Diabetes s11
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Diabetes s11

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  • What is pre-diabetes?People with pre-diabetes have blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes. This condition raises the risk of developing type 2 diabetes, heart disease, and stroke.Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. Some people have both IFG and IGT.IFG is a condition in which the blood glucose level is high (100 to 125 mg/dL) after an overnight fast, but is not high enough to be classified as diabetes. (The former definition of IFG was 110 mg/dL to 125 mg/dL.)IGT is a condition in which the blood glucose level is high (140 to 199 mg/dL) after a 2-hour oral glucose tolerance test, but is not high enough to be classified as diabetes. Pre-diabetes is becoming more common in the United States, according to new estimates provided by the U.S. Department of Health and Human Services. About 40 percent of U.S. adults ages 40 to 74—or 41 million people—had pre-diabetes in 2000. New data suggest that at least 54 million U.S. adults had pre-diabetes in 2002. Many people with pre-diabetes go on to develop type 2 diabetes within 10 years.The good news is that if you have pre-diabetes, you can do a lot to prevent or delay diabetes. Studies have clearly shown that you can lower your risk of developing diabetes by losing 5 to 7 percent of your body weight through diet and increased physical activity. A major study of more than 3,000 people with IGT, a form of pre-diabetes, found that diet and exercise resulting in a 5 to 7 percent weight loss—about 10 to 14 pounds in a person who weighs 200 pounds—lowered the incidence of type 2 diabetes by nearly 60 percent. Study participants lost weight by cutting fat and calories in their diet and by exercising (most chose walking) at least 30 minutes a day, 5 days a week.
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  • Without the help of insulin, glucose does not diffuse easily across cell membranes. High concentrations of glucose cause a shift as the body tries to equalize the osmotic pressure between the intra and extra celluluar fluid. Both of these are lost in uncontrolled diabetes. Increased osmotic pressure in the ex fluid results in a shirft of water from the intra fluid to the extra fluid and glucose spills into the urine.

Diabetes s11 Presentation Transcript

  • 1. Diabetes and Exercise
    PED488
    Exercise Programming for Special Populations
  • 2. 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
  • 3. Scope / Impact of Diabetes
    Estimated % of people >20 yo with diagnosed and un diagnosed diabetes
    • Total:25.8 million of Americans
    • 4. 8.3 percent
    • 5. Diagnosed:18.8 million
    • 6. Undiagnosed: 7.0 million
    • 7. Newly diagnosed: 1.5 million
    Source: 2005–2008 National Health and Nutrition Examination Survey.
  • 8. 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
  • 9. Diabetes Defined
    • Disorder of metabolism
    • 10. deficienciesin how food (energy) processed
    • 11. Typically food glucose used by cells for growth and energy
    • 12. glucose enters cell when insulin is present
    • 13. Diabetic person
    • 14. Type 1 little or no insulin is produced
    • 15. Type 2 cells do not respond appropriately to the insulin
    • 16. Glucose builds up
    • 17. excess blood glucose
    • 18. overflows into the urine, and passes out of the body
    • 19. Pancreas
    • 20. regulate blood glucose levels
    • 21. produces insulin hormone
  • 22. Videos
    Video 1—technical
    Video 2– animation 1
    Video 3– animation
    Video 4–cartoon
  • 23. Diabetes Ranges
    ACSM GETP: Ch10 p. 233
  • 24. 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
  • 25. GTT test
  • 26. Diabetes Signs & Symptoms
    Non-Fasting values
    • Normal
    • 27. ~ 70-150 ml/dL
    • 28. Hypoglycemic
    • 29. < 70…80 ml/dL
    • 30. Drowsy, sweating, hunger, fatigue, irritable
    • 31. Hyperglycemic
    • 32. >250…300 ml/dL
    • 33. 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
  • 34. 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
  • 35. 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
  • 36. 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
  • 37. Common Signs and Symptoms
    • Being very thirsty
    • 38. Urinating often
    • 39. Feeling very hungry or tired
    • 40. Losing weight without trying
    • 41. Having sores that heal slowly
    • 42. Having dry, itchy skin
    • 43. Losing the feeling in feet or having tingling in feet
    • 44. Having blurry eyesight
  • Carbohydrate Metabolism Process
  • 45. 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
  • 46. Glycemic Index
    -6 year study found individuals with the high glycemic index intake  37% increase chance of diabetes
  • 47. 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
  • 48. Blood Glucose Response
  • 49. 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”
  • 50.
  • 51. Diet-Diabetes
  • 52. Diabetes Treatment
    Diet
    Exercise
    Medication
    Percentage of adults with diagnosed diabetes receiving treatment with insulin or oral medication, United States, 2007–2009
  • 53. Exercise
    • Exercise has “insulin like effect”
    • 54. Effective in controlling glucose levels
    • 55. Enhances glucose uptake
    • 56. Improved GTT
    • 57. Increased insulin sensitivity
     decreased insulin requirements
    • Decreased glycosylatedHb
    • 58. Improved blood lipids
    • 59. 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
  • 60. Medication approaches
    Increase Insulin
    Increase Pancrease secrete of insulin
    Alter CHO absorption
    Reduce liver glycogenolysis
    Increase insulin sensitivity
  • 61. Monitoring with a Glucometer
  • 62. Supplemental Insulin: Pump and Injection
  • 63. TYPES OF INSULIN
    • Rapid
    • 64. Short Acting
    • 65. Intermediate
    • 66. Normal
    • 67. Long
    • 68. Ultralong
  • METHODS TO
    DELIVER
    INSULIN
  • 69. METHODS TO
    DELIVER
    INSULIN
  • 70. METHODS TO
    DELIVER
    INSULIN
  • 71. METHODS TO
    DELIVER
    INSULIN
  • 72. METHODS TO
    DELIVER
    INSULIN
  • 73. INSULIN REGIMINES
  • 74.
  • 75.
  • 76. 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
  • 77. 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.
  • 78. 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
  • 79. 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