Physical Activity and Diabetes. Physical Activity Is Like Magic for Type 2 Diabetes.
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Transcript of Physical Activity and Diabetes. Physical Activity Is Like Magic for Type 2 Diabetes.
Physical Activity Is Like Magic for Type 2 Diabetes
Physical Activity Is Like Magic for Type 2 Diabetes
What Can Physical Activity Do For You?
Increase flexibility and strength
Slow bone lossProvide better
quality of life
Physical activity lowers blood glucose in type 2 diabetes by helping: muscle cells become more
sensitive to insulin keep the liver from producing too
much glucose build more muscle you lose weight and keep it off
What Can Physical Activity Do For You?
Keep your heart healthyStrengthening heart
muscleLowering resting heart
rateLowering blood pressure Improving cholesterolReducing risk of heart
attack and stroke
We now must plan physical activity into our schedule
We now must plan physical activity into our schedule
Getting Started Check with your doctor
if you:Are over age 35Have had diabetes
more than 10 yearsHave high blood
pressure, heart disease, poor circulation, or other diabetes complications
Aerobic Activity
Walking briskly Dancing Bicycling Hiking Jogging/running Skating Stair climbing Swimming Water exercise
Resistance Activities “Push, Pull, and Lift”
Activities increase muscle
strengthprevent falls increase mobility improve blood glucose
control
Stretching
Improves your balance and coordination
Makes you more flexible
Reduces stiffness Reduces your risk of
injury
How Can You Begin?
Choose activity (example: brisk walking)
Set a long-term goal - at least 30 minutes a day, 3-5 days a week
Buy comfortable walking shoes
Get a partner
Effect of Physical Activity on Blood Glucose Depends on:
your blood glucose level before you exercise
diabetes medicationwhen and how much you ate last your physical fitnesstype of activity
Effect of Physical Activity on Blood Glucose
Blood glucose checks before and after exercise are the key
To increase compliance, the physician should help the patient choose a type of exercise he or she will enjoy, and offer regular encouragement and suggestions for overcoming barriers to exercise
A reasonable initial regimen is 10 minutes of stretching and warm-up, followed by 20 minutes of gentle aerobic exercise such as walking, cycling, or rowing.
The exercise should be performed regularly (at least 3 times per week) and preferably at the same time in relation to meals and insulin injections in patients treated with insulin.
The duration and intensity of exercise should be increased gradually as tolerated by the patient.
Fluid intake should be maintained at a relatively high level before, during, and after exercise.
For patients who take insulin (particularly those with type 1 diabetes), individual experimentation will be needed to make appropriate changes in the usual regimen when exercising.
General considerations include: Measure the blood glucose before, during and after exercise so that the changes in blood glucose can be documented and then predicted for subsequent exercise sessions]
If the blood glucose concentration is over 250 mg/dL (13.9 mmol/L), exercise should be delayed until a lower level is achieved.
Effect of Physical Activity on Blood Glucose
Physical activity usually lowers blood glucose
Physical activity can raise your blood glucose if:your BG is >250 mg/dl before your exercise
and you have ketones you’re starting a new vigorous exercise
program
Physical Activity and Low Blood Glucose Low blood glucose can result from
exercise only if you take:insulinoral diabetes medication (pills)
sulfonylureas repaglinide
short-term effects in type 2 diabetes
— The physiologic responses to exercise are modified in diabetes, depending upon the serum insulin concentration at the time of exercise and, for those treated with insulin, upon the site and timing of recent insulin injections.
Well-controlled insulin-treated diabetic patients with adequate serum insulin concentrations will usually have a fall in blood glucose concentrations that is much larger than that in normal subjects
1-Exogenous insulin cannot be shut off, thereby maintaining muscle glucose uptake and inhibiting hepatic glucose output.2-The increased temperature and blood flow associated with exercise may speed insulin absorption from subcutaneous depots, resulting in higher serum insulin concentrations.
3- This effect is most prominent if the injection was recent, was given into an arm or leg that is being exercised or was inadvertently given intramuscularly
in contrast, exercise can cause a paradoxical elevation in blood glucose concentrations in diabetic patients with poor metabolic control (blood glucose concentration above 250 mg/dL ,hypoinsulinemia, and some ketonuria.
In these patients, the following factors come into play: -The lack of insulin impairs glucose uptake by muscles and
cannot prevent an increase in hepatic glucose output that is mediated by counterregulatory hormones, particularly epinephrine, cortisol, and growth hormone.
These hormonal changes also lead sequentially to increased lipolysis and enhanced conversion of the free fatty acids to ketones
Recommendations People with diabetes should be advised
to perform at least 150 min/week of
moderate-intensity aerobic physical activity
(50–70% of maximum heart rate).
In the absence of contraindications,
people with type 2 diabetes should be
encouraged to perform resistance training
three times per week
Exercise is an important part of the diabetes management plan.
Regular exercise has been shown to improve blood glucose control, reduce cardiovascular risk factors, contribute to weight loss, and improve well-being.
Regular exercise may prevent type 2 diabetes in high-risk individuals
Structured exercise interventions of at least 8 weeks’→ lower A1C by an average of 0.66% in people with type 2 diabetes, even with no significant change in BMI
Higher levels of exercise intensity are associated with greater improvements in A1C and in fitness
suggest that adults over age 18 years do 150 min/week of moderate-intensity, or 75 min/week of vigorous aerobic physical activity, or an equivalent combination of the two.
the guidelines suggest that adults also do muscle-strengthening activities that involve all major muscle groups two or more days per week.
The guidelines suggest that adults over age 65 years, or those with disabilities, follow the adult guidelines if possible or (if this is not possible) be as physically active as they are able.
Studies included in the metaanalysis of effects of exercise interventions on glycemic control (146) had a mean number of sessions per week of 3.4, with a mean of 49 min/session
Progressive resistance exercise improves
insulin sensitivity in older men with type 2 diabetes to the same or even a greater extent as aerobic exercise
for an additive benefit of combined aerobic and resistance exercise in adults with type 2 diabetes
Evaluation of the diabetic patient before recommending an exercise program
Prior guidelines suggested that before recommending a program of physical activity, the provider should assess patients with multiple cardiovascular risk factors for coronary artery disease (CAD).
Coronary heart disease screening and treatment, the area of screening asymptomatic diabetic patients for CAD remains unclear, and a recent ADA consensus statement on this
issue concluded that routine screening is not recommended
High risk patients should be encouraged to start with short periods of
low intensity exercise and increase the intensity and duration slowly.
patients for conditions that might contraindicate certain types of exercise or predispose to injury,
such as uncontrolled hypertension, severe autonomic neuropathy, severe peripheral
neuropathy or history of foot lesions, and unstable proliferative retinopathy.
The patient’s age and previous physical activity level should be considered.
Exercise in the presence ofnonoptimal glycemic controlHyperglycemia.Hyperglycemia.
vigorous activity should be avoided in the presence of ketosis
Hypoglycemia. In individuals taking insulin and/or insulin secretagogues, physical activity can cause hypoglycemia if medication dose or carbohydrate consumption is not altered. For individuals
Carbohydrate should be ingested if pre-exercise glucose levels are 100 mg/dl (5.6 mmol/l).
Exercise in the presence of specificlong-term complications of diabetesRetinopathy.
In the presence of proliferative diabetic retinopathy (PDR) or severe nonproliferative diabetic retinopathy (NPDR), vigorous aerobic or resistance exercise may be contraindicated because of the risk of triggering vitreous hemorrhage or retinal detachment
Peripheral neuropathy
Decreased pain sensation in the extremities results increased risk of skin breakdown and infection and of Charcot joint destruction.
Prior recommendations have advised non–weight-bearing exercise for patients with severe peripheral neuropathy.
However, studies have shown that moderateintensity
walking may not lead to increased risk of foot ulcers or reulceration in those with peripheral neuropathy
Peripheral neuropathy
All individuals with peripheral neuropathy should wear proper footwear and examine their feet daily to detect lesions early. Anyone with a foot injury or open sore should be restricted to non–weight-bearing activities.
Autonomic neuropathy
Autonomic neuropathy can increase the risk of exercise induced injury or adverse event through decreased cardiac responsiveness to exercise, postural hypotension, impaired thermoregulation, impaired night vision due to impaired papillary reaction, and unpredictable carbohydrate delivery from gastroparesis predisposing to hypoglycemia
People with diabetic autonomic neuropathy should undergo cardiac investigation before beginning physical activity more intense than that to which they are accustomed.
Albuminuria and nephropathy.
Physical activity can acutely increase urinary protein excretion. However, there is no evidence that vigorous exercise increases the rate of progression of diabetic kidney disease, and there is likely no need for any specific exercise restrictions for people with diabetic kidney disease
What Is Happening to?
She takes insulin and is walking briskly in her neighborhood in the late afternoon. She becomes shaky, is unable to think clearly, and has changes in her vision.
What should Sandra do?
Treatment for Low Blood Glucose
Equal to about 15 grams of carbohydrate:
½ cup fruit juice ½ cup soft drink (not diet) 3 glucose tablets 8 Lifesavers
Glucose Tablets
Physical Activity and Hypoglycemia
More common after physical activity
Body is replenishing stored carbohydrate (glycogen)
Check your blood glucose after you exercise
How Can Sandra Prevent Low Blood Glucose Next Time?
Adjust Insulin For planned,
regularly scheduled physical activity
Eat Snack For unplanned
physical activity When exercising for
an extended period of time
Check blood glucose before, during, and after exercise
Carbohydrate Snacks for Physical Activity
Intensity Time (minutes)
Carbohydrate
Mild Less than 30 May not be needed
Moderate 30-60 15 grams
High Over 60 30-50 grams
Exercising With Diabetes Complications If you have diabetes complications:
An exercise stress test is recommended
Don’t consider diabetes a barrier to exercise
Most moderate lifestyle activities are safe Some activities may need to be modified
Exercising With Heart Disease
Caution: Very strenuous
activity Heavy lifting or
straining Exercise in extreme
cold or heat
Choose: Moderate activity
such as walking, swimming, biking, gardening
Moderate lifting, stretching
Exercising with Hypertension (high blood pressure)
Caution Very strenuous
activity Heavy lifting or
straining
Choose Moderate activity
like: walking weight lifting with
light weights stretching
Make sure your blood pressure is in control first
Exercising with Retinopathy (eye disease)
Caution Strenuous exercise Heavy lifting and
straining High-impact aerobics,
jogging Bending your head
below your waist – toe touching
Choose Moderate, low-impact
activities: walking cycling water exercise
Moderate daily chores that don’t require lifting or bending your head below your waist
Exercising with Nephropathy (kidney disease)
Caution Strenuous activity
Choose Light to moderate
activity like walking, light housework, gardening, water exercise
Exercising with Neuropathy (nerve disease)
Caution Weight-bearing, high
impact, strenuous, or prolonged exercise: jogging/running step exercise jumping exercise in heat/cold
Choose Low impact,
moderate activities: biking swimming chair exercises stretching light to moderate
daily activities
Check feet after exercise
Exercise Safely
Check your blood glucose before and after exercise
Don’t exercise if your blood glucose is too high or too low
Carry carbohydrate to treat low blood glucose if you are at risk
Exercise Safely
Stop exercising if you feel pain, lightheaded, or short of breath
Avoid strenuous activity in extremely hot, humid, or cold weather
Wear proper shoes for the activity to reduce the risk of injury