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How Exercise Can Help Improve Metabolic Control in Type 1 Diabetes

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Story at-a-glance -

  • Type 1 diabetes is a complex disease that likely has several causative factors, including genetic predisposition, viral infection, gut microbiome changes and vitamin D deficiency, to name a few
  • High blood sugar increases damage to your vascular system and increases your risk for stroke, heart attack, kidney damage and blindness
  • Recent research demonstrates aerobic exercise helps improve metabolic control of type 1 diabetes, and may reduce your potential risk for related health problems

By Dr. Mercola

There are two major types of diabetes and the number of people diagnosed with either continues to grow each year. In the first, type 1 diabetes, also known as insulin-dependent diabetes, your pancreas stops producing insulin altogether.

Researchers are still attempting to pinpoint reasons this may occur. It may be the result of a genetic predisposition, deficiency in vitamin D, unbalanced gut microbiome, exposure to a virus or a combination of these and other factors.

If you have type 2 diabetes, your body often continues to secrete insulin for a number of years, but your cells have become resistant to using it, resulting in higher than normal blood sugar levels. This is also called insulin resistance.

Type 2 diabetes often begins slowly, while type 1 diabetes happens suddenly. If you suffer from type 1 diabetes, within days your pancreas may completely stop secreting insulin, producing dangerously high blood sugar levels that may be lethal.

Past research has demonstrated exercise helps glycemic control in individuals who suffer from type 2 diabetes, the most common form.

In a recent small-sample, collaborative study between scientists from Italy and Florida, researchers demonstrated aerobic exercise may also affect glycemic control in people who suffer from type 1 diabetes.

The Effect Diabetes Has on Your Body

According to the U.S. Centers for Disease Control and Prevention (CDC), every five minutes two people die from a diabetes-related cause and 14 more adults are diagnosed.1 Type 1 diabetes is more commonly diagnosed in individuals younger than 20, and often younger than 10 years.

The highest rate of diagnosis is in non-Hispanic white children, younger than 10 years, where the rate nears 3 percent.2 The effect of poor glycemic control on the body is cumulative, so the earlier a person is affected by the condition, the more damage is possible.

In order to control their blood sugar levels, people with type 1 diabetes require either regular insulin injections throughout the day, or use an insulin pump to more closely approximate a natural delivery of insulin into the body.

Using a pump reduces consistent insulin spikes and blood sugar drops from injections and damage to the blood vessels is minimalized.

Over the years, damage to the arterial system may result in heart disease, stroke, high blood pressure, kidney damage, eye damage, loss of sight, peripheral vascular disease and amputation.3

The total direct and indirect medical costs in the U.S. estimated by the CDC, for both diabetes and the concurrent medical conditions, is a startling $245 billion.4

How and Why Secondary Medical Conditions Occur in Diabetes

Understanding how secondary medical conditions occur with type 1 or type 2 diabetes may help motivate you to control your blood sugar levels through a low carbohydrate diet, exercise and appropriate use of insulin.

Although, theoretically, injecting insulin to "cover" the amount of carbohydrates you eat in a meal will reduce your blood sugar levels, it doesn't stop the damage in your arteries.

Mild elevations in blood sugar don't cause symptoms, so many people who suffer from type 2 diabetes or pre-diabetes may not know they have the condition.

However, those with type 1 diabetes more often experience a sudden and rapid rise in blood sugar at the time of diagnosis that can be lethal. This increase may cause blurred vision, slurred speech and dehydration.5

The secondary health effects from diabetes may result from a reduction in blood supply to the organ or an increase in pressure required for oxygenation. This may develop as the arteries "harden" and become less pliable.

This hardening is called atherosclerosis, and is a common condition in diabetes, leading to damage to kidneys, eyes, heart and your peripheral vascular system. Exactly how high blood glucose increases your risk of atherosclerosis may be related to several factors.

Past studies have demonstrated that blood glucose increases the production of free radicals,6 damaging the lining of your blood vessels and other organs.7 This reduces nitric oxide production responsible for relaxing arterial walls and reducing the pressure required to pump blood.

Conversely, exercise produces a physical force in your arteries, capable of changing biochemical processes. According to Dr. Jun-ichi Abe, study author and associate professor at the University of Rochester Medical Center:8

"Inflammation in blood vessels is one of the main drivers of atherosclerosis, and diabetes makes it much worse. Our study argues that a pathway surrounding a key signaling enzyme both protects the heart in normal cases, and is sabotaged by the chemicals produced in diabetes."

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How High Blood Sugar Causes Problems and Exercise Helps

Without diabetes, fast blood flow triggered by exercise releases an enzyme called extracellular signal-regulated kinase 5 (ESRK5), which then signals a pathway to increase the production of nitric oxide.

This study showed that people with diabetes produce molecules inhibiting the production of ESRK5, and subsequently the production of nitric oxide.9 This process contributes to the development of atherosclerosis in people who suffer from diabetes.

In a different study, researchers from the Medical College of Georgia found the 5 percent of sugar that is not converted in cells to energy, is instead converted to a type of sugar that can modify proteins, O-GlcNAc.10

Increased activity of O-GIcNAc in people with high blood sugar competes with a pathway that also produces nitric oxide, which ultimately reduces tension in your arterial system and therefore also reduces blood pressure.

Further research also found an interaction between the fatty acid needed to bind nitric oxide to your arterial walls and diabetes.11

Nitric oxide attaches to the inner membrane of your arterial walls using a common form of fatty acid (palmitate) found in your system. However, while this form is common, nitric oxide only uses palmitate synthesized by fatty-acid synthase (FAS), an enzyme in your body regulated by insulin.12

While it is clear high blood sugar negatively affects your arterial system and increases your risk of both small and large vessel damage, what is not clear are the diverse ways in which it happens.

Impact of Exercise on Blood Sugar Control in Type 1 Diabetes

In a small study performed over three months, researchers monitored the effect aerobic exercise had on individuals with type 1 diabetes.13 They found participants who included aerobic exercise in their daily activities enjoyed better metabolic control and lower insulin requirements throughout the day.

Participants were middle-aged, type 1 diabetic patients using an insulin pump. Dr. Livio Luzi of the Diabetes Research Institute at the University of Miami said:14

"We found that being physically active can improve glycemic control for patients with type 1 diabetes. Our results suggest that an educational program addressed to T1D patients, and focused on insulin injecting monitoring, diet and exercise, is highly advantageous for management of T1D."

Participants who exercised also experienced fewer hyperglycemic episodes, or times when their blood glucose levels exceeded their goal levels. While aerobic exercise will lower blood glucose levels, anaerobic (working without oxygen) will tend to raise your glucose levels.15 Exercises during which you tend to hold your breath, such as strength training, or breathe heavily, may place you in an anaerobic state.

In another review of several research studies evaluating the efficacy of exercise and glucose control in a pediatric population, researchers found conflicting information.16 Three of the four studies with a combined patient population total of over 400 demonstrated improved glycemic control with exercise, while the fourth did not.

Consider These Exercises to Balance Your Blood Sugar

Exercising with type 1 diabetes presents unique challenges. In this short video, a young man named Jason talks about what it's like to be a competitive cyclist with type 1 diabetes. Before starting an exercise program, it's important to do your homework. If you don't already, use a daily diary to record your food intake, insulin use, blood glucose levels and current exercise habits.

Watch for consistent changes in your glucose levels with the number of carbs, protein and fats you eat, in combination with your current exercise level. You'll use this to help predict your glucose levels as you begin to increase your aerobic exercise. Always exercise with a partner. A precipitous drop in blood glucose can be lethal. It's safer to exercise with someone who can recognize the symptoms of low blood sugar and is able to treat your symptoms appropriately.

Choose aerobic exercises that meet your current physical fitness abilities. Remember to include those activities you might not consider aerobic exercise, but which may impact your blood sugar levels, such as gardening.

Start slowly to reduce the potential for injury that might sideline you for weeks. While you might be excited to embark on a new fitness program, it is important to practice patience. Keep your daily diary and track your metabolic results over time. You may find that one activity impacts glucose control more significantly than another.

No matter your age or your physical ability, there are aerobic exercises in which you may participate. Your initial goal is to increase your heart rate for 20 to 30 minutes each day. Find a partner who works out at the same level you do, so your exercise is challenging to both of you. Here's a short list of possible fitness workouts you may find interesting.







Elliptical trainer


Water aerobics


Aerobic classes






Table tennis



Cross country skiing


Jump rope

Stair climbing


Scientists Continue to Search for What Triggers Type 1 Diabetes

Type 1 diabetes is a complex condition without a single causative factor. Scientists have theorized some people may have a greater genetic potential to develop type 1 diabetes in combination with an immune response.17 Others theorize a virus triggers the failure of insulin secretion from the pancreas,18 and others link type 1 diabetes to nutritional deficiencies.19

The likelihood is that each of these factors, and more, may play a role in the development of this complex disease, for which there is no known cure. With the information known today, there are several nutritional steps you can take, whether you currently have type 1 diabetes or if it tends to run in your family, to improve your outcome.

Your gut microbiome is intricately involved in your immune system. Scientists have discovered patients who develop type 1 diabetes have a subclinical prodromal stage in the disease, during which there are no clinical symptoms.20 Initial research findings have determined the intestinal microbiota in people who subsequently go on to develop type 1 diabetes is different from those who do not.

Research demonstrating compositional change in gut bacteria is not new.21,22,23,24 However, one recent study25 found a link between the development of new colonies in the intestines to changes in the immune system, potentially implicating the bacterial growth with progression of B-cell autoimmunity rather than in the development of the disease process.

It's important to include fermented foods in your daily diet to improve the variety of bacteria residing in your intestines. You may also consider using a quality probiotic supplement to augment your gut microbiome. You can read more about this process in my previous article, "Research Reveals the Importance of Your Microbiome for Optimal Health."

Studies have determined children infected with enterovirus have a much higher risk of developing type 1 diabetes than those who have not had the infection.26 A second study demonstrated similar results. Researchers found a type of enterovirus in the pancreatic cells that produce insulin in patients who were recently diagnosed with type 1 diabetes.27

The Role of Vitamin D

Vitamin D also plays a role in the development of type 1 diabetes and in the overall risk of death from the disease. For starters, vitamin D plays a vital role in the efficiency of your immune system.28 Since one possible factor in the development of type 1 diabetes is in response to an infectious agent, it stands to reason that maintaining optimal levels of vitamin D will help reduce the potential for triggering this disease.29

Studies have demonstrated that low levels of vitamin D may increase your risk of developing type 1 diabetes as an adult by 50 percent.30 Using blood samples from active duty military personnel, researchers identified 310 people diagnosed with type 1 diabetes over a 12-year period. They compared samples taken before the onset of disease with 600 military personnel without the disease.

Those with higher levels of vitamin D had half the risk of developing the disease as those with the lowest levels. Low levels of vitamin D in people with type 1 diabetes also appeared to raise the risk of death from any cause.31 As noted by lead author of the study, Kassandra Munger, research associate in the department of nutrition at Harvard T.H. Chan School of Public Health:32

"It is surprising that a serious disease such as type 1 diabetes could perhaps be prevented by a simple and safe intervention."

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