Diabetes Mellitus Barbara Schlichte http://www.youtube.com/watch? v=MMRHGW_K-M8&feature=related Why I Chose This Topic Father diagnosed with Type 2 Father-in-law died from complications with type 2 Genetics Dad
Outline Definition of Diabetes Mellitis Epidemiology Clinical Aspects Treatment Effects of Exercise Exercise Testing Exercise Prescription Summary Conclusion What is diabetes mellitus? Diabetes mellitus is a group of diseases characterized by high blood glucose concentrations resulting from defects in insulin secretion, insulin action, or both. Abnormalities in metabolism of CHO, protein and fat are present. People with diabetes have bodies that dont produce or respond to insulin.
Without effective insulin, hyperglycemia (elevated blood glucose) occurs. Types of diabetes mellitus Type 1 Type 2 Gestational Other types Type 1 Absolute deficiency of insulin Marked reduction of beta-cells in pancreas Thought to involve an autoimmune responseno known means to prevention Exogenous insulin must be supplied Prone to ketoacidosis Accounts for 5% to 10% of diagnosed cases Can occur at any age although most affected
people are children and young adults Type 2 Relative insulin deficiency-insulin resistant Elevated, reduced or normal insulin levels Risk factors include: (test on diabetes website) Genetics Older age Obesity (particularly abdominal) Sedentary lifestyle Gestational diabetes Pre-diabetes Race or ethnicity
Type 2 cont Most cases do not require exogenous insulin Do not develop ketoacidosis except in cases of unusual stress Accounts for 90% to 95% of diabetes cases Usually occurs after the age of 40 but is developing in young adults and youth NO CURE-only management! Types of Diabetes Glucose intolerance during pregnancy Due to contra-insulin effects of pregnancy 20% to 50% of women with
gestational diabetes develop type 2 within 5 10 years 5 Gestational Results from specific genetic syndromes, surgery, drugs, malnutrition, infections, or other illnesses Depending on pathophysiology, may or may not require insulin
Other types Epidemiology Total: 25.8 million children and adults in the US-8.3% of the population have diabetes Diagnosed: 18.8 million Undiagnosed: 7 million Pre-diabetes: 79 million New Cases: 1.9 million new cases were diagnosed in 2010 Cost: $174 billion! In 2007 Medical costs are 2.3 times more for diabetics Diabetes Does Discriminate! Percentage of Ethnic Group with type 2 diabetes 90.0% 60.0% 30.0% 0.0%
7.1% 8.4% 12.6% 11.8% Symptoms Frequent urination Extreme thirst Extreme hunger Unusual weight loss Extreme fatigue and irritability
Type 1 Any of the type 1 symptoms Frequent infections Blurred vision Cuts/bruises that are slow to heal Tingling/numbness in hands/feet Recurring skin, gum or bladder infections
OR NO symptoms! Type 2 Diagnosis Diagnosis Criteria Diabetes FPG126 mg/dl CPG200 mg/dl 2hPG200 mg/dl Pre-diabetes Impaired fasting glucose Impaired glucose tolerance Normal FPG100-125 mg/dl
2hPG140-199 mg/dl FPG<100 mg/dl 2hPG<140 mg/dl *2bPG, 2-hour plasma glucose level *FPG, fasting plasma glucose * CPG Casual plasma glucose Complications-heart disease and stroke Adults with diabetes have heart disease death rates 2 to 4 times higher than those without diabetes Adults with diabetes have a 2
to 4 times greater risk of having a stroke High blood pressure In 2005-2008, 67% of adults with diabetes had high blood pressure Blindness Diabetes is the leading cause of new cases of blindness in
adults ages 20 to 74 Other complications Leading cause of kidney failure in US Accounts for 44% of cases in 2008 Neuropathy-about 60% to 70% of diabetics have some form of nerve damage Amputation-about 60% of nontraumatic lower limb amputations occur in diabetics Treatment Insulin therapy
Type 1 Some type 2 Individual nutritional care plan Exercise-especially for type 2 Oral medication/type 2 Types of insulin Generic name Rapid acting Insulin lispro Insulin aspart Insulin glulisine Short acting Regular Intermediate acting
NPH Lente Long acting Insulin glargine Ultralente Trade Name Humalog NovoLog Apidra Humulin R Novolin R Onset <15 min Peak 30-90 min
Duration 1-3 h 3-6 h 30-60 min 2-3 h 2-4 h 4-10 h 10-16 h 2-4 h Does not peak
18-36 h Humulin N Novolin N Humulin L Lantus Humulin U Oral agents used for treatment of type 2 diabetes Generic name Biguanides Metformin Metformin(liquid) Glucosidase inhibitors Acarbose Miglitol Meglitinides Nateglinide repaglinide
Trade name Concerns with exercise Glucophage, Glucophage XR, Riomet Precose Glyset Starlix Prandin May produce hypoglycemia with postprandial exercise May produce hypoglycemia with
Generic only Diabinese Tolinase Orinase Amaryl Glucotrol, Glucotrol XL Diabeta, Glynase, PresTab, Micronase Actos Avandia Januvia Concerns with exercise Can produce hypoglycemia during or after exercise No hypoglycemia
unless given with another drug Other injectable meds Generic name Trade name Comments and concerns with exercise Exantide Byetta Exantide is used in treatment of type 2 and is found to increase postprandial insulin response, delay gastric emptying, suppress glucagon secretion, and reduce appetite
Pramlintide Symlin Pramlintide is a synthetic hormone similar to human amylin. It may be used in combination with insulin therapy for treatment of either type 1 or 2. Pramlintide works by suppressing glucagon secretion and delaying gastric emptying. Effects of diabetes on ability to exercise Insulin and counter regulatory hormones dont respond to exercise in the normal
manner Balance between peripheral glucose utilization and hepatic glucose production may be disturbed= hypo/hyperglycemia Effects of medication on exercise Insulin allows glucose to enter the cells of insulin-sensitive tissue Oral and injectable agents for type 2 diabetes are meds that help the pancreas secrete more insulin, alter CHO absorption, reduce liver glycogenolysis, increase insulin sensitivity, or a combination of effects Meds may cause hypoglycemia Pay attention to med timing, food intake, blood
glucose level before and after exercise Acute effects of a session of exercise Muscle contractions increase glucose uptake Both aerobic and resistance exercises increase GLUT4 abundance and BG uptake Insulin action and glucose tolerance is increased (type 2) Dependent on several factors
Use and type of meds to lower blood glucose Timing of meds Blood glucose level prior to exercise Timing, amount, and type of previous food intake Presence and severity of diabetic complications Use of other meds Intensity, duration and type of exercise Chronic effects of exercise Weight loss (type 2) Improved insulin sensitivity Possible prevention of type 2 For those with type 2-possible improvement in blood glucose control Improved CV health Lower triglycerides Lowers blood pressure
Exercise testing Exercise testing using protocols for populations at risk for CAD recommended in individuals who: Have type 1 and are over 30 yrs Have had type 1 longer than 15 years Have type 2 and are over 35 yrs Have either type 1 or 2 and one or more other CAD risk factors Have suspected or known CAD, or Have any microvascular or neurological diabetic complications High risk for CAD testing Methods Measures endpoints
Aerobic Cycle (ramp protocol 17 W/min; staged protocol 25-50 W/3 min stage) Treadmill (1-2 METs/stage) 12-lead ECG, HR Serious dysrhythmias >2 mm ST-segment depression or elevation Ischemic threshold Significant T-wave change BP
RPE (6-20) SBP >250 mmHg or DBP >115 mmHg Onset of peripheral pain Exercise testing People with diabetes who dont meet any of the criteria for CAD may be tested with use of protocols for the general healthy population Primary objectives are to: Identify the presence and extent of CAD Determine appropriate intensity range for aerobic exercise training Exercise programming Must
be individualized according to med schedule, presence and severity of diabetic complications, and goals of program Hypoglycemic meds=additional 15 g of CHO before or after exercise 15 to 30 g CHO (fat free) every hour during vigorous or exercise>60 min Proper hydration Good foot care-proper shoes and socks Athletes will most often know their limits but trial and error with beginners-monitor BG!! Exercise contrandications Active retinal hemorrhage or recent retinopathy therapy Illness or infection Blood glucose >250 mg/dl and ketones are present
Blood glucose <70 mg/dl If blood glucose is <100 mg/dl, CHO should be consumed Exercise prescription Modes Goals Aerobic Large muscle activities Increase aerobic capacity, time to exhaustion, work capacity, BP response to exercise, Reduce CV risk factors
Strength Free weights Weight machines Elastic tubing or bands Increase max reps Improve performance for competitive patients Intensity/ frequency/ duration 50-80% peak HR 50-80% VO2peak Monitor RPE
4-7 sessions/week 20-60 min/session low resistance, high reps for most High resistance OK for patients with well controlled diabetes Time to goal 4-6 month 4-6 months Exercise prescription Modes
Goals Anaerobic High-intensity intervals Only for athletes in good diabetic control Maintain/ Flexibility Stretching/yoga increase ROM Improve gait Neuromuscula Improve r balance and Yoga coordination Functional Activity-specific
exercise Increase ADLs Increase vocational potential Increase self confidence Intensity/ frequency/ duration Time to goal Same as for nondiabetic athletes Limited data; 23 xs/week may suffice
Individualized to each client 4-6 months Summary Diabetes song http://www.youtube.com/watch? v=Ni8lwD7Z0c8 Conclusion Diabetes is a disease that should be taken seriously Some type 2 can be managed with diet and exercise If there are no significant complications with diabetes mellitus, patients can enjoy exercise with very few limitations Exercise for type 2 patients is a must!!
References American College of Sports Medicine, A. D. (2010). Exercise and type 2 diabetes. Medicine and Science in Sports & Exercise. Diabetes Statistics. (n.d.). Retrieved February 24, 2012, from American Diabetes Association: www.diabetes.org Durstine, J. M. (2009). ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities. Champaign: Human Kinetics. Farrell, P. (2003). Diabetes, exercise and competitive sports. Gatorade Sports Science Institute Sports Science Exchange , 1-6. LaFontaine, T. (2004). Exercise considerations for individuals with type 1 diabetes. Strength and Conditioning Journal , 16-18. Mahan, L. E.-S. (2008). Krause's Food and Nutrition Therapy. St. Louis: Saunders Elsevier.
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