Galbo Henrik, Tobin Lillan, van Loon Luc J C
Copenhagen Muscle Research Centre (CMRC) and Department of Rheumatology, Bispebjerg Hospital, Copenhagen, Denmark, and Department of Movement Sciences, Nutrition and Toxicology Research Institute, Maastricht University, the Netherlands.
Appl Physiol Nutr Metab. 2007 Jun;32(3):567-75. doi: 10.1139/H07-029.
In people with type 1 diabetes mellitis (DM), insulin administration, food intake, and exercise have to be carefully matched to avoid either hypo- or hyperglycemia. People with type 2 DM have some insulin secretion, which changes with needs. Accordingly, during exercise, these people do not run the same metabolic risks as people with type 1 DM. However, a contraction-mediated increase in glucose clearance in muscle is intact in type 2 DM. Therefore, in the postabsorptive state in diet-treated type 2 DM, a marked reduction in hyperglycemia can occur during prolonged moderate exercise. Sulfonylurea drugs augment the rate of decline in plasma glucose, because stimulation of insulin secretion reduces hepatic glucose production. After abstention from sulfonylurea for 5 days, the rate of decrease in plasma glucose with exercise is also enhanced, but from a higher glucose level. In the postabsorptive state, brief vigourous exercise elicits an increase in plasma glucose concentration, reflecting an exaggerated counterregulatory hormone response and glucose production. Moreover, insulin sensitivity is reduced in the early postexercise period. In the postprandial state, both prolonged moderate exercise and intermittent high-intensity exercise markedly decrease meal-induced increases in glucose, insulin, and C-peptide concentrations, whereas glucose appearance in plasma is unchanged. When exercise bouts are isocaloric, responses are identical, indicating that overall energy expenditure, and not peak exercise intensity, is the major determinant of exercise-induced changes in overall glucose homeostasis and insulin secretion in type 2 DM. Neither prolonged moderate nor intermittent high-intensity exercise performed in the postprandial state influences glucose or insulin responses to a subsequent meal. Finally, in people with type 2 DM, after a high-fat meal, prolonged moderate exercise reduces the exaggerated increases in plasma concentrations of triglycerides contained in chylomicrons and very low-density lipoproteins.
在1型糖尿病患者中，胰岛素给药、食物摄入和运动必须仔细匹配，以避免低血糖或高血糖。2型糖尿病患者有一定的胰岛素分泌，且会随需求变化。因此，在运动期间，这些人与1型糖尿病患者面临的代谢风险不同。然而，2型糖尿病患者肌肉中收缩介导的葡萄糖清除增加是完好的。所以，在饮食治疗的2型糖尿病患者的空腹状态下，长时间适度运动期间高血糖可显著降低。磺脲类药物可提高血浆葡萄糖下降速率，因为刺激胰岛素分泌可减少肝脏葡萄糖生成。停用磺脲类药物5天后，运动时血浆葡萄糖下降速率也会提高，但起始葡萄糖水平更高。在空腹状态下，短暂剧烈运动可导致血浆葡萄糖浓度升高，这反映了反调节激素反应和葡萄糖生成过度。此外，运动后早期胰岛素敏感性降低。在餐后状态下，长时间适度运动和间歇性高强度运动均可显著降低餐后葡萄糖、胰岛素和C肽浓度的升高，而血浆中葡萄糖的出现不受影响。当运动 bout 等热量时，反应相同，这表明总能量消耗而非运动峰值强度是2型糖尿病患者运动诱导的整体葡萄糖稳态和胰岛素分泌变化的主要决定因素。餐后进行的长时间适度运动或间歇性高强度运动均不会影响对随后一餐的葡萄糖或胰岛素反应。最后，在2型糖尿病患者中，高脂餐后，长时间适度运动可降低乳糜微粒和极低密度脂蛋白中甘油三酯血浆浓度的过度升高。
