2. â..In some people suffering from this affliction,
exercise can improve the condition and should
be done regularly. In more extreme cases its
effects worsen the condition. These people
should rest until the condition improvesâŚ.â
-SUSHRUTA , 600 BC
6. TYPES OF DIABETES MELLITUS
1.Type 1 diabetes : results from the bodyâs failure to produce insulin.
Between 5% and 10% of Americans diagnosed with diabetes have
the type 1 subgroup.
2. Type 2 diabetes : refers to a relative insulin deficiency that results
in hyperglycemia. Approximately 90% to 95% of Americans
diagnosed with diabetes exhibit insulin resistance.
3. Gestational diabetes : affects about 4% of all pregnant women or
about 135,000 cases in the United States each year.
4. Pre-diabetes : occurs when a personâs blood glucose reaches
higher-than-normal levels but not high enough for diagnosis as type 2
diabetes.
7. DIABETES : SIGNS & SYMPTOMS
Twelve diabetes signs and symptoms include:
1. Elevated blood glucose (hyperglycemia)
2. Frequent urination (polyuria)
3. Excessive thirst (polydipsia)
4. Extreme hunger (polyphagia)
5. High levels of blood ketones from reliance on excessive fat
catabolism
6. Unexplained weight loss
7. Increased fatigue
8. Irritability
9. Blurry vision
10. Numbness or tingling in the extremities (hands, feet)
11. Slow-healing wounds or sores
12. Abnormally high frequency of infection
8. DIABETESâŚ.
IN OUR GENES & LIFESTYLE..!!??
ďśMost type 1 diabetics inherit risk factors from both parents, with
inherited traits more common in whites than blacks or Asians. The
most prominent âenvironmental triggersâ include cold weather
exposure (develops more often in winter than summer and more
frequently in places with cold climates), viral infection, and early
diet (less common in those who were breastfed and in those who
first ate solid foods at a later age).
ďśType 2 diabetes has a stronger genetic basis than type 1, yet its
occurrence also depends more on environmental factors. The
disease most likely results from the interaction of genes and
lifestyle factors, including physical inactivity, weight gain (>80%
of type 2 diabetics are obese), aging, and possibly a high-fat diet.
9. âŚ.ITS ALL ABOUT THE
BEST USE OF MUSCLESâŚ.
ďą A dysregulation in glycolytic and oxidative capacities of
skeletal muscle relates to insulin resistance in type 2 diabetes .
ďą Experts estimate that up to 92% of type 2 diabetes can be
changed by diet and lifestyle. Use the following Internet site to
calculate your diabetes risk: www.diabetes.org/risk-test.jsp.
10. WHY PEOPLE WITH DIABETES
EXERCISE??...
ď§ Exercise generally lowers blood glucose resulting
in decreased insulin or OHA requirements.
ď§ CVD risk factors are potentially improved by
regular exercise.
ď§ Exercise may prevent or delay the progression of
diabetes related complications.
ď§ Exercise improves general health.
11. ⢠To survive, people in early times had to have genes
that permitted the body to store fuel in times of
excess so that they would have a source of energy
during times of famine.
⢠These genes that permit efficient food storage are
termed, âThrifty Genesâ. They cause rapid weight
gain in times of abundant food supply.
⢠The advantage of this trait is that the bearer is much
more likely to survive in the absence of food.
12. âŚTHUS..PEOPLE NEED TO
BE PHYSICALLY ACTIVEâŚ
ď§ The problem is that in a society where food is
always plentiful and physical activity is not a
part of the lifestyle, thrifty genes cause obesity,
diabetes and related problems.
ď§ In the absence of the need to hunt and gather and
with food always available we need to make an
effort to incorporate physical activity in our
lives.
13. âŚâŚ. BECAUSE OF THE HUMAN
GENOME , IT IS NECESSARY TO
RE-INTRODUCE PHYSICAL
ACTIVITY IN OUR ROUTINEâŚ.
24. PROPOSED MEACHANISM BY WHICH
ACUTE EXERCISE ENHANCES
INSULIN SENSITIVITY
⢠Increased muscle blood flow
⢠Increased capillary surface area
⢠Direct effect on working muscles
⢠Indirect effect mediated by insulin-induced suppression of FFA
levels
27. EXERCISE INDUCED HYPOGYCEMIA
⢠While exercise-induced hypoglycemia is generally not common
in non-insulin dependent diabetes, it is extremely prevalent in
insulin dependent diabetes.
⢠Hypoglycemia may occur during exercise or after exercise (even
up to 24 h following the cessation of an exercise session).
⢠Hypoglycemia can be prevented by eating more, taking less
insulin, or both.
28. GENERAL CONSIDERATIONS IN DIABETIC
PEOPLE PRIOR TO EXERCISE PRESCRIPTION
⢠Physical screening prior to starting an exercise program
⢠Metabolic control
⢠Blood glucose monitoring
⢠Food intake
⢠Insulin administration (when applicable)
⢠Make physical activity compatible with a person's lifestyle
and interests
30. ⢠If blood glucose <5 mM extra calories before exercise
likely required.
⢠If blood glucose 5-12 mM extra calories probably not
required.
⢠If blood glucose >12 mM measure urine ketones.
⢠If urine ketones negative, exercise can be performed
and extra calories not required.
⢠If urine ketones positive, take insulin and delay
exercise until ketones negative.
31.
32. ⢠A source of CHO should be readily available during
and after exercise.
⢠Consume CHO as needed to avoid hypoglycemia.
⢠Consume proteins & fats for prolonged exercise in
order to prevent post-exercise hypoglycemia.
33. THE 3 MOST IMPORTANT FACTORS
IN DETERIMING THE SUCCESS OF
ANY EXERCISE PROGRAM AREâŚ
34. âThose who think they have no time to
exercise will have to find time for illness..â
- Edward Stanley,Earl of Derby (1826-1893)
Editor's Notes
The affliction he referred to was diabetes.
The role of exercise in diabetes management expressed by Sushruta was essentially the prevailing sentiment for 2500 years.
This all changed dramatically in 1921. A 14 year old boy, Leonard Thompson, was successfully treated with insulin by Frederick Banting in Toronto, Ontario. This changed the lives of people with diabetes forever. It also changed the way that exercise and its relationship to diabetes was viewed in two markedly different ways. First, although exercise and insulin were now viewed as cornerstones of diabetes therapy the two together could result in potentially dangerous hypoglycemia, a condition rarely seen in these people before 1921. Exercise-induced hypoglycemia now becomes a concern.
The second way that the perception of exercise in diabetes changed was that people with diabetes were now living longer. Diabetic complications, such as heart disease and atherosclerosis, become a serious concern. There is now a reason for people with diabetes to be fit. Exercise should be advocated so as to keep risk factors for cardiovascular disease, which are particularly prevalent in people with diabetes, from manifesting themselves.
The interaction between glucose and insulin serves as a feedback mechanism to maintain blood glucose concentration within narrow limits. Rising levels of plasma amino acids also increase insulin secretion.
A decline in plasma glucose concentration below 100 mgdl stimulates the alpha cellsâ release of glucagon, resulting in a nearinstantaneous glucose release from the liver. Glucagon contributes to blood glucose regulation during endurance exercise and starvation.
Interestingly, plasma amino acids also stimulate glucagon release. This pathway prevents hypoglycemia after a person ingests a pure protein meal. If a meal contains protein without carbohydrate, amino acids in the food trigger insulin secretion. Even though no glucose has been absorbed, insulin-stimulated glucose uptake increases, and plasma glucose concentration decreases. Co-secretion of glucagon in this situation prevents hypoglycemia by stimulating hepatic glucose output. With amino acid ingestion, both glucose and amino acids become available to peripheral tissues.
Clinicians have discontinued the former use of the terms insulin-dependent diabetes mellitus (IDDM; type 1) and noninsulin-dependent diabetes mellitus (NIDDM; type 2) because these diseases often require treatments that overlap and vary rather than reflect the underlying pathogenesis.
The lifestyle factors contribute to the 70% increase in the disorder among persons in their 30s during the last decade of the 20th century and a 33% overall increase nationally.
There is good reason to believe that regular physical activity is a good thing. The metabolic demands posed by each individual exercise bout presents challenges to the body. In response to exercise, there is an increase in the mobilization of fuels and an increase in the availability of these fuels to the muscles. FFA are mobilized from fat cells where it supplies energy for working muscle and drives gluconeogenesis at the liver. Amino acids are mobilized from the GI tract. Glucose is mobilized from the liver and utilized by working muscle. The feature that makes glucose unique is that in healthy individuals glucose is usually regulated within narrow limits. I would like to focus on the process of glucoregulation during exercise.
This scheme illustrates the sites at which skeletal muscle glucose uptake can be regulated. Glucose moves from capillaries to sarcolemma in the cell and is then phosphorylated in the cell. The gears are used to illustrate the close coupling of glucose flux in these three sites. Below each gear are potential mechanisms of regulation.
One remarkable aspect of the response to exercise is that it also leads to an increase in glucose tolerance and insulin action that is sustained well into the post exercise state. This is particularly important to people with diabetes, because failure to adjust diet or therapy can lead to post-exercise hypoglycemia.
In addition, to an improvement in these risk factors for CV disease. Regular physical activity leads to many adaptations that are consistent with improved cardiovascular function (increased capillarization of skeletal and heart muscle, improved stroke volume, greater myocardial mass).