Diabetics Develop Higher Blood Sugar During Exercise
Nov. 18, 1999 (Santa Cruz, Calif.) -- Insulin-dependent diabetics who take
part in sports may need to take more insulin after intense exercise rather than
less, contrary to conventional wisdom.
A new study, published in the November issue of the Journal of Clinical
Endocrinology and Metabolism, shows that insulin-dependent diabetics, known
as type 1 diabetics, are likely to see an increase in their blood sugar, not a
decrease, after an intense bout of physical exertion.
It is healthy for blood sugar to rise during exercise because the muscles
need the excess fuel to compensate for the increased demand placed upon them.
But in most people the body will adjust after exercising and bring the blood
sugar levels back to normal. That is not the case for a type 1 diabetic,
because their bodies will not circulate enough insulin, which is required to
convert the sugar in the blood.
"Anyone who is competitive, who is doing a sprint, playing hockey,
[playing] basketball ... is at significant risk of developing high sugar as a
consequence of their exercise," study investigator Errol Marliss, MD, tells
WebMD. Marliss is professor of medicine and director of the McGill Nutrition
and Food Science Center at the Royal Victoria Hospital in Montreal.
"There's a big difference in the blood [sugar] response depending on the
intensity of exercise," Marliss says. "The classic teaching about
[exercise by a diabetic] who is insulin-treated is, 'Look out, because your
blood sugar is going to go down; you may have to either take extra carbohydrate
or less insulin.' [But] a lot of very athletic, type 1 diabetic people have
been telling their doctors for years, 'Look, Doc, I'm getting [too much blood
sugar] when I exercise,'" Marliss says, "and that is a predictable
consequence of higher intensities of exercise."
"Intense exercise makes you put out anti-insulin hormones," says
Stanley Feld, MD, chairman of the task force of the American Association of
Clinical Endocrinologists (AACE), who reviewed the study for WebMD. That's
normal, and a healthy person will secrete enough insulin after exercise to
lower the excess blood sugar no longer needed by the muscles. That is not the
case with a type 1 diabetic.
To show this, the researchers tested six diabetic young men who had been
diagnosed and treated for type 1 diabetes since childhood. None displayed any
evidence of diabetic complications; all had excellent diabetes control, and all
engaged regularly in sports and weight training. The researchers took steps to
ensure that the diabetics had normal levels of insulin in their blood before
exercising, so that their blood sugar was at a healthy level.
The participants underwent cycling tests to the point where they were unable
to continue because of muscle exhaustion. They were then compared to other
participants in the study who did not have diabetes. By testing people with
type 1 diabetes whose blood sugar was healthy before exercise, the researchers
found that after the cycle test their blood sugar remained higher when compared
to the healthy control group.