Hormones Assignment

Type 2 Diabetes Mellitus (DM) Patient Information

1. How does DM occur? Be detailed and accurate in your answer.  

Type 2 Diabetes Mellitus occurs when a person's body cells become resistant to insulin and no longer behave correctly.  In a non diabetic person, insulin works efficiently and aims to lower blood glucose back to a homeostatic level (70-99 mg/dL fasting). This occurs by signaling to the muscular and adipose tissues to uptake the glucose in the blood and convert it to glycogen for storage.  However, those with type 2 diabetes mellitus are resistant to insulin and need more insulin to lower blood sugar.  However, the pancreas is unable to produce the amount of insulin that is needed to reach a homeostatic level. This results in a chronic state of hyperglycemia (too much glucose in the blood).  The pancreatic islet β-cells stop functioning correctly, as they have been working overtime to keep up with the demand for insulin.  If left untreated, persistent hyperglycemia can lead to complications such as cardiovascular disease, neuropathy, nephropathy, retinopathy, and impaired wound healing. 

2. What are some precautions you should take while this patient is exercising? Why?  

For those living with type 2 diabetes, it is important to monitor their blood glucose before, during, and after exercise.  This is especially important to monitor if the patient is taking insulin medications or medications that stimulate insulin secretion, such as sulfonylureas, as these can cause hypoglycemia.  Additionally, due to the risk of diabetic neuropathy, the patient may be less susceptible to feeling sensations in distal body parts (fingers/toes) and delay of injury recognition,  which could cause further injury if proper footwear is not worn. An individual should not exercise if blood glucose is significantly elevated, 250-300 mg/dL, and accompanied by symptoms or ketones. 

3. What changes might you expect to see in this patient's circulating hormones during exercise? Why?  

While exercising, for any person, blood glucose generally will decrease, which causes the pancreas to secrete less insulin and begin secreting glucagon, which aids in the hepatic glucose production and maintains blood glucose availability.  Secondly, cortisol, growth hormone, and the hormone class of catecholamines, which include epinephrine and norepinephrine, may become elevated.  The elevation of these hormones being secreted to the bloodstream helps the body begin to break down glucose, lipolysis, and gluconeogenesis so that the body can be supplied with sufficient energy for activities.  Specific things that those living with TD2 can experience are an improvement in insulin sensitivity as the skeletal muscle is able to uptake glucose more effectively by utilizing an insulin-independent mechanism.   

4. What types of exercise would be most appropriate for this patient population? Why?  

Any exercise that is enjoyed would be greatly beneficial for those living with TD2, as exercise will improve their insulin resistance and overall health.  However, studies have shown that the TD2 patient may benefit more from certain styles of exercise, such as aerobic exercise, resistance/strength training, and flexibility/balance exercises.  Taking a brisk walk consisting of medium-intensity exercise would fall into the category of ‘aerobic exercise.’  Additional aerobic exercises that can be beneficial and easy on the joints include swimming and biking. Ideally, these exercises are performed for a minimum of 150 minutes per week to improve cardiovascular health and insulin sensitivity.  Secondly, weight lifting and resistance training can be especially beneficial. Building and using skeletal muscle can increase muscle mass and improve blood glucose uptake.  Lastly, flexibility and balance exercises such as yoga or stretching can be beneficial as they have been linked to a reduction in falls and improved mobility.  

References

American College of Sports Medicine. (2022). ACSM's Guidelines for Exercise Testing and Prescription (11th ed.). Wolters Kluwer.

American Diabetes Association Professional Practice Committee. (2025). Standards of Care in Diabetes—2025. Diabetes Care, 48(Suppl. 1).

Bredin, Shannon, and Darren Warburton. “Health benefits of physical activity: a systematic review of current systematic reviews.” Current Opinion in Cardiology, vol. 32, no. 5, Sept. 2017, pp. 541–56, doi:10.1097/HCO.0000000000000437. 

Sheri R. Colberg, Ronald J. Sigal, Jane E. Yardley, Michael C. Riddell, David W. Dunstan, Paddy C. Dempsey, Edward S. Horton, Kristin Castorino, Deborah F. Tate; Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 1 November 2016; 39 (11): 2065–2079. https://doi.org/10.2337/dc16-1728