By Serena Gordon
HealthDay Reporter Wednesday, Mar. 19, 2008; 4:00 AM
Copyright © 2008 ScoutNews, LLC. All rights reserved.

TUESDAY, March 18 (HealthDay News) — Forget about regular, scheduled exercise for a minute. If you just drop your average daily activity level — by taking elevators instead of stairs, by parking your car in the closest space, or by never walking to do errands — you increase your risk of diabetes, heart disease and premature death, according to new Danish research.

And, those changes begin in as little as 14 days after you start to reduce your activity level, the researchers say.

The team found that when healthy men cut their daily activity, their insulin levels spiked dramatically, as did levels of blood factors such as C-peptide and triglycerides — suggesting an increased risk of diabetes and heart disease.

“It is amazing that only two weeks of reduced stepping can induce numerous metabolic abnormalities,” said the one of the study’s authors, Dr. Rikke Krogh-Madsen, from the Centre of Inflammation and Metabolism in Copenhagen. “It is of special interest that impaired metabolism occurred without a total weight gain,” she added.

“The message here is that a lot of significant changes can occur without a huge change in weight, so if your only barometer of success and health is weight, you’re missing out,” said exercise physiologist Polly deMille, from the Hospital for Special Surgery in New York City.

Results of the study were published as a letter in the March 19 issue of the Journal of the American Medical Association.

The study included 18 young, healthy men with no family history of diabetes. None of the men smoked, and none participated in a regular exercise program for more than two hours each week.

The study volunteers were divided into two groups. The first group included eight men with an average age of 27 and an average BMI of 22.9, which is well within the normal range (obesity starts at a BMI of 30).

Prior to the study start, the men wore pedometers and averaged 6,203 steps each day. To reduce the amount of steps, the researchers asked the volunteers to take cars on short trips instead of walking or bicycling, and to take elevators instead of stairs. During the study period, the men reduced their daily steps to an average of 1,394 daily steps. After two weeks of reduced daily activity, the amount of insulin circulating in the blood increased by about 60 percent, suggesting that the body was no longer efficiently processing glucose (energy) from food and needed to increase insulin production to metabolize the sugar in food.

The second group included 10 men with an average age of 23.8 years and a BMI of 22.1. At the start of the study, their average daily number of steps were 10,501. After two weeks, they had reduced their average daily steps to 1,344 — an almost 90 percent reduction in daily activity. In this group, insulin levels also rose by nearly 60 percent after two weeks of inactivity.

In this group, the researchers also measured additional effects and found levels of heart disease risk factors had also increased with reduced activity. For example, triglyceride levels increased and the lack of physical activity was associated with a 7 percent increase in abdominal fat, even though there was no overall weight gain, according to Krogh-Madsen.

“Reduced daily activity can induce metabolic changes, which can be associated with the progression of chronic disorders and premature mortality,” the researcher said.

The good news here, deMille added, is that the flip side is also true.

With just a couple of weeks of increased physical activity, you can start to reduce your risk of diabetes and heart disease, even if you don’t notice a big difference on the bathroom scale.

“Just get some movement in. Even if it’s not what you think you should be doing, every lit bit helps in terms of keeping metabolism healthy,” she said. DeMille recommended getting a pedometer to see how many steps you’re already taking in a day, and then working toward adding to that each day.

“Ten thousand steps a day is recommended as a goal, but if you could get up to 5,000 a day, that’s a big gain in terms of becoming a more active, healthy person. If you can do more, that’s great, but every little bit counts,” deMille said.

More information

For tips on beginning an exercise program, visit the American Academy of Orthopaedic Surgeons.

But tight control is not for everyone and it involves hard work.

By the Numbers

Good control means getting as close to a normal (nondiabetic) blood glucose level as you safely can. Ideally, this means levels between 90 and 130 mg/dl before meals, and less than 180 two hours after starting a meal, with a glycated hemoglobin level less than 7 percent. The target number for glycated hemoglobin will vary depending on the type of test your doctor’s laboratory uses.

In real life, you should set your goals with your doctor. Keeping a normal level all the time is not practical. And it’s not needed to get results. Every bit you lower your blood glucose level helps to prevent complications.

What Tight Control Does

No one knows why high glucose levels cause complications in people with diabetes. But keeping glucose levels as low as possible prevents or slows some complications.

The Diabetes Control and Complications Trial (DCCT) proved it. Researchers followed 1,441 people with diabetes for several years. Half of the people continued standard diabetes treatment. The other half followed an intensive-control program. Those on intensive control kept their blood glucose levels lower than those on standard treatment, although the average level was still above normal. The results? In the tight-control group, compared with the standard-treatment group,

• Diabetic eye disease started in only one-quarter as many people.
• Kidney disease started in only half as many people.
• Nerve disease started in only one-third as many people.
• Far fewer people who already had early forms of these three complications got worse.

Living With Tight Control

To get tight control, you must pay more attention to your diet and exercise. You must measure your blood glucose levels more often. And, if you take insulin, you must change how much you use and your injection schedule.

In intensive therapy, you provide yourself with a low level of insulin at all times and take extra insulin when you eat. This pattern mimics the release of insulin from the normal pancreas.

There are two ways to get more natural levels of insulin: multiple daily injection therapy and an insulin pump. Both are good methods. Your choice should depend on which best fits your lifestyle.

In multiple daily injection therapy, you take three or more insulin shots per day. Usually, you take a shot of short-acting or Regular insulin before each meal and a shot of intermediate- or long-acting insulin at bedtime.

With an insulin pump, you wear a tiny pump that releases insulin into your body through a plastic tube. Usually, it gives you a constant small dose of Regular insulin. You also have the pump release extra insulin when you need it, such as before a meal.

With either method, you must test your blood glucose levels several times a day. You need to test before each shot or extra dose of insulin to know how many units to take and how long before eating to take it. Also, you may want to test 2-3 hours after eating to make sure you took enough insulin. You must adjust your insulin dose for how much you plan to eat and how active you expect to be.

You do not need to figure these things out on your own. Whatever method you choose, your health care team (your doctor, dietitian, diabetes educator, and other health care professionals) should spend a lot of time teaching you about it. Your team will help you make guidelines for how much insulin to take and when. You will also come up with guidelines for eating and exercising. These guidelines may change several times as you test them out.

You shouldn’t try tight control on your own. A good health care team is a must. Choose a doctor who understands diabetes well or is willing to learn for your sake. Your doctor should have ties with other health professionals you need, such as dietitians and a mental health worker. If you live in a small town, look at your options carefully. You may be better off driving to a city to see a specialist.

How to Keep Going and Going

Starting a program of tight control is exciting. But it can also be overwhelming. How do you keep from running out of energy?

One way is to start slowly. For example, you might start by checking your blood glucose more times each day. Get used to that first. Then start multiple daily injections. Once you’re used to those, add your new exercise program and make the changes in your diet.

If you are newly diagnosed with diabetes, look honestly at yourself. Are you still angry and depressed that you have diabetes? If so, you already have a big challenge facing you. You may want to wait to try tight control until after you’ve come to terms with the changes in your life.

Keep your goals realistic. No matter how hard you try, your blood glucose readings will not be perfect every time. If they are often too high or too low, you should talk to your doctor about whether your plan needs to be adjusted. But if “wrong” levels happen only sometimes, that’s life. With practice, you will become more skilled at choosing the right insulin doses for various situations.

If you need to, take a breather from the new routine. Having some time off may make it easier to stick to your plan when you start again.

Pluses and Minuses

One big reason to try tight control is to prevent complications later. But tight control has effects you can enjoy right now. You will probably feel better and have more energy. Also, because you adjust your insulin dose to your life, and not the other way around, you have more freedom. You can vary your activities more. And you’re not locked into having your meals at the same time each day.

Tight control is especially good for pregnant women. It can reduce the risk of birth defects in the baby.

But the DCCT found two major problems with tight control.

First, people had three times as many low blood glucose reactions (hypoglycemia). You will need to be alert to the symptoms of hypoglycemia so that you can treat yourself quickly. Also, you should always check your blood glucose levels before you drive.

If you often have low blood glucose reactions when you try tight control, talk to your doctor. You may need to ease up on your goals or go back on standard therapy for a while.

Second, people on tight control gained more weight than people on standard insulin treatment. The average in the DCCT was 10 pounds. If you are concerned about putting on pounds, work with your dietitian and doctor to devise a meal and exercise plan to prevent it.

You should also consider the cost. You will need to see your health care team more often. Pumps cost about $5000, and pump supplies run $60 to $80 a month. Multiple injection therapy is much cheaper. But you will still use more supplies, like test strips and syringes, than before.

Tight Control and Type 2 Diabetes

The DCCT studied only people with type 1 diabetes. But doctors believe that tight control can also prevent complications in people with type 2 diabetes.

Most people with type 2 diabetes do not take insulin. You may be wondering how you can achieve tight control without it.

One way is to lose weight. Shedding excess pounds may bring your glucose levels down to normal. The key to losing weight and keeping it off is changing your behavior so that you eat less and exercise more. Your doctor should work with you to find an eating and exercise plan you can stick to.

Even if you don’t need to lose weight, exercise is helpful in controlling your blood glucose levels. It makes your cells take glucose out of the blood.

You will need to check your blood glucose regularly. You should decide with your doctor how often. Once a day or even once a week may be enough for some people with type 2 diabetes.

If exercise and good eating habits are not enough to keep your glucose under control, you doctor may prescribe pills. And if these don’t work, you may need to take insulin.

People with type 2 diabetes should talk to their doctors before starting tight control.

Tight Control Is Not for Everyone

Tight control is not safe for everyone with diabetes.

Children should not be put on a program of tight control. Having enough glucose in the blood is vital to brain development. Some doctors say that tight control should wait until a child reaches 13; others say after the age of 7 is okay.

Elderly people probably should not go on tight control. Hypoglycemia can cause strokes and heart attacks in older people. Also, the major goal of tight control is to prevent complications many years later. Tight control is most worthwhile for healthy people who can expect to live at least 10 more years.

Some people who already have complications should not be on tight control. For example, people with end-stage kidney disease or severe vision loss probably should not try it. Their complications are probably too far along to be helped. Some people who have coronary artery disease or vascular disease should not try tight control. People who have hypoglycemia unawareness probably should not go on tight control.