Diabetes and Its Affects to the Body - Essay Example

Diabetes Physical therapists who wish to provide their patients with the best possible care should makeit a practice to stay current in research studies that may have an affect on the way in which they work with those patients. In working with diabetic patients, there are many advances happening all the time as researchers learn more about how diabetes affects the normal functioning of the body and how exercise and physical therapy play a part. By studying the chemical processes that occur when the body is in active motion, such as in exercise, researchers have discovered numerous advantages for the diabetes patient in maintaining a stable exercise routine as well as the most beneficial degree of physical involvement and frequency of physical activity, but each of these realizations could have an impact on best practices for physical therapists in working with diabetic patients. In “Metallothionein-Mediated Antioxidant Defense System and Its Response to Exercise Training Are Impaired in Human Type 2 Diabetes” (Scheede-Bergdahl 2005), the authors discuss the importance of metallothioneins I and II (MT 1&2) as part of the antioxidant defense system and its relationship to exercise in the diabetic patient. Previous studies regarding these antioxidants have indicated that exercise has only beneficial effects on the production of MT 1&2, but the research team noticed that none of the studies had actually been conducted on people with Type 2 Diabetes. Further evidence had suggested the possibility that these important chemicals are reduced with exercise in persons with Type II Diabetes. During the study, it was confirmed that levels of MT 1&2 are increased in the skeletal muscle tissue and plasma of healthy individuals who have participated in a regular exercise program. Participants who had Type 2 Diabetes showed no corresponding increases though. While the study was careful to note that there were no increases or decreases in MT 1&2 levels in the skeletal musculature in these patients, it was also noted that levels were decreased somewhat in the plasma levels. Decreased MT 1&2 can lead to oxidative stress, which “contributes to the development and acceleration of related conditions such as nephropathy, neuropathy, retinopathy and macro- and microvascular damage” (Scheede-Bergdahl 2005). At the same time, tissue samples taken from patients with Type 2 Diabetes indicated increased oxidative stress from the control group with tissue appearing more susceptible to damage. As further research is conducted as to just how important the decreased levels of MT 1&2 are in the overall health and well-being of the diabetic patient, some changes may occur in the types of physical therapy recommended for these patients. Before this occurs, however, it must be determined the exact role these compounds play in the antioxidant defense as well as whether pharmacological or therapeutic treatment options will work best to provide the patient with the greatest possible benefit. However, exercise will continue to play a large role in the treatment of diabetic patients thanks to the many other benefits it offers. According to Kennedy et al (1999), exercise also helps to distribute GLUT4 throughout the body, a process that doesn’t occur as readily in the person with diabetes as it does in those without the illness. GLUT4 is the glucose transporter that brings glucose into the cell through the plasma membrane. For various reasons, GLUT4 is considered to be “the major mechanism responsible for the increased rate of glucose transport after insulin or exercise stimulation” (Kennedy et al 1999). However, this is a process that takes place primarily in the skeletal muscle, which, in the diabetic patient, has proven to have decreased insulin-stimulated uptake. This study showed that the muscle is not similarly resistant to the effects of exercise by demonstrating that the GLUT4 transporter enters the plasma membrane in response to exercise where it doesn’t respond to insulin. “In contrast to insulin stimulation, acute exercise promotes normal glucose uptake and GLUT4 translocation” (Kennedy et al 1999). In addition, the study showed that exercise can increase the GLUT4 content in the plasma membrane to be nearly identical with people who don’t have diabetes, are leaner and younger. This study begins to outline the various ways in which exercise and physical therapy in diabetic patients can assist them in their disease maintenance. Exercising the muscle helps to increase the levels of GLUT4 in the plasma membrane making it more possible for the patient’s body to absorb the glucose within the bloodstream. Even more specifically, exercise targets an area of dysfunction that insulin has little to no effect upon as skeletal muscle has been shown through this and other studies to have little to no reaction to insulin. This study is backed up by a subsequent study conducted by Musi et al (2001) in which it was determined that AMP-Activated Protein Kinase (AMPK) activity was normal in response to exercise, as it should be if the previous study regarding the effect of exercise on the GLUT4 transporter held true. “AMP-activated protein kinase (AMPK) has recently emerged as a potentially key signaling intermediary in the regulation of exercise-induced changes in glucose and lipid metabolism in skeletal muscle” (Musi et al 2001). AMPK plays a significant role in the signaling of the GLUT4 to release into the plasma membrane. This study proves that AMPK functions properly in the Type 2 Diabetic during exercise and suggests that it does not function properly while at rest. This was done by comparing the blood sugar levels of a test group of diabetics with the blood sugar levels of the control groups before, during and after riding an exercise bicycle for 45 minutes. While the blood sugar levels of the diabetics were significantly reduced after the exercise, the blood sugar levels of the control groups remained the same. However, like GLUT4, the mean AMPK content in diabetic patients as compared to the control group did not show a significant difference. Because of its believed role in the regulation of this process, however, this study suggests further investigation as to just how the AMPK pathway stimulates the uptake of glucose with the intent of the development of a new set of drugs designed to stimulate the exercise-induced response. For the physical therapist, this further emphasizes the importance of ensuring muscles are exercised to provide the patient with the maximum benefit and ability to regulate glucose on their own. The introduction of new medicine may also have unexpected side effects to the effectiveness of exercise or to the reactions of the muscles. With the importance of exercise firmly established, the questions then arise, what constitutes acute exercise and what type of exercise is most important – organized exercise in the physical therapy room or other structured program or leisure time activities? Laaksonen et al (2005) organized a study to determine just how much the increase in leisure time physical activity might impact the development of Type 2 Diabetes among a group of men and women with impaired glucose tolerance. The study, conducted over a period of a little over four years, determined that those people who increased their leisure time activity level to include many strenuous or structured physical activities were 63-65 percent less likely to develop Type 2 Diabetes. The same study indicated that even smaller changes in exercise and lifestyle leisure time physical activities such as adding a walk around the block every day could provide benefits over those who participated in little or no daily exercise. “Thus increasing physical activity may substantially reduce the incidence of Type 2 Diabetes in high-risk individuals” (Laaksonen et al 2005). Exercises used in the study included walking at a moderate or very strenuous intensity, bicycling, swimming, resistance training, skiing, jogging, participating in ball games and outdoor lifestyle activities such as chopping wood or clearing brush. Low intensity activities were reported as included casual or mildly exertive walking, bicycling at a leisurely intensity, gardening and yard work and picking berries and mushrooms. ‘Strenuous’ was determined by whether the activity was practiced at a moderate or high subjective intensity, causing a moderate or heavy sweating or degree of breathlessness. It is important to note that many of the activities, classified as both strenuous and non-strenuous, could be couched in terms of household chores. When working with patients and trying to encourage more active participation in their well-being, physical therapists can recommend several types of household chores such as gardening, vacuuming, cleaning or washing the car as beneficial activities that can be done at home to bring physical benefit to the diabetic or pre-diabetic patient. With exercise comes the possibility of broken bones, making the studies of Lu et al (2003) necessary for proper physical therapy treatment and understanding following an accident. In their study, “Diabetes Interferes with the Bone Formation by Affecting the Expression of Transcription Factors that Regulate Osteoblast Differentiation,” researchers found that people with Type 1 Diabetes do experience inadequate bone formation, osteopenia and delayed fracture healing as a result of their illness. Previous studies are cited that have already established diabetics have decreased bone density and bone formation as compared to control groups which suggests they have diminished osteoblast activity. “In streptozotocin-induced diabetic rats, abnormal bone repair was shown to be insulin dependent because the deficient osseous healing was reversed by insulin treatment. This finding demonstrates a specific cause and effect relationship between inadequate insulin production and abnormal bone formation” (Lu et al 2003). The study indicated that these deficiencies could be reversed with the proper application of insulin, yet finding the mechanism that prevents the bone formation at the protein level would enable researchers to further negate the effects of diabetes on patients. Physical therapists working with patients following an accident involving a broken bone must remember that diabetes may not heal as quickly as other patients and bones in the diabetes patient may be more brittle than those of the non-diabetic patient. As it becomes more and more clear how the diabetic patient’s body differs from those of the normal body, some of these issues can be resolved. However, regardless of the situation, it does seem clear that the benefits of exercise for a diabetes patient far outweigh any negative effects it may have, enabling them to more naturally and completely manage their own health. References Kennedy, J.W.; Hirshman, M.F.; Gervino, E.V.; Ocel, J.V.; Forse, R.A.; Hoenig, S.J.; Aronson, D.; Goodyear, L.J. & Horton E.S. (May 1999). “Acute Exercise Induces GLUT4 Translocation in Skeletal Muscle of Normal Human Subjects and Subjects with Type 2 Diabetes.” Diabetes. Vol. 48, Laaksonen, D.; Lindstrom, J.; Lakka, T.; Eriksson, J.; Niskanen, L.; Witstrom, K; Aunola, S.; Keinanen-Kiukaanniemi, S.; Laakso, M.; Valle, T.; Ilanne-Parikka, P.; Louheranta, A.; Hamalainen, H.; Rastas, M.; Salminen, V.; Cepaitis, Z.; Hakumaki, M.; Kaikkonen, H.; Harkonen, P.; Sundvall, J.; Tuomilehto, J. & Uusitupa, M. (2005). “Physical Activity in the Prevention of Type 2 Diabetes.” Diabetes. The Finnish Diabetes Prevention Study. Vol. 54, pp. 158-65. Lu, H.; Kraut, D.; Gerstenfeld, L. & Graves, D. (2003). “Diabetes Interferes with the Bone Formation by Affecting the Expression of Transcription Factors that Regulate Osteoblast Differentiation.” Edocrinology. Vol. 144, N. 1, pp. 346-52. Musi, N.; Fujii, N.; Hirshman, M.; Ekberg, I.; Froberg, S.; Ljungqvist, O.; Thorell, A. & Goodyear, L. (2001). “AMP-Activated Protein Kinase (AMPK) is Activated in Muscle of Subjects with Type 2 Diabetes During Exercise.” Diabetes. Vol. 50, pp. 921-27. Scheede-Bergdahl, C.; Penkowa, M.; Hidalgo, J.; Olsen, D.; Schjerling, P.; Prats, C.; Boushel, R. & Dela, F. (2005). “Metallothionein-Mediated Antioxidant Defense System and Its Response to Exercise Training Are Impaired in Human Type 2 Diabetes.” Diabetes. Vol. 54, pp. 3089-94. Read More