What is diabetes?

Diabetes is a chronic health condition which occurs when there is too much glucose within the blood. Either the body is unable to make insulin, make enough insulin or the body is unable to effectively use the insulin that it does make to lower or maintain our blood glucose levels within normal readings. The three different types of diabetes include type II, type I and gestational.

It is currently estimated that more than 415 million individuals around the world have diabetes, with >90% of these individuals having type II. Staggeringly, this number is expected to increase by more than 50% by 2040. However, fortunately research has demonstrated that exercise can be used as an effective tool to assist with the management of diabetes.

Whilst type II diabetes cannot be cured, individuals can have their glucose levels return to non-diabetic range (complete remission) or pre-diabetes glucose levels (partial remission). The main mechanism for achieving remission is by achieving significant weight loss. It is thought that weight loss results in increased insulin sensitivity through a reduction of inflammation, improved adipocyte function, reduced oxidate stress, reduced endoplasmic reticulum stress and improved genetic make-up.

Exercise and diabetes

Traditionally, exercise advice has mainly focused on aerobic activity. Aerobic exercise includes walking, running, swimming, bike riding and rowing. These exercises are of lower-intensity and can therefore be undertaken for longer periods of time, which can contribute to both lowering blood glucose and can increase energy expenditure which can aid in weight loss.

However, more recently, an exercise type known as high-intensity interval training (HIIT) has shown promising benefits for acutely lowering blood glucose levels. High intensity interval training consists of short bursts of high intensity exercise interspersed with recovery periods. A common way of prescribing HIIT is known as the 4:4 method. This method involves completing 4 minutes of aerobic exercise at a low intensity which is then followed by 4 minutes of aerobic exercise at a high intensity. The intensity of exercise is alternated within this manner until a total of 16 minutes of aerobic exercise has been completed.

The recommendations for achieving weight loss through aerobic exercise is to complete 300 minutes per week of moderate intensity activity, or 150 minutes per week of vigorous activity or a combination of both. In addition, exercise durations of greater than 150 minutes per week are associated with a HbA1c reduction of 0.89%, compared to those of less than 150 minutes per week which were only associated with a HbA1c reduction of 0.36%. HbA1c is a measure of your average blood glucose reading over the previous 3 months. For people with diabetes, it is recommended that the HbA1c reading is below 7%.

Furthermore, resistance exercise can also have acute benefits in terms of insulin sensitivity and can increase lean body mass. Resistance exercise can also help to increase functional capacity, which can be important for those wanting to maintain independence. Meeting these recommendations are also linked to improvements in all-cause mortality, reduction in the incidence of breast / colon cancer, reduced blood pressure and improved mood, sleep, and physical function. 

The bottom line
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Ultimately, exercise plays a crucial role in the management of diabetes. Whilst diabetes cannot be reversed there are numerous benefits for those who participate in regular exercise. If people cannot meet the guidelines for exercise and diabetes there is still an abundance of health benefits that can be achieved by working towards these recommendations. 

Author - Rebecca Dostan

In the realm of metabolic health, the adage "knowledge is power" rings especially true. As an Exercise Physiologist, Nutritionist, and Diabetes Educator, I've seen firsthand how understanding and managing blood glucose levels can significantly impact health outcomes. Continuous Glucose Monitors (CGMs) offer a powerful tool for anyone looking to optimize their health, even beyond diabetes management. Let's delve into why CGMs are beneficial for individuals with PCOS, pre-diabetes, those striving for weight loss, and women navigating menopause.

Why Use a Continuous Glucose Monitor if I Don't Have Diabetes?
You might wonder why a CGM would be necessary if you don't have diabetes. The answer lies in the valuable insights it provides into your body's metabolic processes. Blood glucose levels are a critical indicator of how your body responds to different foods, activities, and daily stress. By monitoring these levels continuously, you gain a real-time understanding of how lifestyle factors influence your metabolic health, allowing for more personalized and effective health interventions.

The Benefits of Continuous Glucose Monitoring for Health

1. Polycystic Ovary Syndrome (PCOS)
PCOS is often accompanied by insulin resistance, making blood glucose management crucial. CGMs help women with PCOS by:

• Identifying Blood Sugar Spikes: Understanding how different foods and activities impact blood sugar levels can help in making dietary adjustments that minimize spikes and crashes.
• Personalized Nutrition: Tailoring diet plans based on real-time glucose data ensures more stable blood sugar levels, which can improve symptoms like irregular periods and weight gain.
• Improved Insulin Sensitivity: Monitoring glucose trends can guide interventions aimed at improving insulin sensitivity, a key factor in managing PCOS effectively.

2. Pre-Diabetes
For individuals with pre-diabetes, CGMs are invaluable in preventing the progression to type 2 diabetes:

• Early Detection of Glucose Dysregulation: Continuous monitoring can catch early signs of glucose dysregulation, enabling timely dietary and lifestyle changes.
• Behavioral Modifications: Seeing the immediate impact of food choices and physical activity on glucose levels can motivate healthier habits.
• Better Risk Management: CGMs provide actionable data that can be used to tailor interventions aimed at reducing the risk of developing diabetes.

3. Weight Loss
Weight management is intricately linked to blood glucose control. CGMs support weight loss efforts by:

• Optimizing Meal Timing: By understanding how meals affect blood sugar, you can optimize meal timing to maintain stable energy levels and reduce cravings.
• Enhanced Food Choices: Real-time feedback on how different foods affect your glucose levels can guide better food choices, promoting satiety (feelings of fullness) and reducing overeating.
• Personalized Exercise Plans: Tracking glucose responses to physical activity can help in designing exercise routines that maximize fat burning and improve metabolic health.

The following picture shows a weight loss client who has had a spike in glucose following a meal of spaghetti bolognaise, bread roll and chocolate mouse.  By wearing the GCM we can see how our body reacts to certain meals, exercise and stress within our lives, which provides data for us to moify and improve our overall health score.

How to access and apply a Continuous Glucose Monitor

Access
Our Senior Exercise Physiologist/Diabetes Educator and Nutritionist Lisa is equipped to help you access a CGM, and will support you to apply the sensor, and hook you up with a web interface and app where you can track all of your data.  Not only will this track your CGM/glucose data, but you can also add in your food intake, your exercise and sleep.  If you have a wearable device such as an Apple watch or Garmin, you can link the accounts and all information will be automatically transferred to give you a complete picture.

How to apply a CGM Sensor - see the video below.

Lisa Parkinson
Accredited Exercise Physiologist
Credentialled Diabetes Educator
Nutritionist

Diabetes management involves keeping track of various health indicators, one of which is HbA1c. But what exactly is HbA1c, and why is it important? This article will delve into the significance of HbA1c, its normal range in Australia, and how it differs from fasting glucose measurements.

What is HbA1c?
HbA1c, or glycated hemoglobin, is a blood test that measures the average level of blood glucose over the past two to three months. This test is crucial for monitoring long-term glucose control in individuals with diabetes. Hemoglobin is a protein in red blood cells that carries oxygen. When glucose binds to hemoglobin, it forms glycated hemoglobin. The HbA1c test quantifies the percentage of hemoglobin that is glycated, providing an overall picture of blood glucose levels.

What is a Normal HbA1c in Australia?
In Australia, the target HbA1c level for most adults with diabetes is less than 7% (53 mmol/mol). However, the ideal target can vary based on individual health conditions and healthcare providers' recommendations. It's essential to have regular HbA1c tests to ensure that diabetes is well-managed and to make any necessary adjustments to treatment plans.

What Does the HbA1c Mean?
The HbA1c level reflects the average blood glucose concentration over the past two to three months. Here's a breakdown of what different HbA1c levels indicate:

• Below 5.7% (39 mmol/mol): Normal, non-diabetic range.
• 5.7% to 6.4% (39 to 46 mmol/mol): Prediabetes, indicating higher risk for developing diabetes.
• 6.5% (48 mmol/mol) or higher: Diagnostic of diabetes.

Regular monitoring of HbA1c helps to assess how well diabetes is being managed and to identify any necessary changes in treatment to prevent complications.

What is the Difference Between Fasting Glucose and HbA1c?
Fasting glucose and HbA1c are both important measures in diabetes management, but they serve different purposes:
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• Fasting Glucose: This test measures the blood glucose level at a single point in time after an overnight fast (at least 8 hours without food). It provides immediate information about blood glucose levels and can be used for initial diabetes diagnosis in patients with symptoms.
• HbA1c: Unlike fasting glucose, the HbA1c test gives an average of blood glucose levels over the previous two to three months. It is not influenced by daily fluctuations, making it a more reliable indicator of long-term glucose control.

Both tests are essential: fasting glucose can identify acute spikes in blood glucose, while HbA1c offers a broader view of how well blood glucose is controlled over time.

Need more info?
For more detailed information on managing diabetes and how your Exercise Physiologist can help, please refer to the following resources:

• Optimum Exercise Physiology: Diabetes Management
• Optimum Exercise Physiology: Diabetes Exercise Class

Take Action
Taking control of your diabetes is crucial for long-term health. Regular monitoring and appropriate lifestyle changes can make a significant difference. Book an appointment with our experts to develop a personalized diabetes management plan. Book Now

Conclusion
Understanding HbA1c and its role in diabetes management is vital for maintaining good health. Regular HbA1c testing, alongside fasting glucose tests, provides a comprehensive view of your blood glucose control. By staying informed and proactive, you can effectively manage your diabetes and enhance your quality of life.