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