It’s well established — and comes as no surprise — that regular exercise or structured physical activity is associated with lower blood sugar after an evening meal. But what about daily unstructured activity — just being active? This is an area that has not had much research, but information on it would be helpful in making recommendations on diabetes care.
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Now, however, in a new study just published in the journal Diabetes Technology & Therapeutics, researchers at the University of Virginia reported on their investigation of just this matter. The researchers collected data from 37 patients with type 1 diabetes from two clinical studies, both of which had the same method of data collection. The information they gathered included four weeks of continuous blood glucose monitoring, insulin injections, intake of carbohydrates, and physical activity as measured by a wearable activity tracker, such as the Fitbit. They employed a measurement tool called the glucose area under the curve (GAUC), which is widely used for evaluating how effective medications are for reducing high blood sugar after meals. It measures what are known as postprandial glucose excursions (PPGEs). A PPGE is the change in blood sugar concentration from before a meal to after it. The researchers were able to account for the meals, the insulin levels, and the subjects’ current state of blood sugar.
According to lead researcher Basak Ozaslan, PhD, “I do statistical analyses to understand the factors and their relationship to blood glucose control in everyday life. Then, I use that understanding to build computer models capable of enhancing and individualizing treatment strategies.” In 2019, Ozaslan and her colleagues published research showing how step count data, as measured by a self-monitoring activity tracker, could shed light on the blood-sugar-lowering effects of “recently performed (structured or unstructured) physical activity” and thus lead to improved insulin dosing in people with type 1 diabetes. This new paper built upon that research by leading to information on how to adjust the mealtime insulin dose for blood sugar fluctuations that are related to a patient’s everyday physical activity instead of structured exercise.
The datasets used by the researchers gave 845 total days of data from the 37 subjects. They determined that the higher the total daily physical activity as measured by step counts, the lower the GAUC measurements taken after meals. The same applied for the “total time spent performing higher than light-intensity PA [physical activity].” To sum up, the researchers wrote, “Patients with higher medical total daily PA exhibited lower average postprandial GAUC. Additional analyses indicated that daily PA likely presents an immediate and delayed impact on glucose control. Daily PA assessed by commonly available sensors is significantly associated with glycemic exposure after an evening meal, indicating that quantitative assessment of PA may be useful in mealtime treatment decisions.”
The conclusion is consistent with a position statement from the American Diabetes Association that says, “Increasing unstructured physical activity (e.g., errands, household tasks, dog walking, or gardening) increases daily energy expenditure and assists with weight management. Unstructured activity also reduces total daily sitting time. Increasing nonexercise activity, even in brief (3-15 min) bouts, is effective in acutely reducing postprandial hyperglycemia and improving glycemic control in those with prediabetes and type 1 and type 2 diabetes, most prominently after meals. Increasing unstructured physical activity should be encouraged as part of a whole-day approach, or at least initially as a stepping stone for individuals who are sedentary and unable/reluctant to participate in more structured exercise.”
Want to learn more about managing after-meal blood sugar levels? Read “Strike the Spike II,” “Dealing With After-Meal Blood Sugar Spikes? Don’t Skip Breakfast,” “Managing Your Blood Glucose Ups and Downs” and “How to Lower Blood Sugar? Take a 10-Minute Walk After Meals, Study Says.”