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Acute Effects of Exercise on Blood Glucose Levels in Type 2 Diabetes

Jerry Batschi, Talon Allen, Emily Crapse, Blaine Gustafson, Kelly Johnson

BYUIdaho

July 8, 2014

Acute effects of exercise on blood glucose levels in type 2 diabetics

The glucose regulatory system in the human body is a sensitive yet highly effective system. In a normal

non-diabetic, the system is regulated mainly by hormonal changes in the body. As plasma glucose levels

rise above the normal, the pancreas is stimulated to release insulin, which, in the average individual, will

effectively lower the levels of glucose in the blood by causing glucose receptors to come to the cell wall.

Conversely as blood glucose levels drop below normal the pancreas will secrete glucagon which in turn

will cause the liver to produce glucose. The main tissue that is responsible for regulating the glucoselevels in the body is skeletal-muscle. However, in people who have type 2 diabetes, the body does not

adequately respond to the insulin. As the body builds intolerance to insulin it will begin adapting to fulfill

its need for fuel. With the understanding that skeletal muscles are the tissue in the body that helps

decrease blood glucose levels the most, it would be beneficial to look at what changes glucose uptake into

these cells. Because glucose cannot diffuse freely across the plasma membrane it must be transported

across. Of the transporters that move glucose the GLUT 4 protein is the most common. The GLUT 4

glucose transporters are located intracellular and need to be brought to the plasma membrane. Insulin

binds to receptors on the cell wall and starts a chain reaction that causes this relocation to occur. Another

method for this relocation is through exercise, although the mechanism for how this occurs is still

uncertain (1, 2). As mentioned earlier, type 2 diabetics have a reduced sensitivity to insulin, therefore,

they also have impaired glucose uptake into the muscles. Thus they must rely on other means, mainly

exercise, diet, or medication to regulate their plasma glucose levels. This paper will look at the acute

effects of different intensities, frequencies, duration, and types of exercises to find which would be mostbeneficial in the short term for improved glycolytic regulation in type 2 diabetics.

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Table 1

Copyright (c) 2000-2014 Ovid Technologies, Inc.

Intensity

It has been shown that bouts of LI to MI exercise allows for even, healthy blood flow, for an increase in

personal health condition and benefits, an increase in weight loss, a decrease in cardiovascular

complications, an increase in glucose delivery to peripheral muscles cells, and an increase in glucose

uptake through an increase in insulin-induced translocation of GLUT4 to the cell surface (P =


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administered with samples being taken every 30 minutes. There was a significant (p


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Although MI aerobic training has been shown to significantly increase insulin sensitivity, it is by

resistance training performed at a HI where molecular changes, overall, are determined to be more potentin glucose control and regulation and insulin sensitivity in a more substantial and permanent, long lasting

way, as was found in a 9 week study on the effects of exercise on GLUT 4 receptors in Type 2 Diabetic

patients. For 6 days per week, 30 minutes a day, at 75% VO2 max, a significant increase was found in

GLUT4 protein and GLUT4 mRNA content (to 0.43 0.03, and 0.57 0.08 arbitrary units; (P < 0.05)),

respectively, (10). Another 2-week study further explored the difference between a 60-minute isolated HI

exercise bout compared to 7 consecutive 60 minutes/day HI exercise bout and its therapeutic effect on

Type 2 Diabetes. The results of this study concluded with an increase in Hexokinase production (After 1

day, 1.2 3; After 7 days, 1.4 3, arbitrary units; (P=


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significance (p>.05) Again this study also showed that 3 days a week did not produce significant benefits

to glycemic control. (14)In contrary to the first to study of three days a week, IL.M. Fenicchia et al. found significant benefits in

their study. During the study that looked at blood glucose levels in women with type 2 diabetes the

subjects did resistance training for 3 nonconsecutive days/week for a period of 6 weeks. The pretraining

area under the curve was 3,355.0 324.6 mmol/L*min and after an acute bout of exercise it decreased to

2,868 324.0 mmol/L*min. However the pretaining did not improve in chronic training with a decrease

of only 149 m

mol/L*min with a (p < 0.01). (14)

In a study where the subjects did aerobic exercises for 7 days, the subjects exercised at 60-75% HR

reserve with alternating sessions on a walking treadmill and stationary cycle for 20 min. The minimum

blood glucose for the control was 3.6 0.3 mmol/L for the control and 4.0 0.2 mmol/L for the diabetic

group. The maximum blood glucose for the control was 13.6 1.2 mmol/L and 10.9 0.8 mmol/L for the

diabetic group. In comparing measured fasting blood glucose levels between resistance training and

weight loss (RT and WL) vs. just weight loss (WL) there was a -0.6 mmol/L difference for RT and WLin 3 months and a -0.8 mmol/L difference for WL. (15)

Stephan F. Praet et al. (4) conducted a study in which during a 48 hour time period subjects did a 5 min

warm up on a bicycle ergometer, 10 reps were then done with exercises that targeted the upper body

followed by 2 sets of 20 alternating lunges. After the warm-up the participants did leg press and knee

extension exercises. All exercises were done at 50% of their 1-RM and were performed for about 45 min.

The mean glucose levels over a 24-hour period did not differ between a pre exercise test and a post

exercise test with levels being 8.5+/- .4 and 8.1+/-.4 (mmol/L) respectively. One benefit to this exercise

was it decreased the length of hyperglycemic episodes significantly (7.6+/-1.4hours pre vs. 4.6+/-1.1hours

post) (16)

In a walking study, it was evaluated on how walking affects blood glucose levels. In a single bout of

exercise the subjects walked a total of 1.6 miles without gradients. The walking exercise caused a

decrease in blood glucose levels by -2.2 mmol/L from 10.5 mmol/L with a p value of < 0.001. (17).

In another study the subjects were divided into normal and offspring, they exercised 4 times/week over aperiod of 6 weeks. The subjects used a stair-climbing machine at 65% of their maximum aerobic capacity

with a 5 min warm-up and cool down. The rates of whole-body glucose metabolism increased by 22

percent in the offspring and 27 percent in the normal subjects after the first exercise session. The total

increase from baseline, after six weeks of exercise training, was 42 percent in the group of offspring and

38 percent in the normal group. It found significance by having a p-value of


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DurationWhile doing research on duration there were many times that correlations were found between the lengths

of time exercised, the intensity, and how many times per week exercise was performed. The majority of

the studies chose to do a duration of 60 minutes, others had durations of: 50 minutes, 70 minutes, 45

minutes, 30 minutes, and 25 minutes.

Rogers et al. performed a 1-week study in which the participants exercised for 60 minutes at moderate

intensity (60-68% VO2 max). During exercise, the participants either walked at 60% VO2max, or biked

at 68% VO2 max. The study found that exercising for 60 minutes showed a significant decrease in their

oral blood glucose test, with the before values at 227 +/- 23 mg/dL and 170 +/- 18 mg/dL after [p

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