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Learn about exercise benefits for diabetes, screening precautions, and tailored prescriptions for type 1 and type 2 clients to manage blood glucose levels effectively.
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chapter20 Exercise and Diabetes Dixie L. Thompson
Important Terms • Insulin • Glucose • Hyperglycemia • Hypoglycemia • Diabetes mellitus • Prediabetes • Impaired fasting glucose • Impaired glucose tolerance • Insulin sensitivity • Insulin resistance • Metabolic syndrome
General Information • What is diabetes mellitus? • What are types of diabetes? • Type 1 • Type 2 • Gestational • What are similarities and differences among these types of diabetes?
Interpreting Plasma Glucose Levels • Normal fasting plasma glucose concentration is less than 100 mg · dl–1(5.6 mmol · L–1). • A fasting plasma glucose concentration between 100 and 125 mg · dl–1 indicates impaired fasting glucose.
Diagnosing Diabetes Mellitus For a diagnosis of diabetes, one of the following must exist: • Fasting plasma glucose ≥ 126 mg · dl–1 (7.0 mmol · L–1) • Symptoms of diabetes (e.g., unusual thirst, frequent urination, unexplained weight loss) and a casual plasma glucose ≥ 200 mg · dl–1 (11.1 mmol · L–1) • A glucose value ≥ 200 mg · dl–1 2 hr after the ingestion of 75 g of carbohydrate
Effects of Diabetes Mellitus • Economic effects: $132 billion per year • People affected: over 20 million Americans • Common complications • Vision impairment • Kidney disease • Peripheral vascular disease • Atherosclerosis • Hypertension • Poor healing of wounds • Neuropathy
Exercise and Diabetes • Exercise cannot be used in the treatment and prevention of type 1 diabetes, but diabetic clients will gain many health benefits from exercise. • Exercise has been shown to be helpful in the prevention of type 2 diabetes. • Exercise and weight loss are useful tools in the treatment of type 2 diabetes.
Screening and Testing • Medical history and medical clearance are necessary when working with diabetic clients. • It is important to screen for complications of diabetes, such as peripheral neuropathy. • The choice of exercise testing protocol should be individualized.
Exercise Prescription for ClientsWith Type 1 Diabetes • Insulin dosage and carbohydrate ingestion are critical considerations for the client with type 1 diabetes. • Clients with type 1 diabetes should check their blood glucose levels before exercise. • Clients should consume carbohydrate if their glucose is less than 100 mg · dl–1. • Avoiding hypoglycemia should be a primary concern. (continued)
Exercise Prescription for ClientsWith Type 1 Diabetes (continued) • Symptoms of hypoglycemia include dizziness, nausea, headache, confusion, and irritability. • Regular aerobic exercise is recommended for diabetic clients. • Individualized exercise prescription must focus on specific clients’ needs and limitations. • Progression should be slow.
Precautions for AvoidingExercise-Induced Hypoglycemia • Measure blood glucose immediately before and 15 min after exercise. • Consume carbohydrate if glucose is less than 100 mg · dl–1. • Delay exercise if glucose is more than 250 mg · dl–1 with ketone bodies or over 300 mg · dl–1 without ketones. • Avoid exercising during times of peak insulin action. (continued)
Precautions for AvoidingExercise-Induced Hypoglycemia (continued) • Reduce insulin dose (and inject into inactive areas) on days of planned exercise. • Consume carbohydrate after exercise. Hypoglycemia can appear several hours after exercise, so monitoring after exercise is crucial. • Avoid exercise late at night because hypoglycemia could occur while sleeping. • Warm-up and cool-down may need to be extended for diabetic clients.
Exercise Prescription for ClientsWith Type 2 Diabetes • Type 2 diabetes is often linked with lack of exercise and excess weight. • ACSM recommends expending a cumulative total of 1,000 kcal · wk–1 in aerobic activity. • Moderate-intensity exercise is most often recommended for clients with type 2 diabetes, although high-intensity activity is acceptable for many. (continued)
Exercise Prescription for ClientsWith Type 2 Diabetes (continued) • HR or RPE can be used to monitor exercise intensity. • Resistance exercise is also recommended; the additional muscle mass is thought to assist with glucose control. • A supportive environment helps increase adherence. • Refer to the ACSM position stand.
Metabolic Syndrome Metabolic syndrome exists if a person has three or more of the following: • Abdominal obesity • High triglycerides • Low HDL-C • Elevated blood pressure • Elevated fasting glucose