Journal of Clinical Diabetes
Open Access

Diabetes mellitus; Glucose metabolism; Insulin; Physical exercises; Hypoglycaemia

Introduction

Diabetes mellitus is a condition in which there is decrease in the insulin production or decrease in the glucose utilization. T1-DM is a chronic condition in which beta cells of pancreas known as islets of Langerhans produce no or little insulin. In type 1-DM, there are numerous factors which are responsible for the increase in the blood glucose level scientifically termed as diabetes mellitus. Addition of the physical activity in the daily lifestyle could be a boon for a person to stay healthy physically, emotionally, and mentally, physical exercises bring mental peace and also reduce the risk of various diseases. Such as diabetes mellitus, hypertension, coronary artery disease etc.

For type 1-DM, the management is solely based on the insulin therapy, diet, and regular exercise. The role of physical exercise in DM type-1 is something which is not very latest information but its somewhere started from ancient ayurvedic physician susrutashamita (born around 600 B.C) who says that regular physical exercise reduces the sweetness of urine in diabetic patient [1,2]. A scientist Joslin talked about “troika” which means group of insulin, diet and exercise is the treatment of DM type-1 [3]. Another scientist Lawrence signifies that regular physical exercise balances the glucose uptake and requirement of insulin to neutralize the increased glucose level [4]. Diabetes association has recommended competitive sports, pranayama, yoga beneficial for hyperglycaemia, lipid profile, insulin resistance [5- 8]. There are several studies evaluating the effect of physical activity, physical fitness, aerobic and anaerobic exercises in which some studies are positively correlates the physical exercise in controlling TIDM [9- 14] while others disagree [15-21]. Insulin is a hormone which usually maintains the blood glucose level so when there is destruction in the islets of Langerhans insulin level decreases and blood glucose level rises which cause T1-DM, commonly occurred symptoms are polyurea, polydipsia, increased appetite, and weight loss.

Physical Fitness

Robert et al. [22, 23] observed that there is an increase in the body metabolism that regularly does aerobic exercise which was confirmed by performing aerobic capacity test by using PWC170 and aerobic power index submaximal test. These test shows that there was an increase in physical fitness after 12 weeks.

D’hooge et al. [24] performed a study which revealed that the children who regularly involved in the physical activities required less oxygen to complete the same tasks and also take less time which them physically more active and fit.

Another study performed by the Salem et al. (2010) which evaluate blood lipid level in two groups after 24-hour duration, the study evaluates the improvement in the lipid profile after the session of physical exercise. The study resembles with another study performed by the A, ouadi et al. [25].

Quality of Life

Overall, the literature illustrates that there is positive effect of physical exercise in improving quality of life of an individual as shown in (Figure 1). A study conducted in 2013 among 106 children and adolescent which shows a positive correlation off physical exercise and VO2max in which r = 0.208 but the correlation between quality of life and physical exercise goes entirely opposite [26].

Figure 1: Benefits of exercise in type 1 diabetes mellitus.

There are many factors which are also responsible open trolling type 1 diabetes mellitus in the individual who are physically active and are consistent as depicted in (Figure 2) [27].

Figure 2: Showing TID factors affecting exercise blood glucose responses.

Exercise Related Factors Affecting Glucose Level

Glucose metabolism depends greatly on types of exercises, its duration and of course intensity. These three factors will give different outcome according to the involvement. For example, type of exercises and its effect is shown in the (Figure 3). Getting involved in a particular exercise for a long duration leads to more utilization of glucose and may cause hypoglycaemia. Also, large hormonal variation has been observed in athletics with T1-DM [28,29]. Variation in the intensity of exercise have different outcomes, involvement in high intensity exercise leads to more release of counter regulatory hormones such as Glucagon and epinephrine which causes prolonged increase in blood glucose level [30,31].

Figure 3: Effect of different type of exercise.

Table 1. Superfood helps in controlling Diabetes Mellitus.

How the Latest Technique help in Diabetes Management

A number of new and latest technology are available now which keeps an individual more concern and updated for their physical health and related measures search as heart rate, blood oxygen, calories expended, total steps, also diabetes related devices are available such as [32]:

Calculators for exercise: The primary object of exercise calculators in T1DM is to prevent both hypoglycaemia and hyperglycaemia during the exercise and 24 to 48 hours following exercise [33]. Calculator will provide following benefits:

• It forecast hypoglycemia and hyperglycaemia based on the time of food intake and those of insulin intake [34,35].

• Suggest changes according to the condition by correcting dose and frequency.

• Make a plan of use of medication according to the previous input of glucose level [36].

Pattern recognition and learning

For an effective working out device it is necessary that it should show the real time data of all the physiological system physiological system such as heart rate, calorie intake. The correct input of data help in analysing changes and actual requirement of insulin or to increase the physical activity [37,38].

This operation is carried out with the help of mathematical and algorithms which give a real direction in the management of type one diabetes mellitus.

Artificial pancreas system

Use of all the other methods and even administration of insulin has seemed to increase the risk of hypoglycaemia.

A controversial study says that together insulin and Glucagon is helpful for this condition, but it is not fully acceptable [39-45]. Using APS is highly effective in controlling hypoglycaemia alone without any additional insulin delivery [46-50].

This has established by researchers after collecting data using APS that individual participated in mid-afternoon exercises at least 60 minutes of brisk walking produces a risk of hypoglycaemia [51].

Nutritional advice: meal plans, nutritional types, and hydration

A diabetic patient must consume between 50 and 60 percent of their daily calories as carbohydrates. The timing of the workout and the insulin dosage should be matched. This strategy is essential for achieving appropriate glycemic control, maintaining muscle mass, and storing hepatic and muscular glycogen, as well as for improving exercise performance, lowering tiredness, and avoiding problems.

Patients with T1DM should adhere to the following food guidelines before exercising:

A) Consuming 200-350 g (4 g/kg) of carbohydrates three to six hours before to exercise. This suggestion has been shown to enhance physical performance. Despite the fact that T1DM patients should consume 60–90 g of carbohydrates per meal, diabetics who are training must consume more carbohydrates per meal, monitor their blood glucose levels, and, if necessary, adjust their insulin dosage to increase their glycogen stores before competitions and physical activities.

B) One hour prior to activity, consuming an additional 1g of carbohydrate per kilogram of body weight is advised. Low-fat foods and beverages should be chosen over others.

C) A 15g snack consumed 15 to 30 minutes prior to the activity has been found to be sufficient if the exercise lasts less than 45 minutes.

Strategies to sustain glucose oxidation and avoid a drop in glycogen storage can be employed throughout physical activity lasting longer than 45 minutes, or even after it has ended.

Conclusion

The aim of this study is to increase the awareness of physical activity among the individuals of all age group since this busy schedule and sedentary lifestyle has made all of us very inactive and slothful, which is the topmost reason of various life-threatening disease and disorders including diabetes mellitus.

This study briefed about the fitness, quality of life and various Superfood through which non pharmacologically we can control high blood glucose level. Regular exercise among youth gives both physical and psychological fitness since psychological problems specially depression, anxiety is quite common in youth due to emotional breakdown in this condition yoga and meditation works magically.

1. Lukacs A, Barkai L (2015) Effect of aerobic and anaerobic exercises on glycemic control in type 1 diabetic youths. World J Diabetes 6: 534-42.

Indexed at, Google Scholar, Crossref

2. Tremblay M S, LeBlanc A G, Kho M E, Saunders T J, Larouche R et al. (2011) Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act.

Indexed at, Google Scholar, Crossref

3. Joslin E P (2021) The prevention of diabetes mellitus. JAMA 325: 190.

Indexed at, Google Scholar, Crossref

4. Lawrence R D (1928) The effect of exercise on insulin action in diabetes. Br Med J 1: 648-50.

Indexed at, Google Scholar, Crossref

5. Herbst A, Bachran R, Kapellen T, Holl R W (2006) Effects of regular physical activity on control of glycemia in pediatric patients with type 1 diabetes mellitus. Arch Pediatr Adolesc Med 160: 573-7

Indexed at, Google Scholar, Crossref

6. Miculis C P, Mascarenhas L P, Boguszewski M, Campos W D (2010) Physical activity in children with type 1 diabetes. Jornal de pediatria 86: 271-8.

Indexed at, Google Scholar, Crossref

7. Schmitz K H, Jacobs D R, Hong C P, Steinberger J, Moran A et al. (2002) Association of physical activity with insulin sensitivity in children. Int J Obes Relat Metab Disord 26: 1310-1316.

Indexed at, Google Scholar, Crossref

8. Bernard Z, Neil R, Barbara N C, John T D, Stephen H S (2003) Physical activity/exercise and diabetes mellitus. Diab care 1; 26.

Indexed at, Google Scholar, Crossref

9. Zoppini G, Carlini M, Muggeo M (2003) Self-reported exercise, and quality of life in young type 1 diabetic subjects. Diabetes Nutr Metab 16: 77-80.

Indexed at, Google Scholar

10. Massin M M, Lebrethon M C, Rocour D, Gèrard P, Bourguignon J P (2005) Patterns of physical activity determined by heart rate monitoring among diabetic children. Arch Dis Child 90: 1223-1226.

Indexed at, Google Scholar, Crossref

11. Valerio G, Spagnuolo M I, Lombardi F, Spadaro R, Siano M, Franzese A (2007) Physical activity and sports participation in children and adolescents with type 1 diabetes mellitus. Nutr Metab Cardiovasc Dis 17: 376-382.

Indexed at, Google Scholar, Crossref

12. Schweiger B, Klingensmith G, Snell-Bergeon J K (2010) Physical activity in adolescent females with type 1 diabetes. Int J Pediatr.

Indexed at, Google Scholar, Crossref

13. Lukacs A, Mayer K, Juhász E, Varga B, Fodor B et al. (2012) Reduced physical fitness in children and adolescents with type 1 diabetes. Pediatr Diabetes 13: 432-437.

Indexed at, Google Scholar, Crossref

14. Lukacs A, Mayer K, Török A, Kiss-Tóth E, Barkai L (2013) Better cardiorespiratory fitness associated with favourable metabolic control and health-related quality of life in youths with type 1 diabetes mellitus. Acta Physiol Hung 100: 77-83.

Indexed at, Google Scholar, Crossref

15. Zinman B, Zuniga G S, Kelly D (1984) Comparison of the acute and long-term effects of exercise on glucose control in type I diabetes. Diabetes Care 7: 515-519.

Indexed at, Google Scholar, Crossref

16. Raile K L, Kapellen T H, Schweiger A, Hunkert F R, Nietzschmann U (1999) Physical activity and competitive sports in children and adolescents with type 1 diabetes. Diabetes care 22: 1904-1905.

Indexed at, Google Scholar, Crossref

17. Roberts L, Jones T W, Fournier P A (2002) Exercise training and glycemic control in adolescents with poorly controlled type 1 diabetes mellitus. J Pediatr Endocrinol Metab 15: 621-627.

Indexed at, Google Scholar, Crossref

18. Sarnblad S, Ekelund U, Aman J (2005) Physical activity and energy intake in adolescent girls with type 1 diabetes. Diabet Med 22: 893-899.

Indexed at, Google Scholar, Crossref

19. Skinner T C, Cameron F, Swift P G, Aman J, Aanstoot H et al. (2009) Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere Study Group on Childhood Diabetes. Pediatr Diabetes 10: 234-239.

Indexed at, Google Scholar, Crossref

20. Edmunds S, Roche D, Stratton G (2010) Levels, and patterns of physical activity in children and adolescents with type 1 diabetes and associated metabolic and physiologic health outcomes. J Phys Act Health 7: 68-77.

Indexed at, Google Scholar, Crossref

21. Galler A, Lindau M, Ernert A, Thalemann R, Raile K (2011) Associations between media consumption habits, physical activity, socioeconomic status, and glycemic control in children, adolescents, and young adults with type 1 diabetes. Diabetes Care 34: 2356-2359.

Indexed at, Google Scholar, Crossref

22. Roberts L, Jones T W, Fournier P A (2002) Exercise training and glycemic control in adolescents with poorly controlled type 1 diabetes mellitus. J Pediatr Endocrinol Metab 15: 621-627.

Indexed at, Google Scholar, Crossref

23. Absil H, Baudet L, Robert A, Lysy P A (2019) Benefits of physical activity in children and adolescents with type 1 diabetes: a systematic review. Diabetes Res Clin Pract.

Indexed at, Google Scholar, Crossref

24. Roseline D , Hellinckx T, Laethem C, Stegen S, Schepper J eta l. (2011) Influence of combined aerobic and resistance training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial. Clin Rehabil 25: 349-359.

Indexed at, Google Scholar, Crossref

25. Aouadi R, Khalifa R, Aouidet A, Mdini F, Bahri S et al. (2011) Aerobic training programs and glycemic control in diabetic children in relation to exercise frequency. J Sports Med Phys Fitness 51: 393-400.

Indexed at, Google Scholar

26. Fox K R (2004) At least five a week: Evidence on the impact of physical activity and its relationship to health–A report from the Chief Medical Officer.

Google Scholar

27. Colberg S R, Laan R, Dassau E, Kerr D (2015) Physical activity and type 1 diabetes: time for a rewire? J Diabetes Sci Technol 9: 609-618.

Indexed at, Google Scholar, Crossref

28. Koivisto V A, Sane T, Fyhrquist F, Pelkonen R (1992) Fuel and fluid homeostasis during long-term exercise in healthy subjects and type I diabetic patients. Diabetes Care 15: 1736-1741.

Indexed at, Google Scholar, Crossref

29. Turner D, Luzio S, Gray B J, Dunseath G, Rees E D et al. (2015) Impact of single and multiple sets of resistance exercise in type 1 diabetes. Scand J Med Sci Sports 25: 99-109.

Indexed at, Google Scholar, Crossref

30. Fahey A J, Paramalingam N, Davey R J, Davis E A, Jones T W et al. (2012) The effect of a short sprint on postexercise whole-body glucose production and utilization rates in individuals with type 1 diabetes mellitus. J Clin Endocrinol Metab 97: 4193-4200.

Indexed at, Google Scholar, Crossref

31. Adolfsson P, Nilsson S, Albertsson‐Wikland K, Lindblad B (2012) Hormonal response during physical exercise of different intensities in adolescents with type 1 diabetes and healthy controls. Pediatr Diabetes 13: 587-596.

Indexed at, Google Scholar, Crossref

32. Walsh J, Roberts R, Bailey T (2011) Guidelines for optimal bolus calculator settings in adults. J Diabetes Sci Technol 5: 129-135.

Indexed at, Google Scholar, Crossref

33. Walsh J, Roberts R, Heinemann L (2014) Confusion regarding duration of insulin action: a potential source for major insulin dose errors by bolus calculators. J Diabetes Sci Technol 8: 170-178.

Indexed at, Google Scholar, Crossref

34. Dube M C, Lavoie C, Weisnagel S J (2013) Glucose or intermittent high-intensity exercise in glargine/glulisine users with T1DM. Med Sci Sports Exerc 45: 3-7.

Indexed at, Google Scholar, Crossref

35. Campbell M D, Walker M, Trenell M I, Jakovljevic D G, Stevenson E J et al. (2013) Large pre-and postexercise rapid-acting insulin reductions preserve glycemia and prevent early-but not late-onset hypoglycemia in patients with type 1 diabetes. Diabetes Care 36: 2217-2224.

Indexed at, Google Scholar, Crossref

36. Tang M, Donaghue K C, Cho Y H, Craig M E (2013) Autonomic neuropathy in young people with type 1 diabetes: a systematic review. Pediatr Diabetes 14: 239-248.

Indexed at, Google Scholar, Crossref

37. Facchinetti A, Sparacino G, Guerra S, Luijf YM, DeVries J H et al. (2013) Real-time improvement of continuous glucose monitoring accuracy: the smart sensor concept. Diabetes care 36: 793-800.

Indexed at, Google Scholar, Crossref

38. Facchinetti A, Sparacino G, Cobelli C (2013) Signal processing algorithms implementing the “smart sensor” concept to improve continuous glucose monitoring in diabetes. J Diabetes Sci Technol 7: 1308-1318.

Indexed at, Google Scholar, Crossref

39. Harmer A R, Chisholm D J, McKenna M J, Hunter S K, Ruell P A et al. (2008) Sprint training increases muscle oxidative metabolism during high-intensity exercise in patients with type 1 diabetes. Diabetes care 31: 2097-2102.

Indexed at, Google Scholar, Crossref

40. Russell S J, Khatib F H, Sinha M, Magyar K L, McKeon K et al. (2014) Outpatient glycemic control with a bionic pancreas in type 1 diabetes. N Engl J Med 371: 313-325.

Indexed at, Google Scholar, Crossref

41. Khatib F H, Russell S J, Magyar K L, Sinha M, Nathan D M et al. (2014) Autonomous and continuous adaptation of a bihormonal bionic pancreas in adults and adolescents with type 1 diabetes. J Clin Endocrinol Metab 99: 1701-1711.

Indexed at, Google Scholar, Crossref

42. Damiano E R, Khatib F H, Zheng H, Nathan D M, Russell S J (2013) A comparative effectiveness analysis of three continuous glucose monitors. Diabetes Care 36: 251-259.

Indexed at, Google Scholar, Crossref

43. Russell S J, El-Khatib F H, Nathan D M, Magyar K L, Jiang J (2012) Damiano ER. Blood glucose control in type 1 diabetes with a bihormonal bionic endocrine pancreas. Diabetes care 35: 2148-2155.

Indexed at, Google Scholar, Crossref

44. Ward W K, Castle J R, Youssef J E (2011) Safe glycemic management during closed-loop treatment of type 1 diabetes: the role of glucagon, use of multiple sensors, and compensation for stress hyperglycemia. J Diabetes Sci Technol 5: 1373-1380.

Indexed at, Google Scholar, Crossref

45. Haidar A, Legault L, Dallaire M, Alkhateeb A, Coriati A et al. (2013) Glucose-responsive insulin and glucagon delivery (dual-hormone artificial pancreas) in adults with type 1 diabetes: a randomized crossover-controlled trial. CMAJ 185: 297-305.

Indexed at, Google Scholar, Crossref

46. Zisser H, Renard E, Kovatchev B, Cobelli C, Avogaro A et al. (2014) Multicenter closed-loop insulin delivery study points to challenges for keeping blood glucose in a safe range by a control algorithm in adults and adolescents with type 1 diabetes from various sites. Diabetes Technol Ther 16: 613-622.

Indexed at, Google Scholar, Crossref

47. Kovatchev B P, Renard E, Cobelli C, Zisser H C, Keith-Hynes P et al. (2014) Safety of outpatient closed-loop control: first randomized crossover trials of a wearable artificial pancreas. Diabetes care 37: 1789-96.

Indexed at, Google Scholar, Crossref

48. Finan D A, McCann T W, Rhein K, Dassau E, Breton M D et al. (2014) Effect of algorithm aggressiveness on the performance of the Hypoglycemia-Hyperglycemia Minimizer (HHM) system. J Diabetes Sci Technol 8: 685-690.

Indexed at, Google Scholar, Crossref

49. Doyle F J, Huyett L M, Lee J B, Zisser H C, Dassau E (2014) Closed-loop artificial pancreas systems: engineering the algorithms. Diabetes care 37: 1191-1197.

Indexed at, Google Scholar, Crossref

50. Nimri R, Muller I, Atlas E, Miller S, Kordonouri O et al. (2014) Night glucose control with MD‐Logic artificial pancreas in home setting: a single blind, randomized crossover trial—interim analysis. Pediatr diabetes 15: 91-9.

Indexed at, Google Scholar, Crossref

51. Sherr J L, Cengiz E, Palerm C C, Clark B, Kurtz N et al. (2013) Reduced hypoglycemia and increased time in target using closed-loop insulin delivery during nights with or without antecedent afternoon exercise in type 1 diabetes. Diabetes care 36: 2909-2914.

Indexed at, Google Scholar, Crossref