運動時血糖的變化,在正常人與糖尿病患者身上,是不同的。要知道哪裡不同,就要連正常人的情況也一起分析。
用餐之後,肚子裡的食物消化後,吸收到了血中的這些糖分,主要是由骨骼肌(skeletal muscle)來儲存為肝醣(glycogen)的,這些血中的糖份是怎麼進到肌肉中的?是靠“攜糖蛋白”(glucose transporter carrier proteins, GLUT4)這個小卡車,把糖分搬進去的。這個“攜糖蛋白”小卡車越多,搬血糖就越順暢,我們的細胞在兩種情形,會多多製造“攜糖蛋白”小卡車,1. 有胰島素,2. 有運動。
休息時與用餐後(就是沒有運動時),“攜糖蛋白”小卡車是看胰島素的命令製造的,因此,胰島素不夠時,“攜糖蛋白”小卡車就不夠,用完餐時所上升的血糖,沒地方去,就留在血中,結果血糖就高起來了。
運動時,“攜糖蛋白”小卡車會製造增加,不需要看胰島素臉色,所以,即使是胰島素不夠的糖尿病患者,運動時骨骼肌所需要的血糖,也能進入肌肉細胞來使用。這些多製造出來的“攜糖蛋白”小卡車,能夠持續到運動過後幾個小時,而因此,血糖能夠無障礙的進入肌肉細胞,達到降血糖的效果。
平常休息的時候,肌肉群使用的燃料來源,主要是游離脂肪酸。而肌肉群一開始動作,就慢慢變成脂肪酸、血糖、以及肌肉原本所儲存的肝醣(glycogen)這三種燃料的混合使用。隨著運動的強度增加,能量的來源則慢慢變為醣類為主,肌肉自己的肝醣用完了之後,就開始用血中的醣類、以及游離脂肪酸。
肌肉群在用掉血中糖分的同時,肝臟裡的肝醣會分解釋放出來到血中,而使得血糖穩定不變;糖尿病患者在一般強度的運動時,肌肉群用掉血糖的速度,比肝醣分解的速度來的慢,因為,胰島素正是促進肝醣分解釋放出來的賀爾蒙。這樣聽起來,糖尿病患者運動時,會容易低血糖?不會耶(神奇!),因為他們血中的胰島素,在運動的時候也是慢慢下降的,使得血糖不會下降。因此,只要不是施打胰島素的患者,或者使用類胰島素的口服藥,幾乎不會低血糖。
運動改善血糖的效果,能夠持續24-72小時。而且如果運動的總時間一樣,分段與一次運動的效果是類似的喔。
短時間很高強度的運動,也就是無氧運動,肌肉只會用醣類來當燃料,腎上腺素等賀爾蒙會分泌(造成肝醣分解),使得血糖上升的比醣類的消耗還要快,以至於正常人在這種情況下,也會有短暫的高血糖發生,而這樣的高血糖在糖尿病患者,會持續得更久且更高。
結論:
糖尿病患者在中等強度運動時,不大會低血糖(沒有使用胰島素者),
在高強度的無氧運動時,反而會血糖升高。
個人建議,雖然研究結果是這樣,但運動還是隨身攜帶糖包,以防低血糖的發生喔。
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