Managing Teens and Insulin Resistance

Henry Anhalt, DO, CDEDirector, Pediatric Endocrinology and Diabetes

Saint Barnabas Medical CenterLivingston, NJ

WHAT IS INSULIN RESISTANCE?

• Long associated with type 2 diabetes – a known risk factor for heart disease– occurs when the body does not properly use

insulin to metabolize blood glucose– when insulin fails to enable cells to admit

glucose, necessary for cells' energy production.

– glucose then builds up in the blood, and additional insulin is required

TYPE 2 DIABETES-A CARTOON REVIEW

Coping Skills

Accept what I cannot change Strive to change what I can Attempt to learn all I can Set realistic goals Seek support of others Hope for new insight

Healthy Eating

Finding the Right Balance

DIABETES “TRIAD”

NUTRITION

MedicationExercise

How do we choose our food?

Taste and enjoyment Tradition and custom Convenience Mood Hunger Cost Health and nutrition

Ask Yourself...

Are you at your best weight? Are your blood sugars usually within

target range? Is your cholesterol below 200? Do you have a meal plan which you

usually follow? Is your meal plan varied? Enjoyable?

Why is healthy eating important?

Blood sugar control Reduces risks of complications

– Cholesterol– Blood pressure– Kidney disease

Weight control Feel good

Meal planning questions:

True or FalseYou can’t eat any sugar

You must have 3 snacks a day

False

FalseIt is different for everyone True

You don’t need special foods TrueIt is complicated False

General Guidelines Choose Healthy Foods

– limit fat - especially saturated fat– follow the pyramid

Be Consistent– meal times -don’t skip meals– amount of food - have a balanced plate– types of foods - control carbohydrates

Car

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Your meal plan (carb goal) is….

Based on the way you usually eat Designed to help improve your

control Planned to space out

carbohydrates Changeable… if it doesn’t work

What about “fast foods”?

Look for healthy choices Learn what is in the food Watch out for hidden fats

Exercise

Moving Toward Better Blood Glucose Control

DIABETES “TRIAD”

EXERCISEMedication

Nutrition

Exercise benefits for diabetes control

Weight loss / Weight control Helps insulin work better Uses glucose for energy Lowers blood glucose (in minutes) Improves A1c (in weeks)

Why bother to exercise?

Medical– blood pressure, cholesterol,

triglycerides, weight, A1c

Quality of life– fitness, strength – need for medication, sleep time

Psychosocial– stress, depression feel better

Why exercise?

The main reason I am going to exercise is because I want to:

________________________________________________

What type of exercise should I

do? Aerobic exercise Strength training Flexibility and stretching Enjoyable and Convenient SAFE

– for diabetes (eyes, feet, kidneys)– for other health concerns (heart,

lungs, aches and pains, etc)

Aerobic exercise choices

Weight-bearing activities– walking, jog/run, aerobic dance,

ballroom/folk/line dancing, sports Non weight-bearing activities

– biking, swimming, water exercise classes, rowing, armchair exercise, video

Other options

Strength training Flexibility and stretching Exercise options to explore

– join a health club; use exercise equipment; join an exercise program; call local schools, colleges, malls, clubs, etc. for more information on what is available

My exercise plan...

For my exercise program I will

____________________________

How Often?

For blood glucose control: 3 to 4 times a week

For weight loss: 4 to 5 times a week

My exercise plan…

My goal is to exercise ____ times a week.

I will start with ____ times a week.

How Long?

For blood glucose control: 20 to 30 minutes

For weight loss: 45 to 60 minutes

My exercise plan...

My goal is to exercise for ____ minutes.

I will start with ____ minutes.

(Plus a ____ minute warm-up and a ____ minute cool down.)

What Time of Day?

Pick a time that fits into:– daily schedule– lifestyle– diabetes management plan

My exercise plan...

The time of day I will most likely exercise will be ____ AM / PM.

Pre-exercisesnack adjustments

30 minutes 15g Carb

30 - 60 minutes 15g Carb +

7-8g ProteinLong duration 15g Carb per hour and

> 2 hours decreaseinsulin

Summary

Review your reasons to exercise Review your exercise plan Be consistent Enjoy your success!

Who Succeeds?

Has a clear and realistic plan Is prepared for obstacles Has a strategy for getting support Knows exactly what the first steps

will be

Who loses their way?

Has goals that are too vague or rigid Attempts too large of a lifestyle

change May be overly perfectionistic Thinks that there will be no obstacles Is not concerned about obtaining

support

Developing a clear and realistic plan

Completing the three QuickPlans:– Monitoring– Meal Planning– Making time for exercise

Completing the QuickPlans

One self-care behavior at a time A one month goal Consider your obstacles An immediate action plan to:

– overcome obstacles– begin new behavior

Important principles for completing the

QuickPlans Realistic. Begin with small,

achievable targets for change. Action-oriented. Focus on new

actions to begin, not old actions to stop.

Concrete. Know the exact actions which you will take.

Obstacles to Exercise

Exercise is boring Too hard to find the time May cause hypoglycemia May cause too much

pain/discomfort Too tired to exercise No one to exercise with

Overcoming Obstacles to Exercise

Try something new Turn an unpleasant activity into a

pleasant one Modify environment to make

exercise more convenient

Overcoming Obstacles to Exercise

Pay attention to how exercise positively affects blood glucose

Find an exercise partner / group Seek out professional advice Fight back against self-defeating

thoughts

A Contract for Self-Care

Your action plan for diabetes success

Expect the occasional problems (ongoing problem solving is necessary)

Stay in touch!

Empowerment

The granting of power or authority to oneself

People become empowered when they use all their resources, psychological, social, emotional and spiritual, to solve their own problems or achieve their own goals

Forces that Threaten Empowerment

Fear Anger Ignorance Hopelessness Misguided Help

4 Pillars of Empowerment

Awareness Chioce Freedom Resposibility