Guest guest Posted November 12, 2006 Report Share Posted November 12, 2006 I'm wondering if anyone here knows the best use of exercise to control blood sugar. I understand that aerobic exercise lowers blood sugar. Is it better to exercise fifteen or twenty minutes several times a day, or to do it once for sixty minutes? Is it better to exercise right after eating, to lower blood sugar from food intake? Or does that matter? I have a treadmill, and if I understand correctly, a moderate pace, using 60% to 70% of maximum is better for lowering or maintaining blood sugar, but that's about all I know. I'm doing weight training six days a week, but only two muscle groups a day, using the Eight Minutes In the Morning guide, because I have Fibromyalgia/Chronic Fatigue, and Myofascial Pain Syndrome, and trying to do more causes pain and fatigue significant enough to make me stop. I have a treadmill, but I'm not sure what kind of aerobic schedule would be best for affecting blood sugar. Vicki Lockwood Grant City, MO Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 Dear Vicki, We need a bit more of your history. Do you have diabetes? Type 1 (insulin-dependent) or Type 2 (generally non insulin-dependent)? Are you taking any medication? How old are you and how much do you weigh? Do you regularly monitor your blood sugar? How often and when? In general, multiple bouts of exercise in a day, along with many small eating periods throughout the day will keep blood sugar more even. But there are MANY variables to consider, not the least of which is YOUR individual response. The difficulty with studies is that there is not continuous monitoring of blood sugar, only snapshots. And numbers of people studied are usually small and conducted over short periods of time. And the number of variables to consider is lengthy. If you were up to studying yourself, you could try each schedule for 2-3 weeks; keep detailed records of when, what, and how much you ate in relation to your exercise session as well as the variables of exercise; and monitor how your own blood sugar reacted. Perhaps Dr. Giarnella will have something to add. Merrick, M.A. Bellevue, NE ACSM HFI, NSCA CPT/CSCS, NASM CPT > > I'm wondering if anyone here knows the best use of exercise to control blood sugar. I understand that aerobic exercise lowers blood sugar. Is it better to exercise fifteen or twenty minutes several times a day, or to do it once for sixty minutes? Is it better to exercise right after eating, to lower blood sugar from food intake? Or does that matter? I have a treadmill, and if I understand correctly, a moderate pace, using 60% to 70% of maximum is better for lowering or maintaining blood sugar, but that's about all I know. > I'm doing weight training six days a week, but only two muscle groups a day, using the Eight Minutes In the Morning guide, because I have Fibromyalgia/Chronic Fatigue, and Myofascial Pain Syndrome, and trying to do more causes pain and fatigue significant enough to make me stop. I have a treadmill, but I'm not sure what kind of aerobic schedule would be best for affecting blood sugar. > > Vicki Lockwood > Grant City, MO > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 Okay, here goes. I'm soon to be 52 years old. 5'3 " and 206 pounds. When I was 19 I was diagnosed with hypoglycemia after one of those tests that take several hours of drinking a sweet liquid and testing. With my last pregnancy, when I was 27, I had dangerously high blood pressure and after the baby was born and weighed 11lbs 1oz, the doctor said I had gestational diabetes. That was 1978. I had gained more than 70 pounds with that pregnancy. I tested my blood sugar about once a week after that and it was always 120--whether fasting, eating junk, or eating well. In 1994 I weighed well over 300lbs. I don't really know how much because household scales stop there and I refused to get on a scale anywhere else. I was also diagnosed with Fibromyalgia that year. I gained more weight because I refused to move. It hurt too bad. So for a year I did nothing and what I learned was the pain was there even when I didn't move, and my health was deteriorating. On Mother's Day 1995 I made a decision. I started exercising and cut my food to about 1600 calories a day. I tried to eat lean meats and less sugar. I lost a hundred pounds and continued to exercise, building muscle and getting healthier. My weight stablized at right around 200, give or take 10 pounds. And that's where I still am, weight wise. Near the end of 2004, my husband was diagnosed with Alzheimer's and I began to stress. During 2005 I tried dozens of times to maintain my exercise, but everything I did caused injury. I wasn't doing any MORE exercise, nor anything new without a personal trainer to guide me. But I had tendinitis, bursitis, joint swelling and pain, every time I tried ANY exercise. It was that way all year. And my blood sugar changed. It never went over 120--at least when I was testing--but it started flucuating between 70 and 110. Something had changed. In March of this year, my husband and I got fired from the job because he was no longer able to perform due to the Alzheimer's. That job came with an apartment, so we lost our job and home at the same time. But we've been paying on a small house in NW Missouri, so we moved in. We're now living on his social security, which makes eating properly very hard. But apparently the stress has been reduced because now I am able to exercise without injury. Thursday night I got up several times during the night to urinate and Friday I had an unquenchable thirst. Thought maybe it was my prostate. haha!! Okay, I just couldn't help putting that in since the commercials on TV talk about men having to go and go at night. It took me until Saturday night to put two and two together and decide I should check my blood sugar, and another 12 hours to find my lancets. Sunday morning my bg was 95. I had a pancake (I know, I know, but that's what we were given by the food bank) and tested 20 minutes after eating. Bg was 151. And twenty minutes later it was 105. So there you have it. You know my weight, age, stress levels, exercise and bg history. Sorry to take so much space but I wanted you to get the whole pictures. Besides, you asked. Vicki Lockwood Grant City, MO Re: Exercise and Blood Sugar <<<We need a bit more of your history. Do you have diabetes? Type 1 (insulin-dependent) or Type 2 (generally non insulin-dependent)? Are you taking any medication? How old are you and how much do you weigh? Do you regularly monitor your blood sugar? How often and when?>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 After reading your questions again, and my long post about my history, I realize I left out some answers. I'm type 2 diabetic. No meds so far. I was testing about once a week and my bg was never over 110. After seeing it at 151, I'm testing before I eat, right after I eat, and twenty to thirty minutes after I eat, though I don't know how long I'll be able to keep that up since the test strips cost money and we don't have much. I have about 70 strips left. After that I may be SOL. Vicki Lockwood Grant City, MO Re: Exercise and Blood Sugar Dear Vicki, We need a bit more of your history. Do you have diabetes? Type 1 (insulin-dependent) or Type 2 (generally non insulin-dependent)? Are you taking any medication? How old are you and how much do you weigh? Do you regularly monitor your blood sugar? How often and when? In general, multiple bouts of exercise in a day, along with many small eating periods throughout the day will keep blood sugar more even. But there are MANY variables to consider, not the least of which is YOUR individual response. The difficulty with studies is that there is not continuous monitoring of blood sugar, only snapshots. And numbers of people studied are usually small and conducted over short periods of time. And the number of variables to consider is lengthy. If you were up to studying yourself, you could try each schedule for 2-3 weeks; keep detailed records of when, what, and how much you ate in relation to your exercise session as well as the variables of exercise; and monitor how your own blood sugar reacted. Perhaps Dr. Giarnella will have something to add. Merrick, M.A. Bellevue, NE ACSM HFI, NSCA CPT/CSCS, NASM CPT > > I'm wondering if anyone here knows the best use of exercise to control blood sugar. I understand that aerobic exercise lowers blood sugar. Is it better to exercise fifteen or twenty minutes several times a day, or to do it once for sixty minutes? Is it better to exercise right after eating, to lower blood sugar from food intake? Or does that matter? I have a treadmill, and if I understand correctly, a moderate pace, using 60% to 70% of maximum is better for lowering or maintaining blood sugar, but that's about all I know. > I'm doing weight training six days a week, but only two muscle groups a day, using the Eight Minutes In the Morning guide, because I have Fibromyalgia/Chronic Fatigue, and Myofascial Pain Syndrome, and trying to do more causes pain and fatigue significant enough to make me stop. I have a treadmill, but I'm not sure what kind of aerobic schedule would be best for affecting blood sugar. > > Vicki Lockwood > Grant City, MO Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 I am glad that you clarified the reasons for controlling your glucose levels since it makes it much easier to answer your question. Based on the the numbers you posted it sounds like you are at very early stage in your diabetes. I have several hundred diabetics in my practice and I emphasize with them that the most important part of the treatment is lifestyle modification which includes regular exercise, diet management and weight loss. In the early phase of diabetes the most important problem is insulin resistance. In this phase the pancreas is often producing large amounts of Insulin but the body is very resistant to its effects. Insulin resistance has been shown to decrease with weight loss (as little as 10 lbs can make a big difference) and exercise. Studies have shown that a single bout of exercise can lower insulin resistance and that this effect may last up to 48 hours. It is difficult to quantify for you how much exercise, what volume or what intensity is necessary to have the effect you desire. I can only say the more daily exercise you can do the greater the effect. I am on my lunch break right now and do not have the time to go into greater detail right now. The whole issue of Insulin resistance is very complex and not fully understood but nevertheless very interesting. As for your testing of your sugars you may be testing more than you need to. I would suggest the following regimen for better efficacy and to save some money. Test in the fasting state (first thing in the morning). This does not have to be done every day. Your fasting glucose level should Ideally be less than 90 but 90-100 is acceptable and 100-110 is tolerable. Test 1 hour after your meals. This is when your glucose levels are going to be at the highest. However you do not have to test after every meal. For instance test after breakfast. Your blood glucose should be no higher than 140-150 1 hr after any meal. If the sugar falls below that range the next time you have the same items for breakfast you do not have to test- you can assume that you will probably be normal each time you have the same breakfast. Test 1 hour after lunch and 1 hour after supper. Make note of what you had to eat and how much. If you find that eating a certain type of meal or combination then you do not have to test every time you eat that meal or combination again. If you find that your glucose levels are above 140-150 then try to determine what item in the meal may have caused your glucose to rise. The culprit will be a form of starch. Next time cut back on the amount of starch. I have had patients tell me that their glucose levels are fine if they limit themselves to 1/2 potato but if they eat the whole potato the sugar goes out of control. Over time you will find out for yourself how much you can tolerate. You may also find that as you increase your exercise tolerance you glucose levels for any given meal will begin to decrease. Concerning your exercise- you can divide your exercise bouts into 3 10 minute sessions through out day if you are unable to exercise more than 10 minutes at a time. Not all exercise has to be formal exercise in a gym or treadmill. Whenever possible walk up stairs instead of taking the elevator, park your car a little farther away when shopping. Take a short walk before or after meals etc. If you have any detailed questions feel free to email me personally. Ralph Giarnella MD Southington, CT --- vicki lockwood wrote: > After reading your questions again, and my long post > about my history, I realize I left out some answers. > I'm type 2 diabetic. No meds so far. I was testing > about once a week and my bg was never over 110. > After seeing it at 151, I'm testing before I eat, > right after I eat, and twenty to thirty minutes > after I eat, though I don't know how long I'll be > able to keep that up since the test strips cost > money and we don't have much. I have about 70 strips > left. After that I may be SOL. > > Vicki Lockwood > Grant City, MO > > Re: Exercise and Blood > Sugar > > > Dear Vicki, > > We need a bit more of your history. Do you have > diabetes? Type 1 > (insulin-dependent) or Type 2 (generally non > insulin-dependent)? Are > you taking any medication? How old are you and how > much do you > weigh? Do you regularly monitor your blood sugar? > How often and > when? > > In general, multiple bouts of exercise in a day, > along with many > small eating periods throughout the day will keep > blood sugar more > even. But there are MANY variables to consider, > not the least of > which is YOUR individual response. > > The difficulty with studies is that there is not > continuous > monitoring of blood sugar, only snapshots. And > numbers of people > studied are usually small and conducted over short > periods of time. > And the number of variables to consider is > lengthy. > > If you were up to studying yourself, you could try > each schedule for > 2-3 weeks; keep detailed records of when, what, > and how much you ate > in relation to your exercise session as well as > the variables of > exercise; and monitor how your own blood sugar > reacted. > > Perhaps Dr. Giarnella will have something to add. > > Merrick, M.A. > Bellevue, NE > ACSM HFI, NSCA CPT/CSCS, NASM CPT > > > > > > I'm wondering if anyone here knows the best use > of exercise to > control blood sugar. I understand that aerobic > exercise lowers blood > sugar. Is it better to exercise fifteen or twenty > minutes several > times a day, or to do it once for sixty minutes? > Is it better to > exercise right after eating, to lower blood sugar > from food intake? > Or does that matter? I have a treadmill, and if I > understand > correctly, a moderate pace, using 60% to 70% of > maximum is better for > lowering or maintaining blood sugar, but that's > about all I know. > > I'm doing weight training six days a week, but > only two muscle > groups a day, using the Eight Minutes In the > Morning guide, because I > have Fibromyalgia/Chronic Fatigue, and Myofascial > Pain Syndrome, and > trying to do more causes pain and fatigue > significant enough to make > me stop. I have a treadmill, but I'm not sure what > kind of aerobic > schedule would be best for affecting blood sugar. > > > > Vicki Lockwood > > Grant City, MO > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 Dr. Giarnella: Thank you so much for the answers. This helps me a lot. So, if I understand correctly, every diabetic is different and I need to experiment with foods and exercise and see what I can tolerate and what I need to limit or eliminate. So, if I happen to eat something that spikes my bg, will hitting the treadmill for 20 minutes affect it? I know you can't make guarantees but if I experiment with food and my bg goes up, I want to be ready to do something about it. I really appreciate your time. Vicki Lockwood Grant City, MO Re: Re: Exercise and Blood Sugar <<<I am glad that you clarified the reasons for controlling your glucose levels since it makes it much easier to answer your question. Based on the the numbers you posted it sounds like you are at very early stage in your diabetes. I have several hundred diabetics in my practice and I emphasize with them that the most important part of the treatment is lifestyle modification which includes regular exercise, diet management and weight loss. In the early phase of diabetes the most important problem is insulin resistance. In this phase the pancreas is often producing large amounts of Insulin but the body is very resistant to its effects. Insulin resistance has been shown to decrease with weight loss (as little as 10 lbs can make a big difference) and exercise. Studies have shown that a single bout of exercise can lower insulin resistance and that this effect may last up to 48 hours. It is difficult to quantify for you how much exercise, what volume or what intensity is necessary to have the effect you desire. I can only say the more daily exercise you can do the greater the effect. I am on my lunch break right now and do not have the time to go into greater detail right now. The whole issue of Insulin resistance is very complex and not fully understood but nevertheless very interesting. As for your testing of your sugars you may be testing more than you need to. I would suggest the following regimen for better efficacy and to save some money. Test in the fasting state (first thing in the morning). This does not have to be done every day. Your fasting glucose level should Ideally be less than 90 but 90-100 is acceptable and 100-110 is tolerable. Test 1 hour after your meals. This is when your glucose levels are going to be at the highest. However you do not have to test after every meal. For instance test after breakfast. Your blood glucose should be no higher than 140-150 1 hr after any meal. If the sugar falls below that range the next time you have the same items for breakfast you do not have to test- you can assume that you will probably be normal each time you have the same breakfast. Test 1 hour after lunch and 1 hour after supper. Make note of what you had to eat and how much. If you find that eating a certain type of meal or combination then you do not have to test every time you eat that meal or combination again. If you find that your glucose levels are above 140-150 then try to determine what item in the meal may have caused your glucose to rise. The culprit will be a form of starch. Next time cut back on the amount of starch. I have had patients tell me that their glucose levels are fine if they limit themselves to 1/2 potato but if they eat the whole potato the sugar goes out of control. Over time you will find out for yourself how much you can tolerate. You may also find that as you increase your exercise tolerance you glucose levels for any given meal will begin to decrease. Concerning your exercise- you can divide your exercise bouts into 3 10 minute sessions through out day if you are unable to exercise more than 10 minutes at a time. Not all exercise has to be formal exercise in a gym or treadmill. Whenever possible walk up stairs instead of taking the elevator, park your car a little farther away when shopping. Take a short walk before or after meals etc. If you have any detailed questions feel free to email me personally.>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 I would like to add to my earlier post several more thoughts. I had not read your long post but congratulations are in order for managing to lose the weight that you lost. Based on the glucose tests you reported I am not sure that you fit the criteria for type II diabetes. The basic criteria is a fasting glucose of greater than 125 or a post prandial blood sugar greater than 200. You probably fit the diagnosis of Pre diabetes or impaired fasting glucose. This is a very important distinction since it has some very important short term and long term repercussions. In Pre diabetes or IFG the individual has increased insulin resistance but the pancreas is able to compensate for this increased insulin resistance by producing much higher amounts of insulin and for this reason the fasting glucose stays in the low 100 range. As time goes on and this condition persists the pancreas begins to fail and at some point it is no longer able to compensate. When this occurs the blood sugars begin to go above 125 in the fasting state and can reach levels of 200-1000. Usually by the time diabetes is diagnosed the patient has had signs of impaired fasting glucose for up to 10 years and at the time of diagnosis the pancreas has lost 50% of its beta cells (the cells that produce insulin). At this point the diabetes is irreversible. The important point for you Vicki is that you can prevent true diabetes by continuing to do what you are doing. If you can increase your exercise tolerance, especially the cardio, and continue to lose weight you may never need medication and avoid all the bad consequences of Diabetes. My recommendation would be to slowly increase your work on the treadmill or walking until you can tolerate 30-45 minutes at a time and preferably a total of 60 minutes daily. You might start with a treadmill workout of 8-10 minutes 2-3 times daily and add 1 minute to each session every 1-2 days. Walk at whatever speed you can tolerate (go as slow as you have to) for that length of time. Once you reach to 30 minutes for a session (no matter how lon it takes) you can slowly increase the speed of your walking. You should try to lose 20-30 lbs a year over the next 2-3 years. If you can get your weight under 150 and your exercise tolerance up to 60 minutes daily you may never need medication to treat Diabetes. It is not easy but as the old saying " you've come a long way baby " (no offense intended) persistance will pay off great dividends. As for your diet I would simply recommend the South Beach diet which is a moderate carb diet with emphasis on fruits and vegetables as the main source of carbs. I would skip to first two weeks of the diet since it is too low in carbs and many find it very difficult. It is important to emphasize smaller meals to avoid overloading the pancreas and the body with too much glucose in one sitting. Diabetes is considered a cardiac disease since most diabetics (80%) at some point develop severe cardiac disease or stroke. The article I posted concerning exercise for cardiac disease prevention applies to diabetics as well. Ralph Giarnella MD Southington, CT --- vicki lockwood wrote: > After reading your questions again, and my long post > about my history, I realize I left out some answers. > I'm type 2 diabetic. No meds so far. I was testing > about once a week and my bg was never over 110. > After seeing it at 151, I'm testing before I eat, > right after I eat, and twenty to thirty minutes > after I eat, though I don't know how long I'll be > able to keep that up since the test strips cost > money and we don't have much. I have about 70 strips > left. After that I may be SOL. > > Vicki Lockwood > Grant City, MO > > Re: Exercise and Blood > Sugar > > > Dear Vicki, > > We need a bit more of your history. Do you have > diabetes? Type 1 > (insulin-dependent) or Type 2 (generally non > insulin-dependent)? Are > you taking any medication? How old are you and how > much do you > weigh? Do you regularly monitor your blood sugar? > How often and > when? > > In general, multiple bouts of exercise in a day, > along with many > small eating periods throughout the day will keep > blood sugar more > even. But there are MANY variables to consider, > not the least of > which is YOUR individual response. > > The difficulty with studies is that there is not > continuous > monitoring of blood sugar, only snapshots. And > numbers of people > studied are usually small and conducted over short > periods of time. > And the number of variables to consider is > lengthy. > > If you were up to studying yourself, you could try > each schedule for > 2-3 weeks; keep detailed records of when, what, > and how much you ate > in relation to your exercise session as well as > the variables of > exercise; and monitor how your own blood sugar > reacted. > > Perhaps Dr. Giarnella will have something to add. > > Merrick, M.A. > Bellevue, NE > ACSM HFI, NSCA CPT/CSCS, NASM CPT > > > > > > I'm wondering if anyone here knows the best use > of exercise to > control blood sugar. I understand that aerobic > exercise lowers blood > sugar. Is it better to exercise fifteen or twenty > minutes several > times a day, or to do it once for sixty minutes? > Is it better to > exercise right after eating, to lower blood sugar > from food intake? > Or does that matter? I have a treadmill, and if I > understand > correctly, a moderate pace, using 60% to 70% of > maximum is better for > lowering or maintaining blood sugar, but that's > about all I know. > > I'm doing weight training six days a week, but > only two muscle > groups a day, using the Eight Minutes In the > Morning guide, because I > have Fibromyalgia/Chronic Fatigue, and Myofascial > Pain Syndrome, and > trying to do more causes pain and fatigue > significant enough to make > me stop. I have a treadmill, but I'm not sure what > kind of aerobic > schedule would be best for affecting blood sugar. > > > > Vicki Lockwood > > Grant City, MO > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 Hi Vicki Congratulations on your weight loss. Just some thoughts that I hope may contribute and I hope that others can help out here. In a recent post by Ralph the improvement in health of cardiac patients and in particular lifestyle through the dancing is wonderful. In addition Carruthers posted two articles on training and neurobiology. In those posts the researchers seemed to conclude that learning new exercises seemed to help cognitive function of those tested and that this improved neural ability helped improved cognitive function of people including those of people suffering from Alzheimer's. Putting two and two together, learning to waltz or ballroom dance with your husband, may help both of you in that it may help with the neural cognitive processes and help your exercise regime. Dancing is also fun and may provide some relief for the difficulties that you must experience as a couple living with Alzheimer's. Regards Nick Tatalias Johannesburg South Africa Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 14, 2006 Report Share Posted November 14, 2006 --- vicki lockwood wrote: > Dr. Giarnella: > Thank you so much for the answers. This helps me a > lot. > So, if I understand correctly, every diabetic is > different and I need to experiment with foods and > exercise and see what I can tolerate and what I need > to limit or eliminate. So, if I happen to eat > something that spikes my bg, will hitting the > treadmill for 20 minutes affect it? I know you can't > make guarantees but if I experiment with food and my > bg goes up, I want to be ready to do something about > it. > > I really appreciate your time. > > Vicki Lockwood > Grant City, MO <<So, if I happen to eat something that spikes my bg, will hitting the treadmill for 20 minutes affect it?>> A simple answer to your question is yes, exercise will help lower your blood sugar. With regards to food, I tell my patients that it is not so much what you eat but how much you eat at a given meal that affects your blood glucose. The more active you are the easier it will be to maintain proper levels of blood glucose because physical activity helps to lower insulin resistance. The main function of Insulin is to maintain a normal blood glucose level. In the normal individual this blood glucose should be in the 70-90 range in the fasting state. After a meal a normal individual can expect the blood glucose to reach levels as high as 140 approximately 1 hr after a meal and return back to below 100 approximately 2 hrs after a meal. These numbers are only approximate since the rate of absorption of nutrients is dependent on various factors that affect the digestive tract. I alluded to this in my previous post several months ago concerning the digestion of foods. I many individuals there is a condition known as Insulin resistance. Insulin resistance is a very interesting and complex condition. The amount of insulin resistance varies between individuals and there are multiple factors that influence the degree of insulin resistance. There may be a genetic component to insulin resistance, exercise or lack of exercise affects insulin resistance, excess visceral fat increases insulin resistance, muscle mass or lack of muscle mass affects insulin resistance. Stress may increase insulin resistance. It is estimated that from the time of the early manifestation of insulin resistance to onset of full blown irreversible diabetes there may be a span of 10 years. In the early stages of insulin resistance blood sugars fall within the normal ranges noted above because the pancreas is able to compensate by producing more insulin. However over time the pancreas begins to lose its ability to compensate and is no longer able to produce enough insulin to maintain a normal blood sugar. Why this occurs is not fully understood but there are many factors that contribute to this. It is estimated that by the time the fasting blood sugars are found to be in the low 100 (100-110) the pancreas has lost about 10% of its beta cells (the cells that produce insulin). At this point the individual has a condition referred to as Impaired Fasting Glucose. This is not Diabetes but is often called pre-diabetes. Vicki, I believe, based on the glucose numbers you reported, that you are presently not a Diabetic but rather you are in the pre-diabetes condition. The good news is that with proper intervention, namely increased physical activity and weight loss you can prevent the condition from worsening, decrease your insulin resistance and hopefully never become Diabetic, or at least delay the onset for many years. As I stated earlier Diabetes is diagnosed when the fasting glucose exceeds 125 and glucose levels after meals exceeds 200. At this point it is estimated that the pancreas has lost approximately 50% of its beta cells. The patient at this point will probably be on several very expensive oral medications and have numerous complications associated with Diabetes. If the pancreas continues to lose beta cells and is no longer able to produce Insulin the patient will become a type I Diabetic and require insulin injections to maintain proper blood glucose levels. When I was in medical school in the late 60’s type II diabetes was considered a disease only seen in patients over the age of 60. Twenty years ago we began seeing type II diabetes in patients in the their 40’s. We are now seeing type II diabetes in teens and even in children. Why? Lack of physical activity and obesity- This ,for the most part, is a very preventable disease. Ralph Giarnella MD Southington, CT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 14, 2006 Report Share Posted November 14, 2006 Dr. Giarnella: This really is good news. I really appreciate your time. One more question and I'll go away and leave you alone for a while. Thanksgiving is coming and everyone knows what that means. So my question is, if I go crazy and eat potatoes and dressing and pie and my bg goes up, will that one time do damage that can't be reversed? I know the body can repair itself given the right circumstances. I'm going to a friend's house for the holiday and I've already seen the menu. I could graze all day, or eat like a...well...pig. Which is worse? I guess that's two questions. I've got to say I love this site. You're the second person here who has shared info that has changed my life!! Vicki Lockwood Grant City, MO Re: Exercise and Blood Sugar --- vicki lockwood wrote: > Dr. Giarnella: > Thank you so much for the answers. This helps me a > lot. > So, if I understand correctly, every diabetic is > different and I need to experiment with foods and > exercise and see what I can tolerate and what I need > to limit or eliminate. So, if I happen to eat > something that spikes my bg, will hitting the > treadmill for 20 minutes affect it? I know you can't > make guarantees but if I experiment with food and my > bg goes up, I want to be ready to do something about > it. > > I really appreciate your time. > > Vicki Lockwood > Grant City, MO <<So, if I happen to eat something that spikes my bg, will hitting the treadmill for 20 minutes affect it?>> A simple answer to your question is yes, exercise will help lower your blood sugar. With regards to food, I tell my patients that it is not so much what you eat but how much you eat at a given meal that affects your blood glucose. The more active you are the easier it will be to maintain proper levels of blood glucose because physical activity helps to lower insulin resistance. The main function of Insulin is to maintain a normal blood glucose level. In the normal individual this blood glucose should be in the 70-90 range in the fasting state. After a meal a normal individual can expect the blood glucose to reach levels as high as 140 approximately 1 hr after a meal and return back to below 100 approximately 2 hrs after a meal. These numbers are only approximate since the rate of absorption of nutrients is dependent on various factors that affect the digestive tract. I alluded to this in my previous post several months ago concerning the digestion of foods. I many individuals there is a condition known as Insulin resistance. Insulin resistance is a very interesting and complex condition. The amount of insulin resistance varies between individuals and there are multiple factors that influence the degree of insulin resistance. There may be a genetic component to insulin resistance, exercise or lack of exercise affects insulin resistance, excess visceral fat increases insulin resistance, muscle mass or lack of muscle mass affects insulin resistance. Stress may increase insulin resistance. It is estimated that from the time of the early manifestation of insulin resistance to onset of full blown irreversible diabetes there may be a span of 10 years. In the early stages of insulin resistance blood sugars fall within the normal ranges noted above because the pancreas is able to compensate by producing more insulin. However over time the pancreas begins to lose its ability to compensate and is no longer able to produce enough insulin to maintain a normal blood sugar. Why this occurs is not fully understood but there are many factors that contribute to this. It is estimated that by the time the fasting blood sugars are found to be in the low 100 (100-110) the pancreas has lost about 10% of its beta cells (the cells that produce insulin). At this point the individual has a condition referred to as Impaired Fasting Glucose. This is not Diabetes but is often called pre-diabetes. Vicki, I believe, based on the glucose numbers you reported, that you are presently not a Diabetic but rather you are in the pre-diabetes condition. The good news is that with proper intervention, namely increased physical activity and weight loss you can prevent the condition from worsening, decrease your insulin resistance and hopefully never become Diabetic, or at least delay the onset for many years. As I stated earlier Diabetes is diagnosed when the fasting glucose exceeds 125 and glucose levels after meals exceeds 200. At this point it is estimated that the pancreas has lost approximately 50% of its beta cells. The patient at this point will probably be on several very expensive oral medications and have numerous complications associated with Diabetes. If the pancreas continues to lose beta cells and is no longer able to produce Insulin the patient will become a type I Diabetic and require insulin injections to maintain proper blood glucose levels. When I was in medical school in the late 60's type II diabetes was considered a disease only seen in patients over the age of 60. Twenty years ago we began seeing type II diabetes in patients in the their 40's. We are now seeing type II diabetes in teens and even in children. Why? Lack of physical activity and obesity- This ,for the most part, is a very preventable disease. Ralph Giarnella MD Southington, CT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 14, 2006 Report Share Posted November 14, 2006 The following article may help with this discussion. Ralph Giarnella MD Southington, CT ************* Exercise and Calorie Cutting Lower Diabetes Risk Equally  By Neil Osterweil, MedPage Today Staff Writer Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. November 08, 2006  Review ST. LOUIS, Nov. 8 -- Eat less? Exercise more? For diabetes prevention, it's a toss up. Decreasing caloric intake and increasing activity are equally effective at improving glucose tolerance and insulin sensitivity, reported researchers here. " Both diet and exercise provide profound benefits to reduce the risk of diabetes, " said Weiss, Ph.D., of Saint Louis University, and colleagues. " Both those who restrict calories and those who exercise benefit from weight loss. " " We thought exercise probably would produce greater benefits, " Dr. Weiss said. " But both of these are providing beneficial health improvements. " In a year-long study, Dr. Weiss and colleagues evaluated nonobese, healthy adults in their 50s who were part of a longevity study. The participants were at the high end of normal in terms of body mass index. The investigators wanted to see whether energy expenditures achieved through exercise could both produce weight loss and further improve glucose tolerance and insulin action through mechanisms independent of weight loss. They enrolled 46 sedentary men and women from the ages of 50 to 60 with BMIs of 23.5-29.9 kg/m2. The participants were randomly assigned to either 12 months of exercise training or 12 months of calories restriction (18 in each group). The remaining 10 participants were assigned to a healthy lifestyle intervention as controls. The intervention consisted of advice for a healthy diet if requested, plus free passes to an offsite yoga facility to use at their option, although few took advantage of the classes or advice, the investigators noted. All participants underwent oral glucose tolerance tests at baseline and at 12 months to measure insulin sensitivity and areas under the curve for both glucose and insulin. The investigators also measured the glucoregulatory factors adiponectin and tumor necrosis factor ?, and used dual-energy x-ray absorptiometry to measure fat mass. Members of the caloric restriction group met weekly with a dietitian who helped them with individual meal plans, portion-size reduction, and substitution of low-calorie density foods for high-calorie ones. The goal was a 16% reduction in calorie intake for the first three months, and a 20% restriction for the remainder. The dieters were monitored with food diaries and with the doubly labeled water test, a measure of metabolism. The exercise group members met weekly with an exercise trainer and had open access to a fitness center. They exercised for 60 to 90 minutes daily and tracked their progress on a heart-rate monitor that also recorded calories burned. " As they got fit, the treadmill could be speeded up, " Dr. Weiss said. " They could exercise on a steeper grade and they could burn more calories. All of them learned very quickly the most efficient way to burn more calories was through cardio. If they pushed themselves, the numbers added up quickly. " The authors found that while the exercisers had more rapid results, there were no significant differences in energy deficits between the exercise and diet groups at one year, as shown by changes in body weight and fat mass. In both the exercise and caloric restriction groups the insulin sensitivity index increased and the glucose and insulin areas under the curve decreased from baseline to the end of the study. There were no significant differences between exercisers and dieters. Among controls, however, insulin sensitivity, glucose, and insulin measured remained unchanged at one year. In addition, there were " marginally significant " increases in adiponectin, and decreases in the ratio of TNF-? to adiponectin among the exercisers and calorie cutters, but not among controls. The authors concluded that " weight loss induced by exercise training or calorie restriction improves glucose tolerance and insulin action in non-obese, healthy, middle-aged men and women. However, exercise-induced weight loss does not appear to be greater than that induced by calorie restriction. " Dr. Weiss said that it's still not known whether the combination of exercise and caloric restriction will be able to provide greater benefits that either intervention alone. The research was funded by the National Institutes of Health. Primary source: American Journal of Clinical Nutrition Source reference: Weiss EP et al. " Improvements in glucose tolerance and insulin action induced by increasing energy expenditure or decreasing energy intake: a randomized controlled trial. " Am J Clin Nutr; 84: 1033 Quote Link to comment Share on other sites More sharing options...
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