Richter E A, Galbo H
Sports Med. 1986 Jul-Aug;3(4):275-88. doi: 10.2165/00007256-198603040-00004.
The metabolic and hormonal adaptations to single exercise sessions and to exercise training in normal man and in patients with insulin-dependent as well as non-insulin-dependent diabetes mellitus are reviewed. In insulin-dependent (type I) diabetes good metabolic control is best obtained by a regular pattern of life which will lead to a fairly constant demand for insulin from day to day. Exercise is by nature a perturbation that makes treatment of diabetes difficult: Muscle contractions per se tend to decrease the plasma glucose concentration whereas the exercise-induced response of the so-called counter-regulatory hormones tend to increase plasma glucose by increasing hepatic glucose production and adipose tissue lipolysis. If the pre-exercise plasma insulin level is high, hypoglycaemia may develop during exercise whereas hyperglycaemia and ketosis may develop if pre-exercise plasma insulin levels are low. Physical activity is often difficult to carry out on a precise schedule and the exercise-induced changes in demand for insulin and calories vary according to the intensity and duration of exercise, time of day, and differ within and between individuals. Thus, physical training can not be recommended as a means of improving metabolic control in insulin-dependent diabetes. However, our present knowledge and technology allows the well-informed and cooperative patient to exercise and even to reach the elite level. To achieve this, pre-exercise metabolic control should be optimal and knowledge of the patient's reaction to exercise is desirable, which necessitates frequent self-monitoring of plasma glucose. It may often be necessary to diminish the insulin dose before exercise, and/or to ingest additional carbohydrate during or after exercise. In non-insulin-dependent (type II) diabetes, exercise is associated with less risk of metabolic derangement, and in genetically disposed individuals physical training may prevent development of overt diabetes possibly by diminishing the strain on the pancreatic beta cell. The latter, however, is only achieved if exercise is not accompanied by increased caloric intake. Whether physical training in diabetes can reduce cardiovascular morbidity and mortality is at present unknown, but training has in diabetic patients been shown to lessen some risk factors for development of arteriosclerosis. However, training of diabetics (especially in the less well-regulated patient) may not lessen coronary risk factors to the same extent as in healthy subjects.
本文综述了正常人和胰岛素依赖型及非胰岛素依赖型糖尿病患者单次运动及运动训练后的代谢和激素适应性变化。在胰岛素依赖型（I型）糖尿病中，通过规律的生活方式可实现最佳代谢控制，从而使每日对胰岛素的需求保持相对稳定。运动本质上是一种干扰因素，会给糖尿病治疗带来困难：肌肉收缩本身会降低血浆葡萄糖浓度，而运动诱导的所谓反调节激素反应则倾向于通过增加肝脏葡萄糖生成和脂肪组织脂肪分解来提高血浆葡萄糖水平。如果运动前血浆胰岛素水平较高，运动期间可能会发生低血糖；而如果运动前血浆胰岛素水平较低，则可能会出现高血糖和酮症。体力活动往往难以精确安排，运动引起的胰岛素和热量需求变化因运动强度、持续时间、时间以及个体差异而有所不同。因此，不建议将体育锻炼作为改善胰岛素依赖型糖尿病代谢控制的手段。然而，根据我们目前的知识和技术，信息充分且配合良好的患者能够进行运动，甚至达到精英水平。要实现这一点，运动前的代谢控制应达到最佳状态，并且需要了解患者对运动的反应，这就需要频繁进行血浆葡萄糖自我监测。运动前通常可能需要减少胰岛素剂量，和/或在运动期间或运动后摄入额外的碳水化合物。在非胰岛素依赖型（II型）糖尿病中，运动导致代谢紊乱的风险较低，对于有遗传易感性的个体，体育锻炼可能通过减轻胰腺β细胞的负担来预防显性糖尿病的发生。然而，只有在运动时不增加热量摄入的情况下才能实现这一点。目前尚不清楚糖尿病患者进行体育锻炼是否能降低心血管疾病的发病率和死亡率，但已证明对糖尿病患者进行训练可减轻一些动脉粥样硬化发展的危险因素。然而，糖尿病患者（尤其是病情控制较差的患者）的训练可能无法像健康受试者那样充分降低冠心病危险因素。
