Evaluate the role of Soleus muscle exercise in management diabetic kidney disease

management of diabetic kidney disease. To enhance their glycemic control, diabetic patients are advised to perform 150 minutes per week of moderate-to-vigorous aerobic activity Diabetic patients with regular physical activity have reduced daily insulin dose with more glycemic control. In addition to glycemic control, it has also been postulated that the addition of brief intervals of high intensity, sprint -type exercise to aerobic exercise can decrease the risk of late nocturnal hypoglycemic episodes Marc T. Hamilton et al., 2022, reported that the human soleus muscle could raise local oxidative metabolism to high levels for hours without fatigue, during a type of soleus-dominant activity while sitting (soleus push up exercise), even in unfit volunteers. They reported that soleus push up exercise can improve systemic VLDL-triglyceride and glucose homeostasis by a large magnitude, e.g., 52% less postprandial glucose excursion (∼50 mg/dL less between ∼1 and 2 h) with 60% less hyperinsulinemia. Muscle biopsies revealed there was minimal glycogen use. This can be explained that the soleus doesn't rely completely on intramuscular glycogen, Instead, it uses a mixture of fuels from glucose and lipoproteins.

Inclusion Criteria:

• Patients age 18-60 yrs.,
• patients with Diabetic kidney disease, not on dialysis
• with stabilized diabetic treatment regimen for 3 months before participating in the study

Exclusion Criteria:

• advanced osteoarthritis of lower limb joints
• advanced poly neuropathic patients
• CKD type V on dialysis
• Diabetic Foot
• hemophilia
• bleeding tendency
• AKI
• other causes of chronic kidney disease
• patients refuse to participate in the study