. Evidence Based Treatment of Type 2 Diabetes Over the past few years evidence in the treatment of Type 2 Diabetes has revealed that the combination of exercise and diet modification can result in successful treatment of Type 2 Diabetes.
For a list of evidence based podcasts and research papers supporting the treatment of Type 2 Diabetes please visit the Members Area and also the Research and Evidence Page.
What is Type 2 Diabetes? Type 2 diabetes is a progressive condition in which the body becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce enough insulin in the pancreas. We do not know what causes type 2 diabetes. Type 2 diabetes is associated with modifiable lifestyle risk factors. Type 2 diabetes also has strong genetic and family related risk factors. Type 2 diabetes is diagnosed when the pancreas does not produce enough insulin (reduced insulin production) and/or the insulin does not work effectively and/or the cells of the body do not respond to insulin effectively (known as insulin resistance).
What is the role of the hormone insulin? Insulin, a hormone that the pancreas makes, allows cells to absorb and use glucose. In people with insulin resistance, the cells are unable to use insulin effectively.
What is insulin resistance? A resistance to the hormone insulin, resulting in increasing blood sugar.
The hormone insulin helps control the amount of sugar (glucose) in the blood. With insulin resistance, the body's cells don't respond normally to insulin. Glucose can't enter the cells as easily, so it builds up in the blood. This can eventually lead to type 2 diabetes.
What else can cause insulin resistance ? The following are risk factors for insulin resistance, prediabetes, and diabetes:
being overweight or having obesity, especially when the extra weight is around the midriff
a sedentary lifestyle or one that is low in exercise
How Does Increased Insulin Levels Affect Weight Management ? Insulin is the primary regulator of carbohydrate, fat, and protein metabolism . It inhibits lipolysis of stored fat in the adipose tissue and gluconeogenesis in the liver. A summarized version of this process is that whilst insulin levels are high, the body is unable to use adipose tissue fat for fuel as the body is seeking its glucose as fuel. It is this block to fat breakdown after a meal high in carbohydrate, that makes it more difficult for weight loss to occur if exercise is the only treatment being used for weight loss and type 2 diabetes management. A solution to this problem is to remove the item that is causing the blockade to fat oxidation, which in this case , is increased insulin levels.
The 2 hormones we discuss during exercise consults at Brainfit, are insulin and cortisol, and how an exercise program can be designed to ensure the best use of exercise for weight management and type 2 diabetes.
In summary, exercise can assist with managing cortisol levels, decreasing stress and at the same time, if exercise can be completed during periods of lower insulin production, then the likelihood of using fat for fuel will be increased.
Let's talk about cortisol..
What is cortisol? Cortisol, a glucocorticoid (steroid hormone), is produced from cholesterol in the two adrenal glands located on top of each kidney. It is normally released in response to events and circumstances such as waking up in the morning, exercising, and acute stress. Cortisol’s far-reaching, systemic effects play many roles in the body’s effort to carry out its processes and maintain homeostasis.
How does cortisol effect blood sugar? (source) Cortisol is a steroid hormone also secreted from the adrenal gland. It makes fat and muscle cells resistant to the action of insulin, and enhances the production of glucose by the liver. Under normal circumstances, cortisol counterbalances the action of insulin.
Cortisol inhibits insulin production in an attempt to prevent glucose from being stored, favoring its immediate use.
High serum cortisol levels are significantly associated with decreased ß-cell function,These results suggest that higher serum cortisol levels are a risk factor for future incidence of diabetes ( Kamba et. al 2016)
Chronically elevated cortisol can lead to insulin resistance, and insulin resistance can lead to chronically elevated cortisol. It is also thought that insulin resistance is a major contributing factor to polycystic ovarian syndrome (PCOS), which makes sense because insulin resistance causes increased testosterone in women. Chronically elevated cortisol also impairs the liver’s abilities of conjugating excess hormones and removing them from the body.
What Effects Cortisol Levels? The following lifestyle issues and illness will effect cortisol production:
High sugar consumption
Pituitary gland issues
Exercise for the Treatment of Type 2 Diabetes
It is important to understand that exercise alone may not be a successful treatment to assist with the management of Type 2 Diabetes.
Exercise and lifestyle change such as dietary modification has been shown to assist with management of the following bio-markers listed below.
Where possible, your exercise physiologist will ask to see initial blood tests that may include the following:
At Brainfit Exercise Physiology, we encourage clients to learn about these bio-markers and what they mean for health. By assisting clients to learn more about the role of these scores in managing health, clients/ patients often become more engaged in the important of daily exercise as they are able to observe improvements in their health. This can help to take the focus off weight loss, and body image during the initial months of an exercise plan and is especially helpful for clients/ patients who have not had a positive relationship with exercise programs in the past.
The effect of exercise on these scores will be discussed with each client/ patient with the aim to increase client engagement in exercise. A progressive and sustainable exercise program will be developed with each client/ patient depending on the number of consults each client attends.
IMPORTANT NOTE In the case of only 1-2 visits being allocated to exercise physiology, the role of insulin and cortisol on blood sugar management and how exercise and lifestyle modification can assist in these areas will be the primary area of focus
How Can Exercise Combined with Lifestyle Modicication Help?
Exercise assists with the treatment of Type 2 Diabetes by increasing " insulin sensitivity" and which then assists with managing blood glucose. Exercise combined with dietary modification has also been shown to improve blood pressure, triglyeride scores, normalise insulin scores and assist with the management of cortisol production. Where possible a review 3 months and 6 months will be requested from your GP, after starting and exerciser and lifestyle program . Changes in these bio-markers will be be discussed with your by your GP and a report outlining the effect exercise and lifestyle may have had on these bio-markers will be forwarded to your GP.
What are the normal values for markers such as triglycerides, blood glucose and insulin? Download the norms for biomarkers here
References Association between Higher Serum Cortisol Levels and Decreased Insulin Secretion in a General Population Kamba, A., Daimon, M., Murakami, H., Otaka, H., Matsuki, K., Sato, E., Tanabe, J., Takayasu, S., Matsuhashi, Y., Yanagimachi, M., Terui, K., Kageyama, K., Tokuda, I., Takahashi, I., & Nakaji, S. (2016). . PloS one, 11(11), e0166077. https://doi.org/10.1371/journal.pone.0166077