going beyond diabetes treatment: exercise!

Originally published at the Medical Fitness Network

There are many treatments for Type II Diabetes (which will be referred to simply as diabetes in this article) but none come with the level of benefits seen by the implementation of a proper exercise program. This is a tall order but exercise is effective for the treatment of insulin resistance and diabetes in three areas. These areas are inflammation, the cell mitochondria (where the cell generates power), and hyperinsulinemia (high blood insulin).2 Treating these areas with exercise goes beyond the benefits of treating just diabetes. In turn, you will be helping prevent other health issues associated with diabetes such as heart disease, stroke, and circulation issues. The questions is how does exercise do this and what kind of exercise is necessary?1
To understand how exercise treats diabetes, it is important to understand that diabetes is the end result of insulin resistance. Insulin resistance can be illustrated in that: when we eat something with carbohydrates or sugar, our body breaks it down into blood sugar known as glucose. This glucose triggers a response from our pancreas to produce the hormone insulin. Insulin in turn shuttles the blood sugar into the cells to be used as energy. However, when someone becomes insulin resistant the cells do not respond to the insulin’s attempt to shuttle the blood sugar into the cell, so the pancreas produces more insulin to get the same job done. In essence, the cells are developing a tolerance to the insulin and in order to get the blood sugar absorbed the cells begin to require more and more insulin to do the same job. This leads to the blood retaining the blood sugar for prolonged periods of time as well as an elevated presence of insulin. When someone has prolonged high blood sugar, we call this hyperglycemia and the person is said to be diabetic. Having high blood sugar is dangerous due to the stress it places on cells. It can cause many problems up to and including death.
In the area of inflammation, it is known that not all inflammation is the same. Inflammation can be acute — meaning it is brought on for a short period of time — which happens with activities such as exercise or when tissue undergoes some sort of trauma. Inflammation can also be chronic, meaning it is persistent and recurrent.
Acute inflammation is necessary, and healthy, because it begins the healing and repair process by bringing in white blood cells, and ridding the tissue of damaged cells. Inflammation is required otherwise the body would be unable to heal.
Chronic inflammation can be found in many conditions, such as autoimmune diseases, prolonged injury/infection, obesity, diabetes and other chronic diseases. When inflammation remains present, even at a low level, it begins to damage the body’s cells. Science now knows that:2

• Obesity creates a level of chronic inflammation.
• Inflammation is the precursor to every chronic disease including heart disease, arthritis, and cancer.
• Inflammation suppresses the insulin signaling pathway (how insulin and your cells communicate) which is believed to be related to a reduction of a heat shock protein, this protein however, can be increased through exercise.
  • Increases of the protein begin after the first session of exercise.3

You may remember from science class the power generator of the cell is the mitochondria. This is where the energy is created from fatty acids and glucose. It is now believed that when the mitochondria of the cell becomes dysfunctional, less fatty acids are taken in, elevating fat (lipids) in the blood, and increasing fat storage. It is also believed that the cell becomes dysfunctional as a result of insulin resistance. This relationship may then further feed into the increased body fat and increased inflammation. Further scientific studies in this area have determined that:

• Proper exercise increases mitochondrial efficiency, proper exercise being summarized as:
  • No less than 150 minutes of moderate activity per week but ideally more than 250 (start light and increase intensity).
  • Incorporate a combination of resistance exercise (i.e. calisthenics and weights) and cardiovascular exercise.
  • Supervision by a registered clinical exercise physiologist if two or more chronic conditions are present is recommended.4
  • Exercising following an interval training protocol ranging from 70-90% of maximal heart rate may provide superior results if tolerable by participant.5
• It is well known that aerobic training increases the number of mitochondria in muscle fibers in order to increase the delivery of oxygen to the muscle. More mitochondria means more energy that can be generated within the cell.

Hyperinsulinemia is best described as an elevated level of insulin relative to the amount of glucose (blood sugar) present in the blood. This may be the truest indicator of someone who is insulin resistant and about to become diabetic.6 In the beginning, it was illustrated how insulin resistance develops, and it being characterized as requiring more insulin to do the same job. This additional insulin is the definition of hyperinsulinemia. When someone has hyperinsulinemia it can be expected that in a matter of time, even higher levels of insulin will be required as the cell increases its tolerance to the insulin. Eventually the pancreas will not be able to produce the level of insulin required to lower blood sugar and the person will be said to have hyperglycemia, and will be classified as diabetic. When someone is experiencing hyperinsulinemia, they are already experiencing inflammation, and a weakening of the insulin signaling pathway (ways the cells communication for glucose uptake), and likely a dysfunction of the mitochondria, which in turn may magnify the issue further.
What is known is:

• Exercise lowers glucose in the presence of insulin, and thus exercise will lower both glucose and insulin levels.
• If you’re currently diabetic and taking insulin, the amount may likely need reduced prior to exercise.
• Consistent proper exercise may lead to the need to have a physician re-evaluate dosage or usage of insulin and/or pills (i.e. metformin). Never discontinue use of a medicine without consulting with your physician.

Proper exercise not only goes beyond the treatment of diabetes to the treatment of the cause (insulin resistance), it helps prevent other health issues that stem from diabetes. Health issues such as cardiovascular disease, stroke, and issues with circulation dramatically decrease with exercise. Also, remember diabetes aside exercise reduces risk of nearly every chronic disease.1

References

1. Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 1143–1211. http://doi.org/10.1002/cphy.c110025
2. Ye, J. (2013). Mechanisms of insulin resistance in obesity. Frontiers of Medicine, 7(1), 14–24. http://doi.org/10.1007/s11684-013-0262-6
3. Matos, M. A. de, Ottone, V. de O., Duarte, T. C., Sampaio, P. F. da M., Costa, K. B., Fonseca, C. A., … Amorim, F. T. (2014). Exercise reduces cellular stress related to skeletal muscle insulin resistance. Cell Stress & Chaperones, 19(2), 263–270. http://doi.org/10.1007/s12192-013-0453-8
4. Moore, G. E., Durstine, J.L., & Painter, P. (2016). ACSM’s exercise management for personals with chronic diseases and disabilities. Champaign, IL: Human Kinetics.
5. Roberts, C. K., Hevener, A. L., & Barnard, R. J. (2013). Metabolic Syndrome and Insulin Resistance: Underlying Causes and Modification by Exercise Training. Comprehensive Physiology, 3(1), 1–58. http://doi.org/10.1002/cphy.c110062
6. Paniagua, J. A. (2016). Nutrition, insulin resistance and dysfunctional adipose tissue determine the different components of metabolic syndrome. World Journal of Diabetes, 7(19), 483–514. http://doi.org/10.4239/wjd.v7.i19.483