Diabetes – MedFitNetwork

Pre-diabetes – A Wellness Opportunity To Help

Dr. Michael Arloski/23 October 2023/ All MFN blog, Conditions/

There is an opportunity for wellness and wellness coaching to impact the lives of millions of people in a life-saving way. 79 million Americans are estimated to have a condition called pre-diabetes. Usually symptom free, without intervention they will develop full-fledged Type II diabetes within ten years and possibly endure physical damage to their heart and circulatory system along the way. Yet, according to the American Diabetes Association, if a person is successful at lifestyle improvement they can completely avoid the onset of diabetes 70% of the time.

Healthy Aging: How Beginner’s Yoga Can Help You Live an All Around Healthier Life

Kaitlin Krull/3 May 2023/ All MFN blog, Conditions/

While most of us know that regular exercise is an important part of overall health, it can be difficult to make our bodies perform in the ways we think are necessary in order to feel the physical benefits. This is especially true as we age, when muscles and organs begin to work differently and we lose flexibility and mobility. Beginner’s yoga is the perfect remedy for addressing these limitations as we age. With both physical and mental benefits, the regular practice of yoga, at any level, can help you to live an all around healthier life. Here are just a few of the best reasons to take up yoga now, regardless of the number on your birthday card.

Physical Benefits

Many people begin practicing yoga in order to reap the physical benefits of the exercise. These are some of the ways yoga improves your physical health:

Increases stamina, flexibility, and mobility
The regular practice of yoga strengthens muscles and joints, allowing you to achieve more with your body, which is especially important as you age. It increases stamina, flexibility, and mobility, together with balance and coordination, which provides an effective yet gentle total body workout.

Helps encourage weight loss
We all know that increased physical exercise, when coupled with a healthy diet, can help you to achieve weight loss success when repeated regularly. This is also true for yoga. Once you begin to strengthen some of those forgotten muscles and joints, you will be able to practice yoga at a higher calorie burning level.

Alleviates physical ailments
Yoga practitioners around the world sing the praises of the exercise’s ability to remedy a number of physical ailments, some of which are particularly prevalent as you age. Regular yoga, even at the beginner’s level, can help to alleviate symptoms of heart conditions, blood flow and circulation issues, and muscle, bone, and joint problems. This kind of physical exercise also lowers cholesterol and blood sugar, thereby lowering your risk for other related health issues like diabetes and stroke.

Mental Benefits

If you weren’t convinced to begin practicing yoga by the physical benefits alone, check out the ways in which yoga can increase mental health as well.

Relaxes mind as well as body
The repetitive and meditative style of yoga is called upon time and again to help relax both the body and the mind. Poses performed at the beginning and end of yoga routines in particular are focused at calming the mind and relaxing the muscles in your body. This relaxation cannot be underestimated when it comes to the state of your mental health and well being.

Gives focus and awareness
Repeated exercises like those found in beginner’s yoga classes are designed to focus and sharpen your mind, increasing both your awareness of the world around you as well as your concentration levels. This can be especially beneficial for very busy people, older adults, and even energetic children, who find that yoga helps them to focus their train of thought and remain calm even in the most stressful of situations.

Relieves stress
Calming thoughts and repeated poses that are common to yoga have the ability to release tension in the body, giving focus to the practitioner. This focus allows positive thought, which logically relieves stress. Lowered stress levels are good for everyone, but best of all they have positive knock-on effects with regards to your physical health too, making yoga an all around positive practice for a healthier life

Kaitlin Krull is a writer and mom of two girls living the expat life in the UK. Her writing is featured on Modernize.com and a number of fitness, health, and home decor sites around the web. She’s a yoga enthusiast of 5 years and loves anything that promotes a healthy mental state and positive lifestyle.

How Exercise May Be the Only Way to Curb the Diabetes Epidemic

Eric Durak/23 August 2021/ All MFN blog/

The incidence rate of type 2 diabetes has been increasing in the United States for the past 40 years. In fact, the American Diabetes Association estimates that at least half of all US adults (over 65 million people) have pre-diabetes or full-blown diabetes. It is often underreported on death certificates, and is probably the third leading cause of premature death in the US.

So why is there such an increase in diabetes in this country? The biggest reason is diet.

From a young age, children are eating processed food. When they enter school – lunchrooms in many school districts are sponsored with food from McDonald’s, Pizza Hut, and Coca Cola. In college – most dorm food is also like fast food, and they can eat as much as they want. That and their foray into alcohol, and we have the beginnings of obesity, insulin resistance, and pancreatic damage. The very concept of type 2 diabetes used to be called “adult diabetes”. Since many teenagers are now diagnosed, it’s now time to change the name.

One would say that if diabetes is a disease of the foods that you eat, then simply change the foods you eat. Not that simple. Once you’re diagnosed with diabetes, you become a ward of the medical system. Doctors will perform a lot of tests, take blood, and prescribe both insulin and drugs to mimic the glucose-lowering effects of the body, and many spend a minimal amount of time counseling on the right type of diet for your needs.

There are, in fact, many good diets to lower blood sugar, like the well-known Keto diet, which emphasizes higher fats and low carbohydrates. This is something that doctors have been prescribing in one form or another since the Atkins diet in the 1960s. What about vegetarian and vegan diets? If you ask Dr. John McDougall, one of the nation’s leading plant-based doctors, he would advocate that a diet higher in plant-based carbohydrates is better for the body than high amounts of meat and cooking oils.

Both may have a point, but if you look at the food choices that most Americans have, they walk into a grocery store, and if they’re not savvy enough to shop on the outside isles (fruits, vegetables, meats, cheeses), they are trapped in an endless cycle of boxed cereals, candy bars, frozen foods, soft drinks and alcohol. It is almost impossible to go to a store and not pick up about 50-75% of food from a box, bucket or bottle. Many still haven’t put two and two together — that the foods they eat now will have an effect on their physiology and medical status in 5-20 years.

So what’s missing? I have been in an interesting position of working in diabetes research in the 1980s, and watching from the sidelines the work, research, and policy in this area of medical care for the past 30 years. Here are my thoughts.

First, although exercise is touted as part of the trilogy of treatment for diabetes (along with diet and insulin), it is the first to be discarded for another type of treatment that is expedient and profitable.

Second, there are little, if any, referrals to the health club sector in order to work on basic exercise programs for persons with diabetes. Even moderate types of programming will results in dramatic drops in body weight (and fat), daily blood sugars, and A1c levels. It simply is not being done. Many in allied health scream that personal trainers and fitness instructors are not qualified to teach exercise programs for diabetes. With the advent of medical fitness over the past 20 years, this simply isn’t the case today. I would think that having a mechanism to get patients into health clubs through their health plan, or Medicare, or a revolving door policy with their physician group, would be an outstanding way to get more patients into the exercise routine.

Third, people who work in the fitness industry should be looking very carefully in getting diabetic persons into their facilities in their communities. This takes an effort with health club trainers, club managers and company owners to reach out to the medical community through health programs, lectures, fairs and membership discounts in order to get patients in the door. It may even entail home exercise visits, or online coaching where patients are taught programs, and keep their exercise routines times and exercise notes.

Lastly, the fitness industry needs to move into the technology realm and look at the effects of exercise on patients both over 3-4 weeks, but also 3-4 years. This will be done through outcomes-based software programs that can be detailed to physicians, health plans, and sports medicine journals. Once the majority of medical fitness centers and health clubs are on board, we will see a changing of the guard in terms of what Americans think is the best type of treatment program to reduce diabetes symptoms, and look at the data of how people exercise, and how many of their health risks are being reduced by a challenging and consistent exercise program. This can be done at any age, and at almost every state of diabetes — whether they are newly diagnosed, or have basic complications that they are dealing with regarding long-standing diabetes.

It is time to embrace exercise as part of a diabetes prevention and reduction strategy. If not, in 20 years we will probably see the epidemic at such a high level, that a good portion of Americans will not be able to work due to their complications. The costs to society will be even higher than they are now. It’s a risk we don’t need to take, because of the untapped market of over 31,000 health clubs in the US, there is virtually no reason not to engage in exercise. It would seem that our nation’s health depends on our next steps – literally.

Eric Durak is President of MedHealthFit – a health care education and consulting company in Santa Barbara, CA. A 25 year veteran of the health and fitness industry, he has worked in health clubs, medical research, continuing education, and business development. Among his programs include The Cancer Fit-CARE Program, Exercise Medicine, The Insurance Reimbursement Guide, and Wellness @ Home Series for home care wellness.

The Pharmacologics of Exercise: Yes, Exercise Is Medicine!

Nicholas A. DiNubile, MD/18 June 2021/ All MFN blog/

It’s been said: “If all the benefits of exercise could be placed in a single pill, it would be the most widely prescribed medication in the world.” Scientific evidence continues to mount supporting the numerous medicinal benefits of exercise. In fact, there’s hardly a disease that I can think of that exercise won’t help in one way or another, be it prevention, treatment, or even cure in some instances.

Senior man in a gym talking to personal trainer

Sarcopenia & Diabetes: Untangling the Connections

Today's Geriatric Medicine/9 March 2021/ All MFN blog/

Muscle loss is a significant quality-of-life issue for patients with diabetes.

Diabetes is extremely common in the older adult population, affecting more than one-quarter of Americans aged 65 and older.(1) It’s increasingly recognized that individuals with type 2 diabetes—who comprise the vast majority of all diabetes cases—are vulnerable to sarcopenia—excessive age-related muscle loss. Although muscle loss can begin in persons with diabetes even at younger ages, it’s of particular concern among older adults.

“People with diabetes are living longer now, which is incredibly exciting,” says Rita Kalyani, MD, MHS, an associate professor of medicine in the division of endocrinology, diabetes, and metabolism at Johns Hopkins School of Medicine. But “it’s important to recognize [the potential for accelerated muscle loss] because it can significantly impact quality of life for people with diabetes and also mortality.”

What Is Sarcopenia?

Muscle loss is natural with advancing age. It is routine for individuals to lose 3% to 8% of their muscle mass per decade beginning at age 30, and the rate of decline is even higher after the about age 60.2 Muscle strength declines even more rapidly—at a rate of 3% to 4% per year in men and 2.5% to 3% per year in women by the age of 75.3

While some muscle loss is typical, sarcopenia refers to a condition of accelerated muscle loss. Earlier definitions of sarcopenia focused exclusively on loss of muscle mass as the key determinant of the condition, but more recent definitions have recognized that muscle strength and function are equally important for predicting adverse outcomes.(4-6) Thus, newer definitions for sarcopenia have included low walking speed and grip strength alongside low muscle mass.(5) Sarcopenia is associated with an increased risk of falls, functional decline, frailty, and mortality.(7)

How Strong Is the Connection Between Diabetes and Sarcopenia?

The link between diabetes and sarcopenia is well established. In a study of 810 Korean adults, 15.7% of participants with diabetes were found to have sarcopenia, compared with just 6.9% of participants without diabetes.(8) A later study led by the same author, also in Korea, produced similar findings: in a sample of 414 adults aged 65 or older, participants with type 2 diabetes had significantly lower muscle mass (defined as appendicular mass/height) than did those without diabetes.(9) A link between low muscle mass and diabetes has been found in several other populations as well.(5,10)

Multiple studies have also linked diabetes to reduced muscle strength. In a cross-sectional investigation of 1,391 adults aged 60 to 70 years from the Hertfordshire (UK) cohort study, men newly diagnosed with diabetes had significantly lower grip strength than did those without diabetes.11 The effect sizes were smaller in women, but the trend was the same for both genders. Similarly, among 1,840 participants aged 70 to 79 years in the Health, Aging, and Body Composition study, subjects with type 2 diabetes showed a greater loss of both muscle mass and a greater loss of leg strength and leg muscle quality (though not arm strength/quality) over three years, compared with those without diabetes.(12) These declines were attenuated after adjustment for demographics, body composition, physical activity, and other factors, but the association remained significant.

The association between sarcopenia and diabetes has led some researchers to argue that sarcopenia is probably one of the underlying mechanisms that explains the reduced functional ability and mobility that is often seen in older patients with type 2 diabetes.(13)

Mechanisms: How Diabetes Contributes to Sarcopenia

While diabetes accelerates the process of muscle loss, the mechanisms aren’t yet thoroughly understood. “There are probably multiple underlying pathways linking the observational findings that we see between type 2 diabetes and accelerated loss of muscle,” Kalyani says.

The presence of insulin resistance, which is the key feature of type 2 diabetes, appears to be a major pathway. “Insulin resistance is associated with decreased protein synthesis in the muscle,” Kalyani says. One of the key roles of insulin is to drive nutrients (ie, glucose) from the blood into skeletal muscle tissue and stimulate protein synthesis. In type 2 diabetes, however, insulin signaling is impaired; insulin is not able to effectively drive glucose into the muscle tissue, and the muscle cannot synthesize new protein rapidly enough to keep pace with natural muscle degradation.(13)

Insulin resistance is linked not only to decreased protein synthesis but also to mitochondrial dysfunction. Individuals with diabetes frequently have decreased mitochondrial function, which again appears to contribute to the impairment of muscle function (possibly in part because these mitochondrial alterations may increase insulin resistance).(5)

Diabetes can also promote sarcopenia via peripheral neuropathy. Approximately 30% to 50% of diabetes mellitus patients experience peripheral neuropathy, and the condition has been shown to be an independent risk factor for sarcopenia in individuals with diabetes.(14) “Nerves are needed to help the muscles contract properly,” says John Morley, MD, a professor of medicine in the division of geriatric medicine at the Saint Louis University School of Medicine. “My leg muscles are almost certainly contracting as I sit here. If I’ve got some degree of neuropathy, I won’t get the same amount of contraction.”

Still other factors also may play a role in causing muscle loss in the context of diabetes. People with diabetes frequently have higher than normal levels of inflammatory cytokines, including tumor necrosis factor and interleukin.(6) Such cytokines have been shown to have negative impacts on both muscle mass and strength in older adults.(15) In addition, “people with diabetes are also more likely to have hypothyroidism, and people with hypothyroidism get a myopathy of the legs as well,” Morley says. “So you should always be thinking, if you see a diabetic who’s lost a lot of muscle, ‘Could this be due to something else, like low thyroid’?”

Thus, a wide variety of factors likely contribute to the connection between diabetes and sarcopenia. Some data suggest that these varying mechanisms come into play even in individuals who are comparatively young or who are comparatively early in the disease process. Kalyani and her colleagues examined a group of 984 participants from the Baltimore Longitudinal Study of Aging and found that loss of muscle function as a result of hyperglycemia was seen in some patients who were only in their 40s. Interestingly, peripheral neuropathy appeared to be a contributing factor. Also of note in this investigation is the fact that hyperglycemia affected muscle strength and quality even for patients with blood glucose levels in the prediabetes range.(16)

A Bidirectional Association: How Muscle Loss Can Lead to Diabetes

Until recently, scholarly attention on the connection between diabetes and sarcopenia has focused on diabetes as a cause of sarcopenia. “Clinically the direction that we think about most is accelerated muscle loss being a complication of diabetes—that people who have diabetes develop accelerated muscle loss over time,” Kalyani says. “But it’s possible that the reverse direction is also true.”

Kalyani herself explored this hypothesis in a recent study of 1,855 US adults (baseline mean age of 58.9 years). She and her colleagues found that men—though not women—who had a higher percentage of total or leg lean body mass had a lower risk of developing diabetes over the seven-year average follow-up period, even after adjusting for race.(17) The findings are in line with a previous study of young and middle-aged Korean adults (median age of 39 years at baseline) showing that individuals in the lowest quartile of relative muscle mass had a two-fold higher risk of developing diabetes than did those in the highest quartile over an average of nearly three years of follow up.(18)

According to Kalyani, the findings make sense. “Skeletal muscle is the main site of glucose uptake in the body after we eat,” accounting for about 80% of glucose clearance in a healthy individual. “So if we don’t have enough skeletal muscle, then the glucose is not taken up by the body, and it stays in the blood. As a result, your glucose levels are higher, and over time that could lead to the development of diabetes,” Kalyani says.

A recent review on the bidirectional relationship between diabetes and sarcopenia supports Kalyani’s hypothesis, arguing that loss of skeletal muscle mass and function is both a cause and a consequence of diabetes. As for how muscle loss can cause diabetes, the review supports Kalyani’s assertion that muscle loss results in a diminished target for insulin, altering glucose regulation. But the review also notes another mechanism by which muscle loss can lead to diabetes—namely, it can contribute to a decreased metabolic rate and a decrease in physical activity, which can cause inter- and intramuscular adipose tissue accumulation, in turn leading to insulin resistance.(19)

One of the difficulties associated with type 2 diabetes is that the disease doesn’t necessarily produce obvious symptoms in the early stages, meaning that some patients may not be diagnosed until after they have already developed cardiovascular problems.

However, the recognition that loss of muscle strength predicts risk of diabetes has led to new possibilities for diagnosing type 2 diabetes in its earlier stages. A recent study led by researchers at Oakland University in Rochester, Michigan, used data from more than 5,000 participants in the National Health and Nutrition Examination Surveys to identify specific cut points of handgrip strength that take into account age, sex, and body weight and that indicate the presence of type 2 diabetes in adults that appear otherwise healthy.(20) According to the authors, these cut points can be a useful screening tool for identifying diabetes at earlier stages and getting patients into treatment sooner.

The Role of Blood-Glucose Management in Preventing Muscle Loss

The growing body of research on the connection between diabetes and sarcopenia has raised an important question: Does lowering blood glucose help preserve muscle mass?

According to Morley, there’s little research on that question, but diabetes medications that control blood glucose levels likely do have a role to play in treating (and preventing) muscle loss among older adults with diabetes. “If you’re using something like metformin or the gliptins, those improve insulin resistance. Improving insulin resistance will allow you to get more nutrients into your muscle tissue.”

The question of whether lowering blood glucose helps prevent sarcopenia is relevant because most clinical practice guidelines for older adults with diabetes recommend less aggressive glucose control as people get older. “The older adult population is heterogenous—there are some people who have long life expectancy, some have greater life expectancy, some are at greater risk for polypharmacy or hypoglycemia,” Kalyani says. “So in general glucose targets for older adults are not as strict as they are for younger adults.”

Unfortunately, Kalyani says, it’s possible that these relaxed targets may exacerbate muscle loss in vulnerable older adults. Key clinical trials on which clinical management guidelines for blood glucose have been based haven’t usually included older adults, so there’s no way to know at present. According to Kalyani, future research is needed to better understand the effects of glucose-lowering on muscle mass in older adults.

The Importance of Exercise

While diabetes medications may have a role to play in lowering blood glucose and in staving off muscle loss, Morley is adamant that no medication is as beneficial for treating sarcopenia as physical exercise. “The major treatment is resistance exercise,” Morley says. “You can argue that aerobic exercise is also useful, but if you’re going to do anything as a diabetic, you want to do resistance exercise to build your muscle bulk.” For older adults with sarcopenia, the key exercises he recommends are walking around the block four to five times, doing some weight lifting, and sitting in a chair and getting up ten times in a row as fast as possible.

Kalyani agrees on the importance of activity. “Physical exercise is always recommended,” in part to promote fat loss and maintain muscle mass, both of which can improve glucose levels. Those recommendations apply equally to both younger and older adults, she says. “As long as they can tolerate the exercise they are doing, we definitely recommend that, particularly muscle strengthening exercise and resistance activity.”

Recommendations for Clinicians

• Take seriously the fact that patients with type 2 diabetes are vulnerable to muscle loss. “Accelerated muscle loss is an underappreciated condition that occurs in people with type 2 diabetes. I don’t think it’s well recognized,” Kalyani says. One reason for the under-recognition, she says, is that most providers who treat diabetes aren’t geriatricians and thus aren’t as likely to be familiar with age-related muscle loss and how it can affect mobility. “It needs to be better recognized in clinical practice that this occurs at greater frequency in people with diabetes,” she says.

• Screen all individuals with diabetes for sarcopenia. Everyone aged 50 or older should also be screened, even if they don’t have diabetes, Morley says. “You can argue, ‘Well, I don’t really need to do that, I just need to get them out exercising, and they’ll do well,’ but people don’t do well if you don’t give them a diagnosis.”

As for a specific screening tool, Morley recommends SARC-F. This screen contains five questions that focus on a patients’ ability to lift and carry 10 pounds, their ease in walking across a room, their ease in rising from a chair, their ability to climb a flight of stairs, and the number of falls they have had in the last year. The questionnaire and scoring instructions are available at cgakit.com/sarc-f-questionnaire.

• Spend time making sure patients understand the importance of exercise. “Every clinician knows that diabetics should exercise and exercise is good for them,” Morley says. “Realistically, every diabetic should be in an exercise program. It should be covered by medical insurance, because that’s by far the best treatment for diabetes, period.” The problem, according to Morley, is that physicians often recommend exercise without driving home how thoroughly important it is. “[We need to] stress that this is more important than the drug.”

Get a Free Subscription to Today’s Geriatric Medicine

This article was featured in the November/December 2020 issue of Today’s Geriatric Medicine.

Today’s Geriatric Medicine is a bimonthly trade publication offering news and insights for professionals in elder care.

Get a Free Subscription to Today’s Geriatric Medicine

This article was featured in the November/December 2020 issue of Today’s Geriatric Medicine (Vol. 13 No. 6 P. 14). Written by Jamie Santa Cruz, a health and medical writer in the greater Denver area. Reprinted with permission from Today’s Geriatric Medicine.

References

1. Centers for Disease Control and Prevention. National diabetes statistics report, 2020. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Published 2020.

2. Volpi E, Nazemi R, Fujita S. Muscle tissue changes with aging. Curr Opin Clin Nutr Metab Care. 2004;7(4):405-410.

3. Wilkinson DJ, Piasecki M, Atherton PJ. The age-related loss of skeletal muscle mass and function: measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans. Ageing Res Rev. 2018;47:123-132.

4. Sobestiansky S, Michaelsson K, Cederholm T. Sarcopenia prevalence and associations with mortality and hospitalisation by various sarcopenia definitions in 85–89 year old community-dwelling men: a report from the ULSAM study. BMC Geriatr. 2019;19(1):318.

5. Morley JE, Malmstrom TK, Rodriguez-Mañas L, Sinclair AJ. Frailty, sarcopenia and diabetes. J Am Med Dir Assoc. 2014;15(12):853-859.

6. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis [published correction appears in Age Ageing. 2019;48(4):601]. Age Ageing. 2019;48(1):16-31.

7. Cruz-Jentoft AJ, Sayer AA. Sarcopenia [published correction appears in Lancet. 2019;393(10191):2590]. Lancet. 2019;393(10191):2636-2646.

8. Kim TN, Park MS, Yang SJ, et al. Prevalence and determinant factors of sarcopenia in patients with type 2 diabetes: the Korean Sarcopenic Obesity Study (KSOS) [published correction appears in Diabetes Care. 2010;33(10):2294]. Diabetes Care. 2010;33(7):1497-1499.

9. Kim KS, Park KS, Kim MJ, Kim SK, Cho YW, Park SW. Type 2 diabetes is associated with low muscle mass in older adults. Geriatr Gerontol Int. 2014;14(Suppl 1):115-121.

10. Leenders M, Verdijk LB, van der Hoeven L, et al. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc. 2013;14(8):585-592.

11. Sayer AA, Dennison EM, Syddall HE, Gilbody HJ, Phillips DI, Cooper C. Type 2 diabetes, muscle strength, and impaired physical function: the tip of the iceberg? Diabetes Care. 2005;28(10):2541-2542.

12. Park SW, Goodpaster BH, Strotmeyer ES, et al. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care. 2007;30(6):1507-1512.

13. Umegaki H. Sarcopenia and diabetes: hyperglycemia is a risk factor for age-associated muscle mass and functional reduction. J Diabetes Investig. 2015;6(6):623-624.

14. Yang Q, Zhang Y, Zeng Q, et al. Correlation between diabetic peripheral neuropathy and sarcopenia in patients with type 2 diabetes mellitus and diabetic foot disease: a cross-sectional study. Diabetes Metab Syndr Obes. 2020;13:377-386.

15. Jang HC. Sarcopenia, frailty, and diabetes in older adults. Diabetes Metab J. 2016;40(3):182-189.

16. Kalyani RR, Metter EJ, Egan J, Golden SH, Ferrucci L. Hyperglycemia predicts persistently lower muscle strength with aging. Diabetes Care. 2015;38(1):82-90.

17. Kalyani RR, Metter EJ, Xue QL, et al. The relationship of lean body mass with aging to the development of diabetes. J Endocr Soc. 2020;4(7):bvaa043.

18. Hong S, Chang Y, Jung HS, Yun KE, Shin H, Ryu S. Relative muscle mass and the risk of incident type 2 diabetes: a cohort study. PLoS One. 2017;12(11):e0188650.

19. Mesinovic J, Zengin A, De Courten B, Ebeling PR, Scott D. Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship. Diabetes Metab Syndr Obes. 2019;12:1057-1072.

20. Brown EC, Buchan DS, Madi SA, Gordon BN, Drignei D. Grip strength cut points for diabetes risk among apparently healthy U.S. adults. Am J Prev Med. 2020;58(6):757-765.

What Fitness Professionals Need to Know About Exercise and Diabetes

Sheri Colberg, Ph.D./10 November 2020/ All MFN blog/

Are you working with any clients who have type 1 diabetes, type 2 diabetes, or even prediabetes? Well, you have a lot to learn if you don’t know the first thing about those conditions! There are over 100 million Americans currently have diabetes or prediabetes—some of them are, or will be, your clients.

Diabetes is a metabolic disorder that results in elevated levels of blood glucose (“blood sugar”) that can cause many health complications if not managed effectively. Although exercise is one of the three cornerstones of diabetes management, sometimes it can complicate keeping blood glucose levels under control, especially in people who have to replace the insulin that their bodies no longer make (or make enough of). How they respond to being active really depends on the type of exercise and diabetes.

In any case, on a basic level, it’s good to know more about how exercise affects people with diabetes. I have lived well with type 1 diabetes for nearly half a century at this point, and I have always known at some level that exercise did good things for my blood glucose, even before I had my first blood glucose meter (after going 18 years without one). How could I tell without a meter to test my levels? Honestly, it was because being active always made me feel better, physically and emotionally.

I earned a PhD in Exercise Physiology to better understand how exercising helped me. You don’t have to go that far with your education, but if you have diabetes or are going to work with clients or patients who have it, here are some basic things that you really need to know.

#1: Exercise can help erase your blood glucose “mistakes”

Exercise acts kind of like an extra dose of insulin.
At rest, insulin is the main mechanism your body has to get glucose into muscle cells.
During exercise, glucose goes your muscles without needing any insulin (via muscle contractions).
Being regularly active makes your muscles more sensitive to insulin, so it takes less to have the same blood glucose lowering effect when you eat during or after exercise.
What better way to help erase a little overeating of carbs (or some insulin resistance) than a moderate dose of exercise to lower your blood glucose?

#2: Exercise doesn’t always make your blood glucose go down

It doesn’t always make your blood glucose come down, at least not right away.
During intense exercise, the excess glucose-raising hormones your body releases can raise your blood glucose.
Over a longer period of time (2-3 hours), it usually comes back down, but who wants to wait that long?
If you take insulin, you’ll need to take less than normal to correct a post-workout high or your blood glucose will likely be crashing low a few hours later.
A cool-down of less intense exercise (like walking) can help bring it back to normal, so do an easy, active cool-down after intense workouts or activities.

#3: Your muscles are critical to managing your blood glucose levels

Exercise also helps you build and retain your muscle mass.
Muscles are the main place you store carbs after you eat them—like a gas tank.
Exercising helps use up stored carbs, but can also increase the size of the tank.
When you eat carbs post-exercise, they can easily go into storage with a little insulin.
Being sedentary keeps the tank full and makes you resistant to insulin.
Aging alone can cause you to lose muscle mass over time, but you can combat it to a certain extent by recruiting all of your muscle fibers regularly.
Resistance training and/or high-intensity intervals build muscle more because they
recruit the faster fibers that you don’t use when walking or doing easier activities.

#4: Exercise is the best medicine there is

Use exercise to control stress and to stave off depression—with no bad side-effects!
It’s a natural antioxidant—more effective and better than supplements!
Being regularly active prevents all sorts of cancers.
If you’re active, you’ll likely feel better and look younger than you are (as long as you don’t exercise too much).
You’ll be even less likely to catch a cold if you exercise moderately and regularly.
Standing more, taking extra steps, and fidgeting even help—be active all day long, and don’t forget your daily dose of the best medicine there is!

LEARN MORE: Join Dr. Colberg for her upcoming webinar, Challenges Related to Diet, Nutrition and Exercise in Diabetes

Sheri R. Colberg, PhD, FACSM, is a Professor Emerita of Exercise Science at Old Dominion University and a former Adjunct Professor of Internal Medicine at Eastern Virginia Medical School. She is an internationally recognized authority on diabetes and exercise. As a leading expert on diabetes and exercise, Sheri has put her extensive knowledge to use in founding Diabetes Motion (diabetesmotion.com), a website providing practical guidance about being active with diabetes. She also founded Diabetes Motion Academy (dmacademy.com), offering training and continuing education to fitness professionals.

Type 1 Diabetes Explained

Riva Greenberg/3 November 2020/ All MFN blog/

I wrote this post two years ago and still have people with diabetes write to tell me how much it has meant to them. How they printed it off and showed it to their family and friends. How people seemed to finally understand the difficulty of what they live with.

Is Sitting Really the New Smoking?

Sheri Colberg, Ph.D./28 October 2020/ All MFN blog/

Make no mistake: sitting less time overall is a good idea for myriad health reasons, but is sitting as bad for you as some would suggest? Is it really the new smoking? In 2017 alone, a slew of new research studies has looked at various health detriments associated with prolonged sitting, even in adults who exercise regularly.

For adults with type 2 diabetes, bouts of either light walking or simple resistance activities benefit not only their glycemic responses to meals (4; 5), but also markers of cardiovascular risk. Both types of interrupting activities are associated with reductions in inflammatory lipids, increases in antioxidant capacity of other lipids, and changes in platelet activation (6).

What is good for one may not be as beneficial for all, though. For example, in adults with low levels of frailty, sedentary time is not predictive of mortality, regardless of physical activity level (1). Sitting more if you are already frail likely just increases frailty and mortality risk, which is not surprising. Along the same lines, being less fit matters in how you respond to breaking up sedentary time. Middle-aged adults with low levels of cardiorespiratory fitness gained the most metabolic benefit from breaking prolonged sitting with regular bouts of light walking, which included five minutes of light walking every 30 minutes over a 7-hour research period (2). If you’re already very fit, adding in some light walking breaks during the day is not going to have as much of an effect—again not surprising.

For in adolescents in school, reducing their sitting time (both in total time and length of bouts) has been shown to improve their blood lipid profiles and cognitive function. A “typical” day (65% of the time spent sitting with two sitting bouts >20 minutes) was compared with a simulated “reduced sitting” day (sitting 50% less with no bouts >20 minutes (3). Can teens stand to improve their health this week? Again, it cannot hurt to break up sedentary time, so why not do it? More recess breaks for teens would be good—and for everyone else for that matter.

All is not lost for people with limited mobility or no ability to engage in weight-bearing activities. Including short bouts of arm ergometry (five minutes of upper body work only every 30 minutes) during prolonged sitting attenuates postprandial glycemia (following two separate meals) when done by obese individuals at high risk of developing type 2 diabetes, even though they remain seated (7). People who cannot walk or stand can, therefore, break up their sedentary time in other ways that can also be metabolically beneficial.

As for other health benefits, breaking up sedentary time is associated with a lower risk of certain types of cancer. In a recent meta-analysis, prolonged television viewing, occupational sitting time, and total sitting time were all associated with increased risks of colorectal cancer in adults (8), which is the most common type after breast/prostate and lung cancers. That study reported a dose-response effect as well, suggesting that both prolonged total sitting time and greater total daily sitting time (2 hours) were associated with a significantly higher risk of colorectal cancer.

In summary, even just the most recent evidence is convincing enough that prolonged sitting is bad for you, and many more studies published similar results in prior years. Is sitting as bad as smoking, though? That remains to be proven. However, you really cannot argue with a recent international consensus statement on sedentary time in older people (9). It states, “Sedentary time is a modifiable determinant of poor health, and in older adults, reducing sedentary time may be an important first step in adopting and maintaining a more active lifestyle.” In fact, the best advice may simply be to consider the whole spectrum of physical activity, from sedentary behavior through to structured exercise (10). Putting yourself anywhere onto that spectrum is definitely better than sitting through the rest of your (shortened) life.

Reprinted with permission from Sheri Colberg.

References cited:

Theou O, Blodgett JM, Godin J, Rockwood K: Association between sedentary time and mortality across levels of frailty. CMAJ 2017;189:E1056-E1064. doi: 1010.1503/cmaj.161034.
McCarthy M, Edwardson CL, Davies MJ, Henson J, Bodicoat DH, Khunti K, Dunstan DW, King JA, Yates T: Fitness Moderates Glycemic Responses to Sitting and Light Activity Breaks. Med Sci Sports Exerc 2017;8:0000000000001338
Penning A, Okely AD, Trost SG, Salmon J, Cliff DP, Batterham M, Howard S, Parrish AM: Acute effects of reducing sitting time in adolescents: a randomized cross-over study. BMC Public Health 2017;17:657. doi: 610.1186/s12889-12017-14660-12886.
Larsen RN, Dempsey PC, Dillon F, Grace M, Kingwell BA, Owen N, Dunstan DW: Does the type of activity “break” from prolonged sitting differentially impact on postprandial blood glucose reductions? An exploratory analysis. Appl Physiol Nutr Metab 2017;42:897-900. doi: 810.1139/apnm-2016-0642. Epub 2017 Mar 1124.
Dempsey PC, Larsen RN, Sethi P, Sacre JW, Straznicky NE, Cohen ND, Cerin E, Lambert GW, Owen N, Kingwell BA, Dunstan DW: Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities. Diabetes Care 2016;39:964-972
Grace MS, Dempsey PC, Sethi P, Mundra PA, Mellett NA, Weir JM, Owen N, Dunstan DW, Meikle PJ, Kingwell BA: Breaking Up Prolonged Sitting Alters the Postprandial Plasma Lipidomic Profile of Adults With Type 2 Diabetes. J Clin Endocrinol Metab 2017;102:1991-1999. doi: 1910.1210/jc.2016-3926.
McCarthy M, Edwardson CL, Davies MJ, Henson J, Rowlands A, King JA, Bodicoat DH, Khunti K, Yates T: Breaking up sedentary time with seated upper body activity can regulate metabolic health in obese high-risk adults: A randomized crossover trial. Diabetes Obes Metab 2017;23:13016
Ma P, Yao Y, Sun W, Dai S, Zhou C: Daily sedentary time and its association with risk for colorectal cancer in adults: A dose-response meta-analysis of prospective cohort studies. Medicine (Baltimore) 2017;96:e7049. doi: 7010.1097/MD.0000000000007049.
Dogra S, Ashe MC, Biddle SJH, Brown WJ, Buman MP, Chastin S, Gardiner PA, Inoue S, Jefferis BJ, Oka K, Owen N, Sardinha LB, Skelton DA, Sugiyama T, Copeland JL: Sedentary time in older men and women: an international consensus statement and research priorities. Br J Sports Med 2017;19:2016-097209
Dempsey PC, Grace MS, Dunstan DW: Adding exercise or subtracting sitting time for glycaemic control: where do we stand? Diabetologia 2017;60:390-394. doi: 310.1007/s00125-00016-04180-00124. Epub 02016 Dec 00112.

Stress Management and Diabetes

Robyn Kade/22 October 2020/ All MFN blog/

Diabetes, is left uncontrolled, can cause a whole host of health complications such as vision impairment and neuropathy. It is important to adhere to any instructions your doctor has given you to keep blood sugars controlled. Your physician may also educate you on exercise, diet and stress management to keep a balanced and healthy lifestyle.

Anyone who suffers from chronic stress may have many health issues later in life. One condition that may arise is diabetes. Prolonged stress can either cause diabetes or make it tough to obtain normal blood sugars. Blood sugar numbers usually go up and down depending on what you do throughout the day. If you are fasting your numbers should be less than 100 but could be 180 two hours after eating a meal. Most diabetics must monitor their glucose levels on a regular basis.

People who have diabetes may also feel stressed because of their treatment plan. This is also called, “Diabetic Distress”. Individuals with diabetes have many things they must do to take care of themselves such as: check glucose levels, exercise, cook and eat healthy meals, maintain a certain diet and take medications as prescribed. This new lifestyle can be very stressful for many people who have diabetes.

Along with Diabetic Distress there are the usual stressors that are a part of life. It is important to find ways to control stress throughout your lifespan. If you are newly diagnosed, the first step to reducing stress is to talk to your physician. Your medical team is on your side and can help you find a Diabetes Educator. These individuals host classes to go over any new information and questions you may have.

When controlling stress, you need to find out what works for you personally. Some individuals like to take a walk in the park, others choose to practice meditation or use a combination of many techniques. When you start to try new practices remember that you may have to try each a few times. The body has to get used to approaches. A qualified stress management consultant can help you to create a stress management plan specifically for you.

A great way to incorporate stress management into your daily routine is through meditation. Choose a certain time of day that you know will work for you. Some individuals find it helpful to meditate before getting out of bed in the morning. Others find it works best at the end of the day when they have finished working. Taking a break at work during lunch can be helpful as well. Once you find the time of day that works best choose your space. You want to find a room in your house that is free from distraction. It will also help to turn off all electronics and the television.

When practicing meditation, remember that there is no right or wrong way to meditate. Some individuals choose to meditate laying on a mat while others sit or stand. Choose a position that is comfortable for you. When sitting for meditation your knees should be lower than your hips to help sustain the position.

Guided meditation is also a great choice for meditation. A trained instructor will guide you through the meditation to help you reduce stress.

Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness.