The practical experience and diabetes

Exercise is frequently recommended in the treatment of diabetes mellitus. Recent studies have improved our understanding of the acute and long-term metabolic and hormonal effects of physical activity in both healthy controls and in people with diabetes. In insulin dependent diabetes mellitus (IDDM), exercise by itself does not have a significant effect on overall glycaemic control and should be encouraged primarily for its nonglycaemic benefits. Hyperglycaemia is the predominant risk associated with exercise in individuals in IDDM and can be reduced by adjusting the insulin and diet prescription in response to information obtained from frequent self-monitoring of blood glucose. In contrast, in non-insulin dependent diabetes mellitus (NIDDM), exercise improves one of the most prominent basic pathophysiologic features of this condition, namely, insulin resistance and, as a consequence, is an important component of management along with diet and/or drug therapy. In addition to the positive effects on overall glycaemic control, exercise in NIDDM also results in non-glycaemic benefits in these patients. The subgroup of NIDDM individuals who have mild moderately impaired glucose tolerance appears most likely to benefit from exercise. However, because people with NIDDM frequently have other concurrent medical conditions, the adverse effects of exercise, particularly in relation to cardiac risks, must be monitored. In both IDDM and NIDDM, appropriate medical screening and patient education before starting on an exercise programme are mandatory to achieve the best quality of life. It is an important component of the management of diabetes, but its role in the therapy for NIDDM and IDDM is clearly distinct. Since exercise programmes have not been shown to have a significant independent beneficial effect on glycaemic control in IDDM subjects, the emphasis must be on developing strategies to allow safe participation in exercise consistent with their lifestyles. Exercise is encouraged in IDDM for its importantly nonglycaemic benefits. Individuals with IDDM should be appropriately screened and educated before starting and exercise have to be individualized, general guidelines regarding frequency of self monitoring of blood glucose, nutrient adjustment, insulin dose regimen modification, and the choice of injection site are appropriate. The majority of diabetic patients have NIDDM.(AU)