[Physical exercise therapy in diabetes mellitus--the role of clinical laboratory examinations]

Physical training has been generally recommended for patients with diabetes mellitus as a basic therapeutic tool. In the present study the metabolic and endocrinological effects during the training program were examined in patients with non insulin dependent diabetes mellitus (NIDDM). Moreover the significance of continuous blood lactate monitoring and that of the determination of plasma atrial natriuretic polypeptide (ANP) during exercise loading in diabetics was also studied. (1) The glucose metabolic clearance rate (MCR) during euglycemic insulin clamp was higher in athletes than in patients with NIDDM and control subjects. (2) MCR increased significantly in the training group after the eight weeks program and a significant relationship between the changes of MCR and those of HbAIc observed. Moreover a decrease in the triglyceride level and increase in the HDL cholesterol level in plasma were significantly related with the improvement of MCR. (3) A continuous blood lactate monitoring system was newly developed. This system was simple and showed good reproducibility. The anaerobic threshold (AT) determined using this system corresponded to that obtained by respiratory gas analysis. It was useful for the determination of the exercise intensity without overloading in patients with diabetes mellitus. (4) The increase of plasma ANP during exercise loading was higher in diabetics than healthy controls, and a significant relationship was found between the increment of ANP during exercise and the diastolic function judged from the echocardiogram in diabetics. In conclusion clinical laboratory examinations and medical checkups are important in the practice of physical exercise therapy in patients with diabetes mellitus.