodless “real time” meters in development </li></ul><ul><li>GOVERNMENT – for DISEASE PREVENTION AND LOWERING OF HEALTH CARE COSTS </li></ul><ul><li>Individuals without good access to health care and therefore poor management of blood sugar </li></ul>

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