Diabetes mellitus is a chronic endocrine disorder, characterized by hyperglycemia resulting from absolute or relative insulin deficiency.

1. University of Gondar
College of natural and computational science
Department of sport science
Exercise physiology
Exercise and diabetes mellitus
By :shumye demissie

2. Diabetes mellitus and exercise
• Introduction
• What is diabetes mellitus?
Type of diabetes mellitus
Effect of diabetes mellitus
Effect of exercise on diabetes
How to manage diabetes mellitus

3. Diabetes and exercise
Introduction
• Physical exercise has been considered as one of the cornerstones in the treatment
of diabetes mellitus along with nutrition and medication since from the past 100
years ago. Diabetes mellitus, a chronic metabolic disease, is characterized by an
increase in the blood-glucose level resulting from a relative insulin deficiency or
insulin resistance or both. As a consequence, it can lead to glycation of tissues,
which proceeds with acute metabolic disturbances and ends with organ damage
with severe health deteriorations.

4. Diabetes mellitus
• Diabetes mellitus is a chronic endocrine disorder, characterized by hyperglycemia resulting from
absolute or relative insulin deficiency.
• A disease in which the body's ability to produce or response to hormone insulin is impaired.
• It results in abnormal metabolism of carbohydrate and elevated the level of glucose in the blood
and urine .
• A group of disease that affect how your body use blood sugar or glucose.
• There are a number of different causes of diabetes but by far the majority of cases are classified as
either type 1 or type 2 diabetes.

5. Diabetes occur in one of the following situations
1. The pancreas produce little insulin or no insulin at all.
2. The pancreas makes insulin ,but the insulin made does not work as it should, This condition
is called insulin resistance .
High insulin level Low insulin level
⦁ Increase muscle glucose uptake
⦁
Impairs muscle glucose uptake
⦁
⦁ Impairs fatty acid use Increased hepatic glucose output
⦁ Reduces stress hormone action Enhances stress hormone action
Risk for hypoglycaemia Risk for hyperglycaemia

6. Types of diabetes
There are two main types of diabetes:
 type 1 and
type 2.
Glucose is the fuel that feeds your body’s cells, but to enter your cells it needs a key. Insulin is that
key.
Type 1 Diabetes: - occurs when the pancreatic beta cells are destroyed by an immune-mediated
process. Because the pancreatic beta cells sense plasma glucose levels and respond by releasing
insulin, individuals with type 1 diabetes have a complete lack of insulin. In this disease, daily
injections of insulin are needed.

7. Cont..
Type 2 Diabetes: -In type 2 diabetes, the pancreas still makes insulin, but the tissues do not respond
effectively to normal levels of insulin, a condition termed insulin resistance.
• Over many years the pancreas will decrease the levels of insulin it secretes, but that is not the main
problem when the disease initiates.
• Type 2 diabetes is becoming more common due to increasing obesity and failure to exercise, both of
which contribute to insulin resistance.
Symptoms of diabetes
• Increases hunger (after eating)
• Dry mouth
• frequent urination
• feeling very thirsty and drinking a lot
• cuts or sores that don’t heal properly
• Weak, tired feeling
• Blurred vision

8. Cont..
• How are type 1 and type 2 diabetes diagnosed
• The primary test for both type 1 and type 2 diabetes is known as the glycated hemoglobin (A1C)
test. An A1C test is a blood test that determines your average blood sugar level for the past two to
three months.
• WHO diabetes diagnostic criteria
• Condition 2-hour glucose Fasting glucose HbA1c
• Unit mmol/l(mg/dl) mmol/l(mg/dl) mmol/mol DCCT %
• Normal <7.8 (<140) <6.1 (<110) <42 <6.0
• Impaired fasting glycaemia <7.8 (<140) ≥6.1(≥110) & <7.0(<126) 42-46 6.0–6.4
• Impaired glucose tolerance ≥7.8 (≥140) <7.0 (<126) 42-46 6.0–6.4
• Diabetes mellitus ≥11.1 (≥200) ≥7.0 (≥126) ≥48 ≥6.5

9. Cont..
effects of diabetes
• The most common long-term diabetes-related health problems are:
• damage to the large blood vessels of the heart, brain and legs (macrovascular complications)
• damage to the small blood vessels, causing problems in the eyes, kidneys, feet and nerves
(microvascular complications).
Causes blindness or blurred vision(retinopathy)
 kidney failure(nephropathy)
Nerve damage (neuropathy)
 tumor occurrence in legs.
 heart failure

10. Cont..
Eye disease and diabetes
• retinopathy – with retinopathy, the blood vessels in the retina become damaged which eventually
affects your vision
• macular edema – the macula is part of the retina and helps you to see things clearly. Swelling of
this area can happen when the blood vessels in the retina are damaged, causing fluid to build up.
This can lead to the macula being damaged and vision may become blurry.
Kidney damage and diabetes
• People with diabetes are at risk of kidney disease (nephropathy) due to changes in the small blood
vessels of the kidneys.

11. Cont..
Nerve damage and diabetes
• Nerve damage (neuropathy) is usually caused by high blood glucose levels,
although similar nerve damage can also result from:
• drinking large amounts of alcohol
• Teeth and gum problems and diabetes
 tooth decay and gum infections. Because small blood vessels that help nourish
your teeth and gums can become damaged.
Thyroid problems and diabetes
overactive and underactive thyroid gland

12. cont..
• Treatment/management of DM
type 1 DM
There’s no cure for type 1 diabetes. People with type 1 diabetes don’t produce
insulin, so it must be regularly injected into your body.
Type 2 DM
diabetes can be controlled and even reversed with medications diet and exercise.
A. Hypoglycaemic Medications

13. Cont..

14. Cont..
B. Diet
• Diet is a basic part of management in every case. Treatment cannot be effective unless adequate
attention is given to ensuring appropriate nutrition.
• Dietary treatment should aim at:
• ensuring weight control
• providing nutritional requirements
• allowing good glycaemic control with blood glucose levels as close to normal as possible
• Dietary fat should provide 25-35% of total intake of calories but saturated fat intake should not
exceed 10% of total energy.
• Protein intake range between 10-15% total energy
• Carbohydrates provide 50-60%

15. Cont..
Exercise
• “Exercise is the best insulin sensitizer on the market; better than any medication we currently have
available"
Bartol
• Exercise is an integral component of the lifestyle management of type 2 diabetes mellitus (T2DM).
• Current exercise guidelines recommend that adults with T2DM should undertake aerobic-type
exercise at moderate and/or vigorous intensity on 3 to 5 days per week, ideally combined with
regular vigorous progressive resistance training
What Happens During Exercise
• The muscles need more energy during exercise, so the body releases extra sugar, or glucose

16. Cont..
• For people with diabetes, this can have some side effects. For example, if the body doesn't have
enough insulin to use the glucose that's released during exercise, then the glucose stays in the
blood, which leads to high blood sugar levels. This is called hyperglycemia
• fuel. When the body starts to burn fat for fuel, substances called ketones are produced. People
with diabetes shouldn't exercise if they have high levels of ketones in their blood because this can
make them really sick.

17. Recommended physical activity in patients with
diabetes
Type Duration/week Special notice
Aerobic 150 min Moderate-to-vigorous intensity*, no more than 2 days
without activity
Resistance 2–3 sessions Sessions should be scheduled on non-consecutive
days;
sessions should include 8–10 exercises with
completion of
1–3 sets of 10–15 repetitions using free weights,
resistance
machines, resistance bands or performing exercise
against
body weight
Flexibility 2–3 sessions Especially recommended for older adults

18. THANK YOU