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Insulin dependent diabetes mellitus, also known as type 1 diabetes, causes severe neurological and cardiovascular disorders. Insulin plays a crucial role in maintaining glucose levels within the circulatory system. Glucose levels that are unregulated in the DM 1 patient may lead to possible life threatening situations.These situations can be either acute, such as diabetic (hyperglycemic) coma; or chronic, such as distal neuropathy and atherosclerosis. The proper education of exercise, nutrition, and monitoring of blood glucose levels is crucial. Physical therapists should necessitate this education for our patients that their acts are imperative to a healthy life.

Diabetes is a condition that can be managed to an extent. Management will reduce the health care costs and promote longevity to our patient’s lives. The role of our profession in patient education is important. Exercise and nutrition has shown to reduce the amounts of insulin required for our bodies.

As physical therapists, we must promote the benefits of exercise and nutrition to diabetes patients.The relationship between exercise, blood glucose, and insulin will be broken down into the following categories: exercise and it’s effects on blood glucose, exercise and it’s effects on insulin, and insulin and it’s effects on blood glucose. These categories will demonstrate the effects of pharmacologic interventions and non-pharmacologic interventions on diabetes.The best possible solution for control of blood glucose levels will be explored. This will demonstrate the importance of insulin injections vs. nutrition/exercise and their effects on blood glucose levels. The final section of this mini-paper will discuss the appropriate regime to be used for a patient with Insulin Dependent Diabetes Mellitus (IDDM).

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Exercise and it’s Effects on Blood Glucose

Exercise demonstrates positive effects on both the cardiovascular and pulmonary systems. These systems are directly affected by IDDM.  By utilizing exercise as a treatment, the therapist can decrease the effects of diabetes. A brief overview of the effects of IDDM on the cardiovascular and neurological systems is reviewed below. This is followed by exercise and it’s effects on glucose.

IDDM has various effects on the body’s systems. In the cardiovascular system, IDDM causes a decreasing diameter inside our arteries, which is secondary to the increased deposits of “fatty plaques.”This decrease in arterial diameter causes an increased cardiac output in order to maintain oxygenation of the body’s tissues. When cardiac output is increased, the respiration rate is also increased to adequately oxygenate the blood. The pulmonary system is then stressed to match the cardiac output.

This cycle is caused primarily by the increased blood-glucose levels found in IDDM patients. An increase of glucose in the body’s vascular system, and the inability to absorb it, leads to increased amounts of sorbitol to be deposited around nerve cells. IDDM patient’s with diabetic neuropathy are at a higher risk to injure their distal extremities. With decreased sensation from diabetic neuropathy, IDDM patients are at higher risk of developing integumentary injuries.

The cycle becomes worse with the possible effects on the distal vascular system. With decreased arterial size, secondary to fatty deposits, the body’s capillary system also begins to restrict blood flow. IDDM then takes a major effect on the healing process.  Wound care is challenged secondary to decreased capillary sufficiency. Minor scrapes or injuries to the distal extremities can require months of wound care and rehabilitation. The immune system is challenged by decreased phagocytosis of leukocytes. This challenges the body in it’s ability to eradicate infections.  

The main goal of exercise in a patient with IDDM is to begin the management of blood glucose levels. Blood glucose levels are decreased during periods of exercise. Glucose is lowered by exercise due to increased permeability to glucose in peripheral tissues. Glucose levels are the primary cause of cardiovascular and neurological disorders in diabetics. With proper exercise, IDDM patients can begin to manage the amounts of insulin required. Exercise should primarily be aerobic.  Resistance exercises tend to increase blood pressure. Blood pressure increase is caused by increased intra-thoracic pressure and muscular compression on blood vessels. This is non-beneficial to long-term diabetic patients who may have decreased blood flow from atherosclerosis. This could result in possible cerebral vascular accidents or heart attacks.

Aerobic exercise offers complete muscle group workouts. This exercising also increases blood flow through distal muscle groups increasing oxygenation to tissues in the feet and hands. Distal extremity blood flow is decreased primarily in a stocking and glove pattern. This increase in oxygenation lessens the chances of tissue ischemia and neuropathy and increases capillary blood flow. Aerobic exercise also increases stroke volume and heart muscle contractibility thus increasing vascular efficiency.

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