Exercise and Type 2 Diabetes

What is the benefit of resistance training in patients with Type 2 Diabetes?

improves insulin sensitivity, which is how effectively the body responds to insulin, and controls blood sugar

What is the result of glucose release during exercise?

AMPk is activated by Ca2+ and muscle contraction, works to upregulate ATP production and inhibit ATP-consuming processes

What is the effect of muscle contraction on GLUT4?

GLUT4 translocates to the cell membrane and becomes active also due to AMPk activation

What is the effect of insulin on blood sugar?

insulin produced in the pancreas binds to insulin receptors (competes with GLUT4), leading to an increase in overall glucose uptake

What is a consequence of not altering insulin dosage and timing to acomodate training?

hypoglycemia (low blood sugar)

What are general tips for training with Type 2 Diabetes?

- monitor blood glucose before, during (if over 60 min) and after exercise

- stay hydrated and have fast-acting carbs available

-adjust insulin dose and timing to prevent hypoglycemia

What is rapid-acting insulin (bolus)?

- onset: 10-20 minutes

- peak: 1-2 hours

- duration: 3-5 hours

- typical use: with or just before meals (4-20 units)

What is slow-acting insulin (bolus)?

- onset: 30-60 minutes

- peak: 2-4 hours

- duration: 5-8 hours

- typical use: 30-60 minutes before meals (4-20 units)

What is intermediate-acting insulin (basal)?

- onset: 1-2 hours

- peak: 4-12 hours

- duration: 12-18 hours

- typical use: once or twice daily

What is long-acting insulin (basal)?

- onset: 1-2 hours

- peak: minimal (flat)

- duration: 20-24 hours

- typical use: once daily at the same time each day

What is ultra long-acting insulin (basal)?

- onset: 1-2 hours

- peak: minimal (flat)

- duration: >24 hours

- typical use: once daily at the same time each day

How should rapid-acting insulin be adjusted before training?

reduce mealtime dose by 25-75%, reduction is greater for high-intensity exercise

How should short-acting insulin be adjusted before training?

reduce dose by 25-60% before training, take at least one hour pre-exercise

How should basal insulin be adjusted before training?

reduce morning NPH dose by 10-20% for afternoon/evening exercise and for prolonged/frequent exercise, consider reducing total dose

How should blood sugar be monitored during training?

check every 30-60 minutes if exercise is moderate-vigorous and over an hour

What should be done if blood sugar falls below 100 mg/dL?

consume 15g fast-acting carbs

What should be done if blood sugar is between 100-150 mg/dL and exercise is over one hour?

consume 15g carbs

What should be done if blood sugar is above 250 mg/dL?

check for ketones, avoid intense exercise if ketones are moderate or large

What are the general guidelines for recovery after training?

monitor blood sugar within 30 minutes and again before bedtime, eat a balanced meal/snack, consider 10-20% reduction in next basal dose, be prepared for delayed lows 6-24 post-exercise