Why Exercise Is Medicine Part II – Diabetes
No I have not died or forgotten about you. This is my first blog post in over a month. I had hoped to keep them more regular, but you know how life has a tendency to get in the way of our best laid plans. Still, all is well on my end, and I hope that all is well with you too.
Today’s post resumes a series that I began a while ago entitled, “Why Exercise Is Medicine.” This is a topic that we strongly believe in at the UMedGym, and it is the title of one of our regular educational classes that we present. I had the opportunity to give the “Why Exercise Is Medicine” presentation on Monday this week, and today’s post will expand on one aspect of that presentation, and that is why exercise is medicine for diabetes.
This is an important topic as diabetes is a chronic disease that is reaching epidemic proportions in the United States, but at the same time it is well within our ability to manage through exercise and lifestyle modifications. I hope you enjoy today’s post, and that it helps you understand a bit more about diabetes and what role exercise plays in managing it.
In Part I of this series entitled “Why Exercise Is Medicine,” I discussed the benefits of exercise when it comes to managing hypertension, or high blood pressure. You can take a look at that one here if you missed it (or if you care).
Now in Part II I will be taking on the topic of Why Exercise Is Medicine for another big-time chronic disease: Diabetes.
Diabetes mellitus is derived from the Greek word diabetes, meaning siphon (or to pass through) and the Latin word mellitus, meaning honeyed or sweet. It is given this name because excess sugar is present in the blood and urine in diabetes, making it sweet.
Diabetes – along with a plethora of associated complications – is unfortunately reaching epidemic proportions within the United States. The latest numbers that I saw from the CDC stated that over 29 million Americans (just north of 9% of the population) are living with diabetes, and 86 million Americans are living with prediabetes, which puts them at an increased risk of developing diabetes.
What makes these numbers even more troubling is that the presence of diabetes increases the risk of death, as diabetes is listed as the 7th leading cause of death in the United States.
The really unfortunate side of this in my eyes is the amount of preventable cases of diabetes that are not being prevented, and the amount of manageable cases that are not being properly managed.
One of the unique things about diabetes is that 90-95% of the diagnosed cases are preventable – or at least manageable. As you’ll see, through lifestyle modifications – especially those featuring exercise – many cases of diabetes can be prevented, managed, or even reversed.
With that being said, it’s important to look at what can be done to get on top of diabetes for those who are struggling with it. So, with this article I hope to provide some information on how we can better manage and prevent diabetes through exercise.
As in Part I of this series, it is important to say that this is not an exhaustive article on diabetes, but rather I will focus on how exercise can help in managing and preventing diabetes.
For further information on the topic, there are many great online and book resources available, as well as your physician or a specialist. But now, without further ado, I will give my two cents.
What Is Diabetes?
Diabetes mellitus is a chronic disease in which excess amounts of glucose (i.e. sugar) are found in the blood stream. The main cause of this is a lack of insulin, which is a hormone manufactured and secreted by the pancreas.
Insulin is secreted in response to rising levels of blood glucose (usually after a meal), and its job is to pick up glucose in the blood stream and transport it into the cells to be used as energy. However, if your body is producing little or no insulin, then it becomes nearly impossible to transport glucose from the blood into the cells, causing high blood sugar and low energy.
Another common contributor to the problem is an inability of the body’s cells to take in glucose even when there is insulin available. This is known as insulin resistance, and it can often combine with low levels of insulin to form a double whammy of poor glucose control.
Now, having excess sugar in the blood may not sound so bad at first, because after all, wouldn’t this just make you sweeter? (OK, yes that was a terrible joke…I should probably be punished for that one.)
In reality, poor control of the amount of glucose in the blood stream can lead to significant problems both in the short-term and long-term.
In the short-term, poor regulation of glucose can lead to excessive fatigue. The cells in your body rely on glucose as a primary energy source, but without the ability to transport glucose into the cells, your body lacks this energy. This can leave you feeling fatigued and hungry, literally needing more energy.
When not transported into the cells to be used as energy, glucose can also be stored as fat to be used later. Unfortunately, this storage of energy as fat does more than just save energy to be used later. It can also lead to more significant problems.
Storing excess body fat and being overweight are more than just cosmetic problems. Excess body fat, particularly that which is stored around the waist, has been shown to contribute to serious health problems, such as insulin resistance, high blood pressure, imbalanced cholesterol, and cardiovascular disease.
While experiencing fatigue and storing excess body fat are not ideal, these short-term complications of diabetes pale in comparison to the long-term effects of elevated blood glucose levels. While I won’t take the time to go into detail, one of the biggest complications associated with diabetes is damaged blood vessels due to long-term exposure to higher glucose levels.
Damaged blood vessels can also result in damage to many parts of the body that these blood vessels course through, such as the heart, kidneys, eyes, skin, and more.
Nerve damage is also common in diabetics, which can cause problems throughout the body, such as loss of sensation, tingling, or pain. This is known as diabetic neuropathy.
While this is not a complete list of complications, hopefully it gives you an appreciation for how detrimental uncontrolled diabetes can be for the body.
Because diabetes can have such a negative impact throughout the body, it is important to learn how to control your glucose levels and prevent diabetes so that you can maintain optimum health.
Type 1 and Type 2 Diabetes
In order to fully understand diabetes and the effect exercise can have on it, we must recognize that there are two different types of diabetes: type 1 and type 2.
Type 1 diabetes (also known as juvenile onset diabetes) is often diagnosed in children, adolescents, or young adults. It is an autoimmune disease in which the body’s immune system attacks and destroys the cells in the pancreas that are responsible for producing and secreting insulin.
Without insulin, very little glucose gets transported into the cells. This results in glucose remaining in the blood stream, causing high blood glucose levels.
Unfortunately, there is no cure for type 1 diabetes, as the insulin producing cells cannot be revived. This leads to a chronic deficiency in insulin and a need to supplement insulin into the body. This is often done through self-administered insulin injections which are timed to coincide with meals, but it can also be done by way of insulin pump therapy, where an insulin pump is inserted into the skin and an appropriate amount of insulin is automatically administered into the body.
While there will always be a need for insulin in type 1 diabetics, exercise can still provide a very positive impact on the body. I will get into this in just a bit.
Type 2 diabetes (also known as adult onset diabetes) is most common later in life. However, as levels of childhood obesity grow, the amount of type 2 diabetics that are diagnosed earlier in life is growing as well. This is due to the high correlation between type 2 diabetes and obese or overweight individuals.
When type 2 diabetes is present, the cause is a bit different than in type 1. In type 2, the body is still able to produce insulin, but the cells in the body resist that insulin and don’t allow glucose to be delivered to them. Often, the body will try to compensate for this by producing more insulin, but as the disease progresses the body’s ability to produce insulin becomes lower and lower.
Impaired secretion of insulin combined with insulin resistance are two defects that are most readily expressed in the setting of obesity resulting from unhealthy diet and a sedentary lifestyle.
As our culture becomes increasingly sedentary and increasingly encouraged to consume unhealthy food, type 2 diabetes continues to rise.
In fact, type 2 diabetes makes up 90-95% of all diabetes cases. While this is unfortunate, the upside of this is that we have a much greater ability to impact type 2 diabetes because insulin resistance and impaired insulin secretion can be reversed to a certain degree.
We know that increased physical activity, improved diet, and reduction in body weight (even as little as a 5-10% reduction) has a dramatic impact on insulin resistance and improves blood glucose control. So, if those with type 2 diabetes or those at risk for type 2 diabetes are able to move more, eat healthier, and focus on losing weight, this can have a dramatic impact on diabetes as a whole.
The question is, if 90-95% of diabetics can improve or eliminate their high blood glucose levels, why is diabetes a disease that continues to get worse? I believe much of the issue is a cultural decline from regular movement and healthy eating, and this is a cultural influence that begins during childhood.
The more we promote sedentary activities like playing video games, watching T.V., and sitting in class all day without physical education programs, the more challenges kids will face with obesity and sedentary behavior.
We combine that with increasingly processed foods that are filled with fats, carbohydrates, and sugars which replace diets full of fruits, vegetables, and other whole foods.
This combination of increasingly sedentary activities and increasingly poor diets leaves us with an uphill battle against obesity and type 2 diabetes.
That being said, the battle can be won.
While the treatment for type 1 diabetes must involve insulin supplementation, the treatment for type 2 diabetes should focus primarily on weight loss, improved diet, and exercise. When these three factors are present, much can be done to improve your glucose levels without medication or supplementing insulin.
The important thing to remember with type 2 diabetes is that you can improve your glucose levels dramatically by simply modifying your lifestyle. That’s not to say that it is easy. New habits have to be formed and adhered to long-term. But if you are willing to stick with those lifestyle changes, you can improve your diabetes and avoid long-term complications.
So, now that you have a bit of a foundation for understanding diabetes and its different types, I would like to finish up by highlighting some of the ways in which exercise is effective as medicine for diabetes.
Exercise and Diabetes
The primary reason why exercise is beneficial for controlling glucose levels is that exercise creates a need for energy in the muscles. A major source for this energy, as I mentioned earlier, is glucose. Exercise, then, is a signal to your body that it needs to mobilize and deliver glucose to the muscles to be used as energy.
During rest and low-intensity exercise, the primary source in your body for energy is fat (sorry, this doesn’t mean that resting is a good way to burn fat). However, as exercise intensity increases to a moderate or vigorous level, the primary energy source switches from fats to carbohydrates, which your body breaks down into glucose so that it can be used by the muscles.
For this reason, as you increase to a moderate or high-intensity level of exercise, your body attempts to mobilize and deliver more glucose to the cells, which can either come from your diet or from your body’s stored glycogen.
The next step after your body mobilizes glucose and elevates glucose in the blood stream is to transport that glucose into the muscle cells and use it. This step is the problematic one for diabetics, but fortunately, exercise provides assistance when it comes to getting glucose into muscle cells.
Under normal conditions, insulin is required to transport glucose into the muscle cells, and this is the primary method for lowering blood glucose. However, there is one condition in which glucose can be transported into your muscle cells independent of insulin, and that is….you guessed it: exercise!
During and immediately following exercise, for up to 24 hours, insulin-independent glucose uptake by the muscle cells is possible. Additionally, insulin action is increased for 24-72 hours following exercise which further stimulates transport of glucose out of the blood stream and into the cells. These two factors combine to provide a natural means of lowering blood glucose, and that means is exercise.
For those with type 1 diabetes, this is also significant because it provides a means to assist self-administered insulin in chronically reducing and managing blood glucose levels.
Not only that, but regular exercise also promotes cardiovascular health. This means that those with diabetes who exercise regularly tend to prevent many of the negative side-effects of diabetes, including heart disease, vascular disease, neuropathy, and nephropathy.
So, even though type 1 diabetics and some type 2 diabetics will always have to use insulin or other medications to assist glucose control, there are numerous benefits to regular exercise that go beyond simply managing blood sugar.
What Type of Exercise, How Much, and How Often?
To finish up I’d like to get practical and speak to how much, how often, and what type of exercise is ideal for managing and preventing diabetes.
While any exercise, including simply walking, is better than none, there is an optimal way to manage diabetes. Firstly, exercise to promote weight loss and weight management is important for those who have diabetes or are at risk for developing diabetes, especially those with type 2. As I mentioned earlier, being overweight or obese is a huge risk factor for diabetes because it affects insulin action and your muscle’s responsiveness to insulin.
With that being said, some form of cardiovascular exercise most or all days of the week is ideal. This, along with proper dietary considerations will allow you to create a caloric deficit and manage body weight.
Secondly, muscle strength and mass are important because the more muscle you have, the greater ability you have to dispose of glucose during exercise and at rest. Now, this doesn’t mean you have to be the hulk, but you should work towards strength training to promote fat loss and muscle gain. When it comes to strength training, 2-4 days per week is best.
With this combination of cardiovascular and strength exercise, you will be performing some kind of exercise nearly every day of the week, and that’s a good thing! Not every workout has to be maximal or near maximal effort, but having that regular exercise will promote regular disposal of blood glucose. Remember above when I mentioned that glucose uptake by the muscles is increased up to 24-72 hours after exercise? Well, if you don’t repeat that stimulus on a regular basis, you will lose this benefit.
Finally, it is important that you work up to a moderate to vigorous intensity during your workouts. You’ll remember that I said fat is the primary energy source at low intensity, but as you increase intensity, glucose becomes a larger source of energy for your body. This means that a leisurely stroll through the park is not optimal for controlling glucose.
You may not be able to run or lift heavy weights right away, and that’s alright. But, you should find a means of exercising that allows you to elevate your heart rate to the point where you begin to sweat and you have trouble holding a conversation. This will indicate that you are beginning to work at a moderate or vigorous intensity level.
Wrapping it up
Hopefully now you have a better idea of the risks associated with diabetes as well as how you can better manage your glucose levels. This is an important topic for many of America’s population, as millions of Americans have type 2 or are at risk for developing type 2 diabetes, but at the same time, the majority of this population remains sedentary.
You can be assured that glucose levels, for type 2 diabetics particularly, are within your control. No matter what stage of this disease you may be at, you can start right now to make lifestyle changes that will positively affect your body.
For all of us, regular exercise is important to maintain our body’s regular functioning, control glucose levels, and prevent cardiovascular disease. So if you have type 1 or 2 diabetes, prediabetes, or you had no idea what diabetes was until reading this, you can help yourself by engaging in regular physical activity.
I hope this helps convince you of its benefits, and why you should begin a regular exercise routine today.
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