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  • Although moderate aerobic exercise improves BG and insulin action acutely, the risk of exercise-induced hypoglycemia is minimal without use of exogenous insulin or insulin secretagogues. Transient hyperglycemia can follow intense PA. ACSM evidence category C.

    Resistance exercise effects.

    The acute effects of a single bout of resistance training on BG levels and/or insulin action in individuals with type 2 diabetes have not been reported. In individuals with IFG (BG levels of 100–125 mg/dl), resistance exercise results in lower fasting BG levels 24 h after exercise, with greater reductions in response to both volume (multiple- vs. single-set sessions) and intensity of resistance exercise (vigorous compared with moderate) (18).

    Evidence statement.

    The acute effects of resistance exercise in type 2 diabetes have not been reported, but result in lower fasting BG levels for at least 24 h after exercise in individuals with IFG. ACSM evidence category C.

    Combined aerobic and resistance and other types of training.

    A combination of aerobic and resistance training may be more effective for BG management than either type of exercise alone (51,238). Any increase in muscle mass that may result from resistance training could contribute to BG uptake without altering the muscle's intrinsic capacity to respond to insulin, whereas aerobic exercise enhances its uptake via a greater insulin action, independent of changes in muscle mass or aerobic capacity (51). However, all reported combination training had a greater total duration of exercise and caloric use than when each type of training was undertaken alone (51,183,238). Mild-intensity exercises such as tai chi and yoga have also been investigated for their potential to improve BG management, with mixed results (98,117,159, 257,269,286,291). Although tai chi may lead to short-term improvements in BG levels, effects from long-term training (i.e., 16 weeks) do not seem to last 72 h after the last session (257). Some studies have shown lower overall BG levels with extended participation in such activities (286,291), although others have not (159,257). One study suggested that yoga's benefits on fasting BG, lipids, oxidative stress markers, and antioxidant status are at least equivalent to more conventional forms of PA (98). However, a meta-analysis of yoga studies stated that the limitations characterizing most studies, such as small sample size and varying forms of yoga, preclude drawing firm conclusions about benefits to diabetes management (117).

    Evidence statement.

    A combination of aerobic and resistance exercise training may be more effective in improving BG control than either alone; however, more studies are needed to determine if total caloric expenditure, exercise duration, or exercise mode is responsible. ACSM evidence category B. Milder forms of exercise (e.g., tai chi, yoga) have shown mixed results. ACSM evidence category C.


    Insulin resistance

    Acute changes in muscular insulin resistance.

    Most benefits of PA on type 2 diabetes management and prevention are realized through acute and chronic improvements in insulin action (29,46, 116,118,282). The acute effects of a recent bout of exercise account for most of the improvements in insulin action, with most individuals experiencing a decrease in their BG levels during mild- and moderate-intensity exercise and for 2–72 h afterward (24,83,204).
    BG reductions are related to the duration and intensity of the exercise, preexercise control, and state of physical training (24,26,47,238). Although previous PA of any intensity generally exerts its effects by enhancing uptake of BG for glycogen synthesis (40,83) and by stimulating fat oxidation and storage in muscle (21,64,95), more prolonged or intense PA acutely enhances insulin action for longer periods (9,29,75,111,160,238).
    Acute improvements in insulin sensitivity in women with type 2 diabetes have been found for equivalent energy expenditures whether engaging in low-intensity or high-intensity walking (29) but may be affected by age and training status (24,75,100,101,228). For example, moderate- to heavy-intensity aerobic training undertaken three times a week for 6 months improved insulin action in both younger and older women but persisted only in the younger group for 72–120 h.

    Acute changes in liver's ability to process glucose.

    Increases in liver fat content common in obesity and type 2 diabetes are strongly associated with reduced hepatic and peripheral insulin action. Enhanced whole-body insulin action after aerobic training seems to be related to gains in peripheral, not hepatic, insulin action (146,282). Such training not resulting in overall weight loss may still reduce hepatic lipid content and alter fat partitioning and use in the liver (128).

    Evidence statement.

    PA can result in acute improvements in systemic insulin action lasting from 2 to 72 h. ACSM evidence category A.



    CHRONIC EFFECTS OF EXERCISE TRAINING

    Metabolic control: BG levels and insulin resistance.

    Aerobic exercise has been the mode traditionally prescribed for diabetes prevention and management. Even 1 week of aerobic training can improve whole-body insulin sensitivity in individuals with type 2 diabetes (282). Moderate and vigorous aerobic training improve insulin sensitivity (9,75,83,111), albeit for only a period of hours to days (141), but a lesser intensity may also improve insulin action to some degree (111). Training can enhance the responsiveness of skeletal muscles to insulin with increased expression and/or activity of proteins involved in glucose metabolism and insulin signaling (39,110,204,270). Moderate training may increase glycogen synthase activity and GLUT4 protein expression but not insulin signaling (39). Fat oxidation is also a key aspect of improved insulin action, and training increases lipid storage in muscle and fat oxidation capacity (64,95,136,223).
    An individual's training status will affect the use of carbohydrate during an aerobic activity. Aerobic training increases fat utilization during a similar duration bout of low- or moderate-intensity activity done after training, which spares muscle glycogen and BG and results in a lesser acute decrease in BG (28,83,223). Type 2 diabetes may be associated with a decrease in lipid oxidation and shift toward greater carbohydrate oxidation at all exercise intensities (87).
    Resistance exercise training also benefits BG control and insulin action in type 2 diabetes (46,65,115,116,118,246). In a randomized controlled trial (RCT), twice-weekly progressive resistance training for 16 weeks by older men with newly diagnosed type 2 diabetes resulted in a 46.3% increase in insulin action, a 7.1% reduction in fasting BG levels, and significant loss of visceral fat (116). An increase in muscle mass from resistance training may contribute to BG uptake from a mass effect, and heavy weight training in particular may reverse or prevent further loss of skeletal muscle due to disuse and aging (34,276). In another RCT, all 20 men with type 2 diabetes who participated in either resistance or aerobic exercise thrice weekly for 10 weeks improved their overall BG control, but those doing resistance training had significantly lower A1C values (32). Diabetic women undergoing 12 weeks of low-intensity training with resistance bands had gains in strength and muscle mass and loss of fat mass but had no change in insulin sensitivity (157).

    Evidence statement.

    Both aerobic and resistance training improve insulin action, BG control, and fat oxidation and storage in muscle. ACSM evidence category B. Resistance exercise enhances skeletal muscle mass. ACSM evidence category A.


    Comment


    • A note here this statement indicates that high intensity cardio like Hitt may not be suitable for blood G impared people .

      Transient hyperglycemia can follow intense PA. ACSM evidence category C.

      Comment


      • So another factor re exercise seems to be not to be inactive for long periods . So siting at a desk for 8 plus hrs nonstop then going to the gym for a hard workout might not be ideal .
        Quote

        Studies also show that interrupting extended periods of sitting is beneficial, so your daily exercise minutes could include getting up at least once an hour to walk around.

        Comment


        • Good study found, I thought it was really interesting about hiit and heavy cardio training. For the walking once an hour, I have my watch set to notify me every hour that it's time to get up and get some steps in. Although, I've been slacking the last few weeks.

          Comment


          • Ok so visceral fat is implicated in D2 so this is interesting

            This study evaluated the effects of omega-3 polyunsaturated fatty acids (PUFAs) on oxidative stress and energy metabolism parameters in the visceral fat of a high-fat-diet induced obesity model. Energy intake, body mass, and visceral fat mass were also evaluated. Male Swiss mice received either a control diet (control group) or a high-fat diet (obese group) for 6 weeks. After this period, the groups were divided into control + saline, control + omega-3, obese + saline, and obese + omega-3, and to these groups 400 mg·(kg body mass)-1·day-1 of fish oil (or saline) was administered orally, for 4 weeks. Energy intake and body mass were monitored throughout the experiment. In the 10th week, the animals were euthanized and the visceral fat (mesenteric) was removed. Treatment with omega-3 PUFAs did not affect energy intake or body mass, but it did reduced visceral fat mass. In visceral fat, omega-3 PUFAs reduced oxidative damage and alleviated changes to the antioxidant defense system and the Krebs cycle. The mitochondrial respiratory chain was neither altered by obesity nor by omega-3 PUFAs. In conclusion, omega-3 PUFAs have beneficial effects on the visceral fat of obese mice because they mitigate changes caused by the consumption of a high-fat diet.


            Visceral fat accumulation is associated with metabolic disease. It is therefore relevant to study factors that regulate adipose tissue distribution. Recent data shows that overeating saturated fatty acids promotes greater visceral fat storage than overeating unsaturated fatty acids.









            Last edited by Pegasus; 07-30-2021, 11:25 AM.

            Comment


            • So there swwms to be an argument for endurance training before breaky .

              https://pubmed.ncbi.nlm.nih.gov/27459862/

              https://pubmed.ncbi.nlm.nih.gov/20837645/

              The evidemce re weights is not there .
              Last edited by Pegasus; 08-03-2021, 03:37 PM.

              Comment


              • Fom Medical News today .
                7 herbs and supplements


                Here are seven herbs and supplements that may be of benefit to people with type 2 diabetes.
                1. Aloe vera

                Consuming aloe vera pulp might help repair and protect the pancreas.
                Aloe vera is a common plant with many different uses. Many people are aware of its benefits for skin care, but it may also have other benefits, including slowing the progress of type 2 diabetes.
                One review, published in 2013, looked at the use of aloe vera to treat symptoms of diabetes in rats. Findings suggested that aloe vera might help protect and repair the beta cells in the pancreas that produce insulin. The researchers believed this might be due to aloe’s antioxidant effects.
                The researchers called for more research into aloe and its extracts to be sure of these effects.
                Ways of taking aloe include:
                • adding juiced pulp to a drink or smoothie
                • taking capsules that contain aloe as supplements

                People should not eat aloe vera skin care products.
                Aloe vera juice may offer a number of health benefits. Find out more here.

                2. Cinnamon

                Cinnamon is a fragrant spice that comes from the bark of a tree. It is a popular ingredient in sweets, baked goods, and other dishes.
                It has a taste that can add sweetness without any additional sugar. It is popular with people with type 2 diabetes for this reason alone, but it may also offer other benefits.
                A 2010 reviewTrusted Source found evidence from studies involving humans that cinnamon may improve levels of:
                • glucose
                • insulin and insulin sensitivity
                • lipids, or fats, in the blood
                • antioxidant status
                • blood pressure
                • lean body mass
                • digestion

                In another review published in 2013, researchers concluded that cinnamon might lead to:
                • lower fasting blood glucose levels
                • less total cholesterol and “bad” low-density lipoprotein (LDL) cholesterol
                • higher levels of “good” high-density lipoprotein (HDL) cholesterol
                • a reduction in triglycerides, or fat, in the blood
                • increased insulin sensitivity

                It did not appear to have a significant impact on hemoglobin A1C. The A1C test is a standard test for diagnosing and monitoring diabetes.
                Nevertheless, lipids, cholesterol, and insulin sensitivity are all important markers for people with diabetes.
                In both studies, the researchers note that the results may depend on:
                • the type of cinnamon, as the amount of active ingredient depends on the type
                • the amount or dose
                • the individual’s response to cinnamon
                • other medications the person may be taking

                Most studies have not involved humans, so there is a lack of evidence about how cinnamon might affect people, including its possible side effects. Scientists need to carry out more research to confirm the safety and effectiveness of cinnamon as a therapy.
                People can take cinnamon:
                • in a variety of cooked dishes and baked goods
                • in teas
                • as a supplement

                Anyone who is thinking of using cinnamon supplements should speak to their doctor first.
                3. Bitter melon

                Momordica charantia, or bitter melon, is a medicinal fruit. Practitioners of traditional Chinese and Indian medicine have used bitter melon for centuries. People can cook the fruit and use it in many dishes. Some scientists have been looking into its potential medicinal uses.
                There is some evidence that bitter melon may help with the symptoms of diabetes. One review has noted that people have used many parts of the plant to help treat diabetes.
                Research has shown that taking bitter melon in the following forms can lead to a reduction in blood sugar levels in some people:
                • seeds
                • blended vegetable pulp
                • juice
                • supplements

                Eating or drinking the bitter melon can be an acquired taste, but taking supplements may make it more palatable.
                There is not enough evidence to support using bitter melon instead of insulin or medication for diabetes.
                However, it may help people rely less on those medications or lower their dosages.
                Learn more here about the impact bitter melon can have on blood sugar levels.
                Bitter melon capsules
                4. Milk thistle

                Milk thistle may have anti-inflammatory properties, making it potentially useful for people with diabetes.
                People have used milk thistle since ancient times for many different ailments, and especially as a tonic for the liver.
                Silymarin, the extract from milk thistle that has received the most attention from scientists, is a compound with antioxidant and anti-inflammatory properties. These are the properties that may make milk thistle a useful herb for people with diabetes.
                Many of the studies on silymarin are promising, but the research is not strong enough to recommend the herb or extract alone for diabetes care, according to one reviewTrusted Source published in 2016.
                There appear to be no reports of significant side effects, and many people take milk thistle as a supplement. However, it is best to speak to a doctor first before using any supplements.
                Find a range of milk thistle capsules
                5. Fenugreek

                Fenugreek is another seed that may help lower blood sugar levels.
                The seeds contain fibers and chemicals that help to slow down the digestion of carbohydrates and sugar.
                There is also some evidence that the seeds may help delay or prevent the onset of type 2 diabetes.
                Findings of a 3-year investigation published in 2015 noted that people with prediabetes were less likely to receive a diagnosis of type 2 diabetes while taking powdered fenugreek seed.
                The researchers concluded that taking the seed led to:
                • increased levels of insulin in the body, leading to a reduction in blood sugar
                • lower cholesterol levels

                The study involved 66 people with diabetes who took 5 grams (g) of the seed preparation twice a day before meals, and 74 controls, who did not take it.
                A person can:
                • include fenugreek as a herb in certain dishes
                • add it to warm water
                • grind into a powder
                • take it as a supplement in capsule form

                A range of fenugreek capsules
                6. Gymnema

                Gymnema sylvestre is a herb that comes from India. Its name means “sugar destroyer.”
                A 2013 review noted that people with both type 1 and type 2 diabetes who took gymnema showed signs of improvement.
                In people with type 1 diabetes who took the leaf extract for 18 months, fasting blood sugar levels fell significantly, compared with a group who received only insulin.
                Other tests using gymnema found that people with type 2 diabetes responded well to both the leaf and its extract over various periods.
                Some people experienced:
                • lower blood sugar levels
                • higher insulin levels

                Using either the ground leaf or leaf extract may be beneficial. But once again, talk to your doctor about using it before starting.

                7. Ginger

                There is some evidence that ginger can lower blood sugar levels.
                Ginger is another herb that people have used for thousands of years in traditional medicine systems.
                People often use ginger to help treat digestive and inflammatory issues.
                However, in 2015, a review suggested that it may also help treat diabetes. The results showed that ginger lowered blood sugar levels, but did not lower blood insulin levels.
                Because of this, they suggest that ginger may reduce insulin resistance in the body for type 2 diabetes.
                However, the researchers were uncertain as to how ginger might do this, and they called for more research to confirm these findings.
                People can take ginger:
                • by adding ginger powder or chopped, fresh ginger root to raw or cooked food
                • brewed into tea
                • as a supplement in capsule form
                • by drinking it in a ginger ale
                Last edited by Pegasus; 08-29-2021, 08:06 PM.

                Comment


                • Ok some comment on this article I pulled off the web.
                  So a lot of these products are in common use but regardless of that some care may be needed . For instance cinnamon it is recommended not to take more than a teaspoon a day . Obviously most people only use a sprinkle at a time but those useing it as a supplement may wish to use more than a sprinkle.


                  Ok so I have eaten aloe vera over doing it can lead to the runs . It is a well known supplement usefull on burns or as a skin care product . Just some care needed when useing it as a food it is in common use and most tolerate it well in moderate doses .
                  Cinnamon is in common use I have taken a teapoon a day at times (max recommended dose ) and it seemed to have a positive effect . Again just some care re dosage as some individuals may be sensitive .
                  Bitter melon have eaten this many times cooked into food . It is commonly eaten in asia and is regarded there as a health positive food . Funny enough western docs seem to have some concern re large doses which I certainly would have exceeded at times . No mention of a max dose among asian people that eat it regularly but like anything some caution with large amounts .
                  Have no experience with milk thistle but it has a long history of wide spread use .
                  Fenugreek is widely used as a herb and I have used it in cooking . Not mentioned here but it may have a positive effect on testosterone .
                  Gymnema first I have heard of it .
                  Ginger in wide use .

                  Most of these are cheap and not that hard to find . Any asian grocer will have most of them .
                  Last edited by Pegasus; 08-29-2021, 08:27 PM.

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                  • https://www.pegym.com/sugar-and-agin...-need-to-know/

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                    • I once read a book by Mr. Jared Diamond(I could be wrong about this as it was well over 20 years ago?) that discussed how most societies have ancient diets that particular groups have adapted to over time. It's only in recent times with fast food and HFCS being added to so many things that you're seeing an explosion in obesity and disease.

                      His solution was to "go native" with diet. He used an example of a gentleman from the Pacific Islands who required injections of insulin every day who switched to a completely native type diet. He lost a massive amount of weight and was able to forego his medical insulin.
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                      • Originally posted by Big Al View Post
                        I once read a book by Mr. Jared Diamond(I could be wrong about this as it was well over 20 years ago?) that discussed how most societies have ancient diets that particular groups have adapted to over time. It's only in recent times with fast food and HFCS being added to so many things that you're seeing an explosion in obesity and disease.

                        His solution was to "go native" with diet. He used an example of a gentleman from the Pacific Islands who required injections of insulin every day who switched to a completely native type diet. He lost a massive amount of weight and was able to forego his medical insulin.
                        Some native australians have found a similar thing .
                        I don't know how much use this is to most of us in the larger sense though .

                        Comment


                        • Originally posted by Pegasus View Post

                          Some native australians have found a similar thing .
                          I don't know how much use this is to most of us in the larger sense though .
                          Unless one grows their own food, forages or has connections, fresh, healthy food is often more expensive than processed food. It also requires preparation. That being said, it's most definitely worth it.
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                          • Originally posted by Big Al View Post

                            Unless one grows their own food, forages or has connections, fresh, healthy food is often more expensive than processed food. It also requires preparation. That being said, it's most definitely worth it.
                            Yes and these are exampes that are achievable .
                            But to give an example native australians might be able to source kangaroo meat instead of beef but a range of "bush tucker " that their ancestors ate are unavailable in the supermarket .
                            Thinking on my ancestors I decided to eat more fish is a simple version of this

                            Comment


                            • Free range food is often tastier, and should be devoid of any of the noxious components often added to most store prepared or industrially farmed foods.

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