Prior meal enhances the plasma glucose lowering effect of exercise in type 2 diabetes

Purpose: To compare the changes in plasma glucose and insulin levels in response to 1 h of exercise performed at 60% of VO 2peak either in the fasted state or 2 h after a standardized breakfast in subjects with type 2 diabetes. Methods: Ten sedentary men with type 2 diabetes treated with oral agents and not under strict metabolic control were tested on two occasions (fasted and fed state) in a random order at a 1-wk interval. Results: Plasma glucose was slightly but not significantly higher at the beginning of exercise performed in the fed state versus the fasted state (12.4 ± 1.3 vs 11.1 ± 1.1 mmol.L -1 respectively; mean ± SE, P = 0.06). However, after exercise, plasma glucose levels were much lower in the fed state (7.6 ± 1.1 mmol.L -1 ) compared with the fasted state (10.0 ± 1.0 mmol.L -1 ; P = 0.009). Insulin levels were higher at the beginning of the exercise bout performed in the fed state (177 ± 26 vs 108 ± 19 pmol.L -1 ; P < 0.05) and during exercise. Similar respiratory exchange ratio at identical workload indicated that the difference in glycemic response was not due to differences in whole body substrate utilization. Plasma concentrations of free fatty acids, glucagon, epinephrine, and norepinephrine were also similar during both experiments. Conclusions: One hour of aerobic exercise has a minimal impact on plasma glucose level when performed in fasted moderately hyperglycemic men with type 2 diabetes but induces an important decrease in plasma glucose level when performed 2 h after breakfast. Because glucose utilization increased similarly during exercise in both conditions, the higher insulin levels after the meal might have blunted glucose production, creating an imbalance between total glucose production and total peripheral utilization in the fed state in contrast to the fasted state.