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March 20, 1937


JAMA. 1937;108(12):974-975. doi:10.1001/jama.1937.02780120044015

Along with diet and insulin, exercise is an accepted part of the present-day treatment of diabetes.1 Knowledge of the mechanism of muscular work suggests the explanation of the ability of exercise to augment the blood sugar-lowering effect of insulin. The utilization of muscle glycogen during exercise results in a hypoglycemia which is effectively counteracted by the rapid hydrolysis of liver glycogen. Thus there is an accelerated catabolism of carbohydrate during exercise, and a working patient will require less insulin for the same amount of carbohydrate catabolized than does a resting patient. In certain conditions, however, exercise may bring about a marked increase in the blood sugar of the diabetic patient. This is seen particularly when the diabetic condition is severe and if several hours has elapsed since insulin and food were given. This relationship between the initial level of blood sugar and the effect of exercise on the diabetic