Description of easy and reliable way to manage blood sugars that prevents weight regain, prevents disease and complications.

1. Pre & Postprandial Brief
(5 minutes!) Muscle Training
for Management of Blood
Glucose
Kathleen Broomall, Ph.D.

2. Postprandial hyperglycemic spike
Glycemic index, postprandial
glycemia, and the shape of the curve
in
healthy subjects: analysis of a
database of more than 1000 foods1,2
Brand-Miller et al_ 89 (1) 97 -- American
Journal of Clinical Nutrition

3. Types of Diabetes
 Type 1 diabetes, formerly called juvenile diabetes, is usually first
diagnosed in children, teenagers, and young adults. In this form of
diabetes, the pancreas no longer makes insulin because the body’s
immune system has attacked and destroyed the pancreatic cells
specialized to make insulin. These insulin-producing cells are
called beta cells.
 Type 2 diabetes, formerly called adult-onset diabetes, is the most
common form. People can develop type 2 diabetes at any age,
even during childhood. This form of diabetes usually begins with
insulin resistance, a condition in which muscle, liver, and fat cells
do not use insulin properly. As a result, the body needs more
insulin to help glucose enter cells to be used for energy. At first,
the pancreas keeps up with the added demand by producing more
insulin. In time, however, the pancreas loses its ability to secrete
enough insulin in response to meals.

4. Diagnostic Criteria for Diabetes
 Fasting Plasma Glucose Result (mg/dL)
Diagnosis
 99 or below Normal
 100 to 125 Pre-diabetes (Impaired Fasting
Glucose)
 126 or above Diabetes

5. Diagnostic Criteria for Diabetes
 2-Hour Postprandial Plasma Glucose Result
(mg/dL) Diagnosis
• 139 and below Normal
• 140 to 199 Pre-diabetes (Impaired
Glucose Tolerance)
• 200 and above Diabetes

6. Pre-Diabetes
 Pre-diabetes is a condition in which blood glucose
levels are higher than normal but not high enough for a
diagnosis of diabetes. This condition is sometimes
called impaired fasting glucose (IFG) or impaired
glucose tolerance (IGT), depending on the test used to
diagnose it. The U.S. Department of Health and Human
Services estimates that about one in four U.S. adults
aged 20 years or older—or 57 million people—had pre-
diabetes in 2007.

7. Metabolic Syndrome
 Metabolic syndrome is defined as the presence of any
three of the following conditions:
 waist measurement of 40 inches or more for men and 35
inches or more for women
 triglyceride levels of 150 milligrams per deciliter (mg/dL) or
above, or taking medication for elevated triglyceride levels
 HDL, or “good,” cholesterol level below 40 mg/dL for men and
below 50 mg/dL for women, or taking medication for low HDL
levels
 blood pressure levels of 130/85 or above, or taking medication
for elevated blood pressure levels
 fasting blood glucose levels of 100 mg/dL or above, or taking
medication for elevated blood glucose levels

8. Role of postprandial spike in
Cardiovascular Disease
Review article doi: 10.1111/j.1742-1241.2006.01168.x

9. Abnormal Glucose Metabolism may
be underestimated in Heart
Patients

Conclusions: Abnormal Glucose Metabolism is prevalent (found in >28%
of patients tested) and underestimated in Primary Hypertension
Coronary Heart Disease patients with normal Fasting Blood Glucose,
and it will develop even if therapeutic life-style changes are adopted.
Except for FBG, more attention should be paid to postprandial blood
glucose. Oral Glucose Tolerance Test should be a routine procedure for
PH patients, especially in-hospital PH patients, regardless of normal
FBG, and active drug intervention for Impaired Glucose Tolerance
patients with PH may be recommended.
 “Glucometabolic state of in-hospital primary hypertension patients
with normal fasting blood glucose in a sub-population in China”
Diabetes Metab Res Rev 2009, Mar 6 (epub)

10. Exercise and Diabetes: Current
Recommendations
 Various recommendations
 30 minutes exercise 5 days a week
 By Borg scale: 12/13 is a brisk walk for 15-20
minutes 4-7 days a week (breathing through
mouth, feeling warm, starting to perspire, but
able to continue activity)
 Thought to improve insulin sensitivity, improves
overall glucose homeostasis

11. Exercise and Muscle Glut 4 Sugar
Receptor
 GLUT4: a key player regulating glucose
homeostasis? (Molecular Membrane Biology, 2001, 18, 205- 211)
 In patients with Type II diabetes mellitus, reduced glucose
transport in skeletal muscle is a major factor responsible for
reduced whole body glucose uptake.
 Thus, GLUT4 is an attractive target for pharmacological
intervention strategies to control glucose homeostasis.
 There are at least two separate pathways by which glucose
transport and GLUT4 translocation can be activated in skeletal
muscle; one stimulated by insulin or insulin mimicking agents and
one activated by muscle contractions or hypoxia (Douen et
al. 1990, Cartee et al. 1991, Lund et al. 1995, Zierath et al. 1997).
 When the two pathways are stimulated concurrently, glucose
transport and GLUT4 translocation are increased in an additive
manner
(Wallberg-Henriksson and Hollosz y 1985, Lund et al. 1995).

12. Can exercise minimize postprandial
damage ?
 “Can exercise minimize postprandial oxidative
stress in patients with TypeII Diabetes? “
Curr Diabetes Rev 2008, Nov 4(4) 309-19
Acute and chronic exercise can:
1. Cause an increase in endogenous antioxidant enzyme
activity.
2. Improve blood glucose clearance via enhanced
Glut 4 (contraction stimulated uptake of sugar into muscles
is still effective in Type II diabetics, while insulin receptors
are ineffective – insulin resistant.)
3. Improves blood triglyceride and lipoprotein lipase
activity.

13. “Can exercise minimize postprandial oxidative
stress in patients with Type II Diabetes? “
Curr Diabetes Rev 2008, Nov 4(4) 309-19

14. Muscle Absorption of Sugar Occurs
within Minutes of Contraction
 “Acute exercise has two separate effects
on skeletal muscle glucose transport. One
effect, which is observed during and
shortly after exercise, is an insulin-
independent stimulation of glucose
transport.” “Can exercise minimize postprandial oxidative stress in patients
with TypeII Diabetes? “
Curr Diabetes Rev 2008, Nov 4(4) 309-19

15. Method of Pre & Postprandial
Muscle Training
 Brief muscle activity done just before meal , or within
within 60 minutes after meal (both are preferable),
geared toward efficient contractile activity with light
cardio, with ease of accessibility for the average person
(5-7 minutes, depending on individual needs). Some
examples are:
 Climbing stairs, walking between flights
 Walking on slight incline
 Resistance training, with walking between
 Optimally, would like to randomly sample postprandial
(60-90 minute) blood sugar to check effectiveness for
individual (return to 100-120)

16. Control of postprandial spike with
5-10 minutes exercise
Before postprandial muscle
training, used 20-30 minutes
long duration exercise,
7 days per week
Blood sugar at 2 hrs postprandial
Postprandial short interval muscle training suppresses blood sugar spike in
reliable and predictable way. (N=1)

17. Fasting Blood Sugar Control of Fasting Blood Glucose
Postprandial short interval muscle training provided better control of fasting
blood glucose. (N=1)

18. Overall Improvement of Glucose
Homeostasis
Fasting, postprandial and random blood sugars
Postprandial short interval muscle training provided better overall control of glucose
homeostasis (exercise on stairs or treadmill, with a sprained ankle!). (N=1)

19. Improvement in A1C
 A1C reflects average blood sugar over
past 90 days
 Normal: 5-6%
 Diabetic: 7%
 Spring 2008: 6.5%
 Spring 2009: 5.8% (Even with increase in BMI)

20. Uses/Advantages of Pre & Postprandial
Muscle Training: Disease Prevention,
Better Glycemic Control
 Very safe for use in pre-diabetic, decreases their
cardiovascular risk and slows or prevents progression of
disease.
 Builds optimal amount of muscle, because muscle
fibers are benefitting from increased frequency of
glucose absorption. (Type II diabetics’ muscles atrophy
faster than normal, and have abnormal histology,
among other defects). Brief training well tolerated,
even palatable to sedentary individuals.
 Better muscle health equals greater ease of
compliance.
 May help prevent weight regain because sugar actively
absorbed into muscles, not into adipose tissues.

21. Advantages of Postprandial Muscle
Training
 Postprandial muscle training is what nature
intended – our glucose homeostasis was never
intended to rely solely on our insulin receptor system.
Instead, we are meant to use our muscles as a
secondary regulatory system, in conjunction with our
insulin receptor system. Apparently, this secondary
system in our muscles operates with amazing efficiency,
such that we can easily and quickly activate this muscle
based (insulin independent) blood sugar regulatory
system with a few simple muscle contraction events,
then continue with our busy, however sedentary,
lifestyles.
 “Resistance exercise increases postprandial muscle
protein synthesis in humans”, Med Sci Sports Exerc 2009
Jan; 41 (1): 144-54.
 Postprandial exercise may be a very efficient way to build new
muscle fiber, which helps regulate blood sugar even at rest.

22. Interested Parties
 Individuals
 Companies wanting to cut health care costs
can incentivize behavior
 Parents and schools
 Exercise equipment sellers
 Blood glucose meter producers, especially
bloodless “real time” meters in development
 GOVERNMENT – for DISEASE PREVENTION AND
LOWERING OF HEALTH CARE COSTS
 Individuals without good access to health care
and therefore poor management of blood sugar

23. 23