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Diabetes and Exercise PED488 Exercise 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 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
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
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
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
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”
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
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