Asking for some real world guidance is a reasonable request, but one that in my experience does seem to be beyond the relevant authorities. This applies to a range of conditions, although there does seem to be a glimmer of hope that things may be moving in the right direction.Hi Richard,
The biggest problem and barrier I've encountered when trying to evaluate and plan exercise since being diagnosed T2 is getting good detailed information that is specific to diabetes. There is no book, no website and no good YouTube channel that spells out the what, when and why in a way that is focussed specifically on what I would assume every diabetic wants as the primary outcome - blood glucose levels that are close to normal as possible for as much of the time as possible.
In my own case I've found for example, after reading on this forum and trying it for myself, that going for a walk beginning 30 to 45 minutes after eating can have a significant effect in lowering my blood glucose levels at times when they would otherwise climb quite high. Very useful information that I read about nowhere else. It may not work for everyone but it works for me. Presumably the exercise lowers insulin resistance in muscle tissue and the muscles sponge glucose up from the blood rapidly as I work them. This has given me a little more freedom with what I can eat, so long as I know I can go for a walk afterwards. All well and good - this demonstrates to me how useful a tool exercise can be - but how do I go about maximizing this effect? Would it be better to spend time lifting weights to build and maintain more muscle to work while I walk, or would it be better to improve my fitness to the point where I could go for a run instead of a walk after eating? Which approach represents time and effort better spent?
Perhaps the answer is both, or neither - perhaps the adrenaline spike produced by more intense exercise, with it's accompanying rise in blood glucose levels, negates the benefit that I'm trying to achieve. Perhaps the duration of the exercise is the most important factor and the BG-flattening effect would stop as soon as I stopped exercising whether I was walking or running. I suspect the answer is 'it depends on the person and the circumstances' but I'm finding it very difficult to find good expert advice to guide me. I don't want to spend a year doing progressive resistance training only to find it has little or no effect. I tried wading through scientific papers on things like the lasting effects of exercise on insulin resistance in muscle tissue to try to figure out the best path forward, and I'm still lost. Build muscle, or run fast? Gym membership or rowing machine? Or save my money and my time and just keep walking. If there was one thing I would like to get from such a programme, if I was lucky enough to be offered such a thing, it would be a manual - a book to study with all I need to know to plan a tailored exercise programme, backed by facts and the real-world experiences of diabetics. I'm pretty sure that's too much to askBravo for coming on a forum to learn more by the way - it shows real dedication.
With glucose and the body, there is actually very little in the blood, about a teaspoon’s worth generally speaking, and not a huge amount in storage either. Glucose is stored in the muscle cells and in the liver too, and that’s about it.
That gives 3 choices of what to do when glucose levels are higher than you’d like them to be.
- Stop adding to what’s already there – low carb eating.
- Use up what is already there – exercise and daily activity.
- Find a way to store more glucose so it’s kept out of the blood,
For option 2, how the body produces energy determines how much glucose gets used. Fat and glucose are the main fuels for exercise, fat producing energy slowly, but for a long time, glucose producing it quickly, but for a shorter amount of time.
This is why you can’t sprint a marathon, you can’t produce the energy required to power a sprint level effort for more than a few minutes.
In reality, both fuels are being used all the time, but the proportion at which each is used alters depending how quickly energy needs to be produced.
When exercising at slower, steadier efforts like a walk, energy can be created at a slower sustainable rate, so there’s no need for the liver to release extra glucose. Test readings still drop though, as glucose will be used, just in smaller amounts.
For efforts where a lot of energy needs to be created quickly, the muscles will burn through glucose quickly. In turn, this sends a message to the liver that more is likely to be needed, so it releases glucose into the blood stream; this is the spike in glucose levels that people notice when they test.
I must say here, that this spike is a perfectly normal response to higher intensity exercise, that occurs with everyone, whether diabetic or not.
This study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587394/ looks at the effect of High Intensity Exercise on glucose levels during and post exercise.
The findings were that yes, HIE does raise blood glucose levels during the exercise bout (as you’d expect), but lowers it for 24 hours afterwards.
Furthermore, a 2 week programme of sprints (which is very little time really), reduced the average blood glucose level by 13% at 48 to 72 hours after exercise and also increased GLUT4 (one of the transporters that takes glucose into the muscle) by 369%.
So both longer/slower exercise and shorter/faster exercise lower blood glucose, but at different rates and for different time periods.
Option 3, is increasing the amount of glucose your body can store, which means increasing the size of the store cupboard.
As said earlier, it’s mainly the liver and skeletal muscle that store glucose; enlarging the liver probably isn’t a good idea, which leaves increasing the size of your muscles, which is where some form of resistance training comes in.
This doesn’t mean becoming a bodybuilder, think of it more like athletic training to improve ability for sport.
It doesn’t really matter what type of resistance (bodyweight, machines, free weights), as long as the muscles get worked, you can progress the work you do, and most importantly, you enjoy it.
So, the answer is that all of them work as management tools and all are different, complimentary parts of an overall fitness plan.
They don’t all need to be used at the same time either, and particularly with “endurance” type activities, with an increasing intensity scale of 1 to 10, people often only consider using 1 or 10, ignoring efforts in between, all of which add value; it’s often the range of intensities that work the magic.
You have my apologies if you’ve gotten this far. If it was too waffly, feel free to ask for clarifications.
