METABOLIC ADJUSTMENTS AND HORMONAL ADAPTATION DURING PHYSICAL ACTIVITY AND EXERCISE

METABOLIC ADJUSTMENTS AND HORMONAL ADAPTATION DURING PHYSICAL ACTIVITY AND EXERCISE

            General guidelines that may prove helpful in regulating the glycemic response to exercise can be summarized as follows:

1. Metabolic control before exercise avoids exercise if fasting blood sugar >250mg/dl and Ketosis is present and use caution if glucose levels are >300mg/dl and no Ketosis is present. Ingest added carbohydrate if glucose levels are <100mg/dl.
2. Blood glucose monitoring before and after exercise identity when changes in insulin or food intake are necessary. Learn the glycemic response to different exercise condition.
3. Food intake: Consume added carbohydrate as needed to avoid hypoglycemia. Carbohydrate based foods should be readily available during and after exercise.
4. Glycemic control: A consistent beneficial effect of regular exercise training on carbohydrate metabolism and insulin sensitivity, which can be maintained for at least 5 years. These studies used exercise regimens at an intensity of 50-80%, Vo2max 3-4 times a week for 30-60 min a session. Improvement in HbA1c were generally 10-20% of baseline and were most marked in patients with mild type II diabetes and in those who are likely to be the most insulin resistant.
5. Prevention of Cardiovascular Disease: In patient with type II diabetes, the IRS continues to gain support as an important risk factor for premature coronary  disease, particularly with concomitant hypertension, hyperinsulinemia, central obesity and overlap of metabolic abnormalities of hypertriglyceridemia, low HDL, altered LDL and elevated FFA. Improvement in many of these risk factors has been linked to a decrease in plasma insulin levels and it is likely that many of the beneficial effects of exercise in cardiovascular risk are related to improvement in insulin sensitivity.
6. Hyperlipidemia: Regular exercise has consistently been shown to be effective in reducing levels of triglycerides rich VLDL.
7. Hypertension: There is evidence linking insulin resistance to hypertension.
8. Fibrinolysis: Many patients with type II diabetes have impaired fibrinolytic activity associated with elevated levels of PAI-1.
9. Obesity:  Exercise may enhance weight loss and in particular, weight maintenance when used along with an appropriate calorie – controlled meal plan.
10. All levels of exercise, including leisure activities, recreational sports and competitive professional performance, can be performed by people with type I diabetes who do not have complications and are in good blood glucose control. The ability to adjust the therapetic regime (insulin and MNT) to allow safe participation and high performance has recently been recognized as an important management strategy in there individuals.
11. Hypoglycemia: Which can occur during, immediately after or many hours after exercise, can be avoided. This requires that the patient have both an adequate knowledge of the metabolic and hormonal responses to exercise and well tuned self management skills. The increasing use of intensive insulin therapy has provided patients with the flexibility to make appropriate insulin dose adjustments for various activities.

            In case of adolescents, hormonal changes can contribute to the difficulty in controlling blood glucose levels. Exercise can be a safe and rewarding experience for the great majority of children and adolescents with type I diabetes.   By maintaining regular exercise, the progressive decrease in fitness and muscle mass and strength with aging is in part preventable. The decrease in insulin sensitivity with aging is also partly due to a lack of physical activity. Lower levels of physical activity are especially likely in the popular at risk for type II diabetes.

CONCLUSION:

            Physical activity plays in health promotion and disease prevention. It recommends that individual accumulate 30min of moderate physical activity on most days of the week. The benefits of exercise in improving the metabolic abnormalities of type II diabetes is probably greatest when it is used early in its progression from IR to IGT to overt hyperglycemia  requiring treatment with oral glucose lowering agents and finally to insulin. All patients with diabetes should have the opportunity to benefit from the many valuable effects of exercise.

Reference:           Clinical Practice Recommendations ADA