Authors: Galbo, Henrik; Tobin, Lillan; van Loon, Luc J.C.

Source: Applied Physiology, Nutrition, and Metabolism, Volume 32, Number 3, June 2007 , pp. 567-575(9)

Publisher: NRC Research Press

Abstract:

In people with type 1 diabetes mellitis (DM), insulin administration, food intake, and exercise have to be carefully matched to avoid either hypo- or hyperglycemia. People with type 2 DM have some insulin secretion, which changes with needs. Accordingly, during exercise, these people do not run the same metabolic risks as people with type 1 DM. However, a contraction-mediated increase in glucose clearance in muscle is intact in type 2 DM. Therefore, , in the postabsorptive state in diet-treated type 2 DM, a marked reduction in hyperglycemia can occur during prolonged moderate exercise. Sulfonylurea drugs augment the rate of decline in plasma glucose, because stimulation of insulin secretion reduces hepatic glucose production. After abstention from sulfonylurea for 5days, the rate of decrease in plasma glucose with exercise is also enhanced, but from a higher glucose level. In the postabsorptive state, brief vigourous exercise elicits an increase in plasma glucose concentration, reflecting an exaggerated counterregulatory hormone response and glucose production. Moreover, insulin sensitivity is reduced in the early postexercise period. In the postprandial state, both prolonged moderate exercise and intermittent high-intensity exercise markedly decrease meal-induced increases in glucose, insulin, and C-peptide concentrations, whereas glucose appearance in plasma is unchanged. When exercise bouts are isocaloric, responses are identical, indicating that overall energy expenditure, and not peak exercise intensity, is the major determinant of exercise-induced changes in overall glucose homeostasis and insulin secretion in type 2 DM. Neither prolonged moderate nor intermittent high-intensity exercise performed in the postprandial state influences glucose or insulin responses to a subsequent meal. Finally, in people with type 2 DM, after a high-fat meal, prolonged moderate exercise reduces the exaggerated increases in plasma concentrations of triglycerides contained in chylomicrons and very low-density lipoproteins.

Chez les diabétiques de type 1, il faut bien harmoniser l'administration de l'insuline, de l'apport alimentaire et de l'activité physique pour éviter l'hypoglycémie ou l'hyperglycémie. Comme les diabétiques de type 2 sécrètent un peu d'insuline dont le taux varie selon le besoin, ils ne courent pas les mêmes risques métaboliques au cours d'une activité physique que les diabétiques de type 1. Chez les patients, on observe encore l'augmentation de la clairance du glucose causée par la contraction musculaire. Par conséquent, on peut observer chez des patients de type 2 suivant un régime alimentaire une diminution substantielle de l'hyperglycémie au cours d'une activité physique d'intensité modérée et de durée prolongée en période postabsorptive. Les sulfamides hypoglycémiants augmentent le taux de clairance du glucose plasmatique, car la stimulation de la sécrétion de l'insuline diminue la production hépatique de glucose. Lorsque les patients cessent de prendre des sulfamides sur une période de cinq jours, ils affichent aussi une diminution de la concentration plasmatique de glucose au cours de l'effort physique, mais la concentration initiale est plus élevée. En période postabsorptive, un bref effort intense cause une augmentation de la concentration plasmatique de glucose, ce qui s'explique par une contre-régulation amplifiée de la réponse hormonale et de la production de glucose. De plus, on observe une diminution de la sensibilité au début de la période de récupération consécutive à l'effort physique. En période postprandiale, on observe que l'exercice physique d'intensité modérée et de bonne durée de même que l'exercice physique de forte intensité et de nature intermittente réduisent substantiellement l'augmentation des concentrations de glucose, d'insuline et de peptides C causée par le repas, et ce, sans variation de l'apparition plasmatique de glucose.

Document Type: Research article

Publication date: 2007-06-01

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• This bimonthly journal has a 30-year history of publishing, first as the Canadian Journal of Sport Sciences, and later as the Canadian Journal of Applied Physiology. It publishes original research articles, reviews, and commentaries, focussing on the application of physiology, nutrition, and metabolism to the study of human health, physical activity, and fitness. The published research, reviews, and symposia will be of interest to exercise physiologists, physical fitness and exercise rehabilitation specialists, public health and health care professionals, as well as basic and applied physiologists, nutritionists, and biochemists.
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