Diabetes and Exercise

PED488Exercise Programming for Special Populations

Overview of Diabetes A disease marked by elevated blood glucose levels

defects in insulin production defects in insulin action both production and action

Can lead to serious complications and premature death

May have benefits from exercise and from lifestyle management modifications

Scope / Impact of Diabetes

•Total: 25.8 million of Americans• 8.3 percent

•Diagnosed: 18.8 million

•Undiagnosed: 7.0 million

•Newly diagnosed: 1.5 million

Estimated % of people >20 yo with diagnosed and un diagnosed diabetes

Source: 2005–2008 National Health and Nutrition Examination Survey.

Complications of Diabetes Heart disease was noted on 68% of diabetes-related death

Adults with diabetes have heart disease death rates about 2 to 4 times

Stroke was noted on 16% of diabetes-related deaths Risk for stroke is 2 to 4 times higher

68% have HTN

28.5% have retinopathy (vision loss

…leading cause of kidney failure…44% of new cases

Neural defects 30% have impaired sensation in feet 60-70% have mild to severe nervous system damage

60% of non-traumatic amputations

Diabetes Defined

• Disorder of metabolism• deficiencies in how food (energy) processed

• Typically food glucose used by cells for growth and energy • glucose enters cell when insulin is present

•Diabetic person• Type 1 little or no insulin is produced• Type 2 cells do not respond appropriately to the insulin

• Glucose builds up• excess blood glucose• overflows into the urine, and passes out of the body

•Pancreas • regulate blood glucose levels • produces insulin hormone

Videos Video 1—technical

Video 2– animation 1

Video 3– animation

Video 4–cartoon

Diabetes RangesTest Normal Prediabet

icDiabetic

12 Fasting plasma glucose

< 100 ml/dL

100 ml/dL to 125 ml/dL

> 125ml/dL

2-h plasma glucose

140ml/dL190 ml/dL

200 ml/dL

ACSM GETP: Ch10 p. 233

Diagnosing Diabetes Fasting plasma glucose (FPG)

blood draw after an 8-hr fast >126 mg/dL = positive for Type 1

GTT Measure glucose after ingestion

HbA1c glucose binds slowly to hemoglobin A = A1c subtype Decomposition is slowly ~ 4 weeks Indicates an individual’s blood glucose control HbA1c levels < 7.0% are desirable

GTT test

Diabetes Signs & Symptoms

Non-Fasting values

• Normal– ~ 70-150 ml/dL

• Hypoglycemic– < 70…80 ml/dL– Drowsy, sweating, hunger, fatigue, irritable

• Hyperglycemic– >250…300 ml/dL– Weakness, thristy, dry mouth, nausea

Types of Diabetes

•Type 1 diabetes~no insulin production

•Type 2 diabetes (~insulin resistance

•Gestational diabetes~insulin resistance due to

pregnancy

Type 1 Diabetes (Juvenile) Body cannot manufacture its own insulin

pancreas dysfunction

Supplemental insulin must be injected or pumped to normalize glucose levels

Accounts for 5-10% of all diagnosed cases of Diabetes > children, young adults

Symptoms: increased thirst and sudden wt loss

Risk factors: autoimmune disorders, genetic traits, environmental conditions

No known way to prevent or cure managed and monitored

Type 2 Diabetes (Adult Onset)

Characterized by insulin resistance

Significant health burden

Increased morbidity and mortality

90-95% of all diabetes

Rate of growth projected to double by 2025—1 in 3

Usually affects individuals over 30 directly related to metabolic syndrome

Incidence in overweight or obese children= ~85%

High association with obesity

Gestational diabetes 100 pregnant US women between 3 - 8

Goes away birth…but increase risk for having diabetes later

Monitor and control your blood sugar levels if already have diabetes before pregnancy

Either type of diabetes during pregnancy raises the risk of problems for the baby and the mother

To help reduce risks follow recommended meal plan exercise Test blood sugar Take prescribed medicine

Common Signs and Symptoms

• Being very thirsty • Urinating often • Feeling very hungry or tired • Losing weight without trying • Having sores that heal slowly • Having dry, itchy skin • Losing the feeling in feet or having tingling in feet • Having blurry eyesight

Carbohydrate Metabolism Process

Lifestyle Management Management means “monitoring”

Blood glucose is measured at scheduled intervals using a glucometer

Baseline measurement should be taken (FBG) upon waking and before eating

Also before (90-130 mg/dL) and 2 hrs after

(< 180 mg/dL) meals

And, before, during and after exercise (see specific guidelines)

Must monitor carb intake (counting carbs )

Control Blood Glucose Levls Diet Exercise Medications

Glycemic Index

-6 year study found individuals with the high glycemic index intake 37% increase chance of diabetes

Glycemic Index Knowing peak height important in diabetes control

High GI food peaks quicker than a low GI food

Slower rates of digestion and absorption of foods Preferred over hi Allow for greater carbohydrate digestion Lower insulin demand Long-term blood glucose control Reduction in blood lipids

Blood Glucose Response

Glycemic Load

Ranking system for carbohydrate content glycemic index (GI) and the portion size

Multiply total carbohydrates glycemic index estimates impact on blood sugar level. GL = GI/100 x Net Carb

Rule of thumb Glycemic Loads below 10 to be "low" Glycemic Loads above 20 to be "high”

Diet-Diabetes

Diabetes Treatment Diet

Exercise

Medication

Percentage of adults with diagnosed diabetes receiving treatment with insulin or oral medication, United States, 2007–2009

Exercise• Exercise has “insulin like effect”

– Effective in controlling glucose levels– Enhances glucose uptake

• Improved GTT

• Increased insulin sensitivity decreased insulin requirements

• Decreased glycosylated Hb

• Improved blood lipids

• Weight Management

Exercise Contraindications

Increased thirst, hunger, urine, blurred vision, fatigue and ketones in urine

Clients should not exercise if BG exceeds 250 and ketones present or 300 and no ketones present

Blood glucose > 400mg/dL—no exercise

Blood glucose < 70mg/dL —no exercise If <100 pre/post then consume CHO

Medication approaches Increase Insulin

Increase Pancrease secrete of insulin

Alter CHO absorption

Reduce liver glycogenolysis

Increase insulin sensitivity

Monitoring with a Glucometer

Supplemental Insulin: Pump and Injection

TYPES OF INSULIN

• Rapid• Short Acting• Intermediat

e• Normal• Long

• Ultralong

METHODS TO DELIVER INSULIN

METHODS TO DELIVER INSULIN

METHODS TO DELIVER INSULIN

METHODS TO DELIVER INSULIN

METHODS TO DELIVER INSULIN

METHODS TO DELIVER INSULIN

INSULIN REGIMINES

Etiology:Hemoconcentration Excess fluid loss or dehydration

Blood viscosity Difficult to circulate blood

Peripheral circulatory failure follows

Drops in BP (hypotension) when blood flow decreases

Low or no perfusion of the vital organs Common effect kidneys…renal failure

Etiology:Carbohydrate: Glycogenolysis blood glucose glucose stores to

mobilized breaks down stored glycogen in liver and

muscle mobilization of glucose increases the already

existing hyperglycemia

glucose spills out into the urine plasma concentration > 180 mg/dl osmotic diuresis: fluid and electrolyte loss, or

dehydration.

Etiology:Protein: (gluconeogenesis) If carbohydrates not use as fuel

Proteins may be metabolized to synthesize new carbohydrate

Protein is taken from the muscle Muscle loss Byproduct is potassium and nitrogen Elevated blood K+ Elevated urinrary nitrogen

Etiology: Fat- lypolysis Glucose scarcity lipid becomes primary

fuel source

Less lipid being synthesized and stored excess lipid in the blood stream (hyperlipemia).

Ketones (ketogenesis) Byproduct of incomplete lipid oxidation excess ketones = ketonemia Leads acidosis and excess ketones in the urine

dehydration