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

4. 8.3 percent

5. Diagnosed:18.8 million

6. Undiagnosed: 7.0 million

7. Newly diagnosed: 1.5 millionSource: 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

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

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

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

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

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

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”

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

54. Effective in controlling glucose levels

55. Enhances glucose uptake

56. Improved GTT

58. Improved blood lipids

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

64. Short Acting

65. Intermediate

66. Normal

67. Long

69. METHODS TO DELIVER INSULIN

70. METHODS TO DELIVER INSULIN

71. METHODS TO DELIVER INSULIN

72. METHODS TO DELIVER INSULIN

73. INSULIN REGIMINES

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