Exercise in the treatment of type 1 diabetes

ABSTRACT

REVIEW OF FUEL METABOLISM DURING AND AFTER EXERCISE Increased skeletal muscle glucose uptake induced by exercise *regional effects (exercised vs nonexercise muscle) *type of exercise (concentric vs eccentric). Importance of skeletal muscle glycogen depletion and replention in glucose homeostatis. Role of the liver in glucose production *hormonal control. Ketone body metabolism *importance of ambient insulin and counterregulatory *hormone concentrations at the onset of exercise. Amino metabolism *acute catabolic effects of exercise *post-exercise anabolic effects of exercise. METABOLIC RESPONSE TO EXERCISE IN TYPE 1 DIABETES Glycaemic response to acute exercise *dependence on ambient insulin concentratios *effects of intensity and duration of exercise *accelerated ketogenesis in the insulin-deprived state *intact net protein anabolic effect following exercise *altered mechanisms in the insulin-deprived state. CLINICAL EFFECTS OF PHYSICAL EXERCISE IN TYPE 1 DIABETIC SUBJECTS: Risks of hypoglycaemia *during exercise *following exercise, long-term benefits of increased physical activity *glycaemic control * cardiovascular risk factor reduction, Risk of worsening diabetic complications due to exercise *retinopathy *proteina *neuropathy *peripheral *autonomic *cardiovascular disease. CLINICAL STRATEGIES TO PREVENT METABOLIC DECOMPENSATION BY EXERCISE Carbohydrate intake *before and during exercise *following evening exercise. MULTIPLE DOSING OF INSULIN (MDI) REGIMENS adjustments of short-acting insulin preparations for exercise, regular vs humalog (lispro) insulin, insulin pump (CSII) therapy, regular vs humalog insulin. RESOURCES FOR THE PATIENT AND THE HEALTH CARE PROFESSIONAL published materials, International Diabetes Athletes' Association (IDAA).(AU)