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Current Research in Type 1 Diabetes and Exercise Jane Yardley Supported by: Canadian Diabetes Association Ottawa Health Research Institute.

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Presentation on theme: "Current Research in Type 1 Diabetes and Exercise Jane Yardley Supported by: Canadian Diabetes Association Ottawa Health Research Institute."— Presentation transcript:

1 Current Research in Type 1 Diabetes and Exercise Jane Yardley Supported by: Canadian Diabetes Association Ottawa Health Research Institute

2 Preliminaries Please ask questions at any time about anything that is unclear to you There will be props – you can ask about them too I like to share (references, tables, files, contact information – if you want it, please ask me for it!)

3 Overview Meet the Researchers Type 1 Diabetes: the Metabolism Basics Exercise studies in type 1 diabetes On-going research in type 1 diabetes and physical activity The Role of New Technologies in Diabetes Research

4 Important Names and Faces

5 Dr. Ronald Sigal MD, MPH, FRCPC

6 Dr. Ron Sigal (University of Calgary) –Clinical medicine, teaching and research –1996-2006 Senior Scientist (OHRI) Medical Director (Ottawa Hospital Diabetes Clinic) –Active member of CDA –Diabetes and exercise randomized trials –ADA and CDA guidelines for physical activity

7 Dr. Glen Kenny BSc, MSc, PhD

8 Dr. Glen Kenny (University of Ottawa) –Professor, University Research Chair –Over 100 peer-reviewed publications –Physical activity (diabetes) –Health and safety of workers (hostile environments) –Holds research funding from:

9 Jane Yardley BSc, MSc, PhD (a.b.d)

10 About me…. B.Sc. in Biochemistry from Mount Allison University (2000) M.Sc. in Evolutionary Anthropology from University College London, UK (2001) PhD Candidate in Population Health at the University of Ottawa Self-proclaimed “geeky jock”

11 Type 1 diabetes mellitus Insulin-producing β cells of the pancreas are targeted by the immune system insulin secretion becomes impossible external sources of insulin become necessary to maintain blood glucose control Can result in chronic hyperglycemia (high blood glucose) with serious long-term health problems

12 Management of Type 1 Diabetes Main tools of treatment include: 1)Diet 2)Insulin 3)Physical Activity

13 Diet Eat three meals a day at regular times Meals should be spaced no more than 6 hours apart Limit intake of sugars and sweets (pop, desserts, candy, etc.) Limit intake of high fat foods Be sure to include high fibre foods (whole grain breads/cereals, dried beans/peas, brown rice, vegetables, fruits etc.) Choose lower fat sources of protein (fish, lean meats, low fat cheeses) Drink plenty of water

14 Insulin a.k.a. “The Anabolic Queen” Promotes energy storage by stimulating glucose uptake into the body’s cells Glucose is then used for: –Lipid synthesis –Protein synthesis –Glycogen synthesis

15 Insulin How it works: Glucose is too big to diffuse across cell membranes Transport proteins (GLUT proteins) are necessary Muscle, fat, and heart cells use a very specific type of transporter (GLUT4) Glut4 transporters are activated by insulin

16 Insulin Activation of Glut-4

17 Insulin Naturally produced insulin –Made by the β-cells of the pancreas –Has a half-life of about 5 minutes Synthetic insulin –Variety of delivery methods (pump, injection, etc.) –Different durations from very short acting (0.5 to 2 hours) to long acting (up to 18 hours duration) –Often necessary to combine more than one type

18 The Pancreas & Blood Glucose Control

19 Non insulin-mediated glucose uptake In certain situations, some cells in the body will take up glucose without the presence of insulin When muscles twitch (generally through physical activity), calcium ions are released Calcium stimulates the Glut-4 receptors on certain cells (mostly skeletal muscle) Exercise allows glucose to be taken into the cells without insulin being present, decreasing blood glucose

20 Main Categories of exercise Aerobic exercise –Repeated and continuous movement of the same large muscle groups –Activity lasts an extended period of time Jogging walking swimming cycling etc.

21 Main Categories of exercise Anaerobic exercise –Powerful bursts of activity requiring large amounts of energy input but sustained for short periods of time –Activities include: Sprinting Weight lifting Plyometrics etc

22 The chronic effects of aerobic activity in type 1 diabetes Measured glycemic control by glycosylated hemoglobin (HbA1c) Intervention studies have shown mixed results

23 Chronic effects of aerobic exercise


25 Why such inconsistent outcomes? In theory, physical activity should lower blood glucose, and in the long run Hb A1c Failure to improve Hb A1c may lie in study design: –Inadequate study duration –Inadequate exercise frequency and/or intensity –Low compliance rates –Lack of supervised exercise sessions –Excessive increase in caloric intake –Excessive decrease in insulin intake

26 Acute Effects of Aerobic Exercise Moderate Aerobic Exercise (non-diabetic) –Glucose uptake ↑↑ –Blood glucose ↓ –Insulin ↓, glucagon ↑ –Glucose and lipids released –catecholamines ↑ (slightly) –hepatic glucose production ↑ –Blood glucose ↑↑ –EUGLYCEMIA MAINTAINED

27 Acute Effects of Aerobic Exercise Moderate Aerobic Exercise (Type 1 diabetes) –Glucose uptake ↑↑ –Blood glucose ↓ –Insulin ↔, glucagon ↑ –Lower glucose and lipid release –Catecholamines ↑/↔ –Hepatic glucose production ↔ –Blood glucose ↓↓ –HYPOGLYCEMIA

28 The chronic effects of physical activity in type 1 diabetes Studies involving resistance exercise, either on its own or in combination with aerobic exercise have generally had positive outcomes

29 Studies Involving Resistance Exercise in Type 1 Diabetes

30 Resistance exercise, whether on its own or combined with aerobic exercise, seems to be beneficial for glycemic control Why? –Different hormonal reaction to high intensity exercise –Different hormones = different fuel source

31 Acute Effects of Anaerobic Exercise Non-diabetic individuals –Catecholamines ↑↑↑↑ –Hepatic glucose production ↑↑↑↑ –Glucose uptake ↑↑ –Blood glucose ↑↑↑ –Insulin ↑ upon exercise completion –Blood glucose ↓↓ –EUGLYCEMIA

32 Acute Effects of Anaerobic Exercise Type 1 diabetic Individuals –Catecholamines ↑↑↑↑ –Hepatic glucose production ↑↑↑↑ –Glucose uptake ↑↑ –Blood glucose ↑↑↑ –Post-exercise Insulin production ↔ –Blood glucose ↑↑↑ –HYPERGLYCEMIA

33 Acute effects of Anaerobic Exercise Bussau VA, Ferreira LD, Jones TW, Fournier PA. Diabetes Care 2006;29(3):601-6. 20 min. of aerobic activity followed by a 10 sec. sprint

34 Acute effects of Anaerobic Exercise Guelfi KJ, Jones TW, Fournier PA. Diabetes Care 2005;28(6):1289-94. 30 minutes of aerobic activity vs. 30 minutes of aerobic activity with 4 second, all-out sprints every 2 minutes

35 Resistance Exercise in Non-diabetic individuals French DN, et al. J Appl Physiol 2007;102(1):94-102. 6 X 10 reps of squats (80% max) vs resting control

36 On-Going Research Two large studies taking place in Ottawa examining the effects of resistance exercise in type 1 diabetes T1-DARE – Type 1 Diabetes Aerobic and Resistance Exercise READI - Resistance Exercise in Already Active Diabetic Individuals

37 T1-DARE Examining the chronic effects of different exercise programs on HbA1c in type 1 diabetic subjects Sedentary type 1 diabetic subjects randomized to four different supervised training programs: –Aerobic only –Resistance only –Aerobic and resistance –Control

38 READI Examining the effects of resistance exercise on type 1 diabetic individuals who are already aerobically active Subjects randomized to one of two groups: –Resistance training* –Control* (*aerobic activities maintained in both groups)

39 Acute Effects of Aerobic and Resistance exercise on Blood Glucose Recruiting participants who have completed T1-DARE or READI OR who are already physically active Looking at blood glucose during and in the 24 hours after an exercise session Also looking at how exercise order affects blood glucose 5 different exercise tests –1. Resting control –2. Aerobic exercise –3. Resistance exercise –4. Aerobic and resistance exercise –5. Resistance and aerobic exercise

40 Hypotheses Aerobic exercise will result in: –Lower blood glucose and more hypoglycemia Resistance exercise will result in: –Higher blood glucose and mild hyperglycemia Combined aerobic and resistance exercise sessions will: –More time spent in euglycemia (compared to single modality exercise sessions)

41 New Research Technologies Continuous Glucose Monitoring System (CGMS) Tiny, flexible sensor Sterile, disposable Inserted just under the skin 24 to 72-hour usable life Sends measurement signal to monitor every 10 seconds Measures glucose values within the range of 2.2-22.2 mmol/L

42 New Research Technologies



45 Even Newer Technologies The CGMS® iPro™ Digital Recorder attaches to the glucose sensor. It continuously records and stores the ISIG signals from the glucose sensor. The glucose sensor is placed under the skin where it measures glucose levels in the interstitial tissue. The Sen-serter ® insertion device is used to insert the glucose sensor The Charger charges the recorder. It is battery- powered, and requires one AAA battery.

46 Questions

47 Contact Information Jane Yardley (613) 562-5800 ext. 4948 Janet Richardson (T1-DARE and READI studies) (613) 738-8400 ext. 81965

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