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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.
  • x
  • 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.
  • 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
    • 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