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Chapter 9

Chapter 9. Exercise for Those with Diabetes. Diagnosis of diabetes. Fasting plasma glucose test Measures blood glucose after 8-hour fast Meaning of values ≤99 mg/dL is normal 100–125 mg/dL suggests prediabetes ≥126 mg/dL indicates diabetes. Diagnosis of diabetes (cont'd).

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Chapter 9

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  1. Chapter 9 Exercise for Those with Diabetes

  2. Diagnosis of diabetes • Fasting plasma glucose test • Measures blood glucose after 8-hour fast • Meaning of values • ≤99 mg/dL is normal • 100–125 mg/dL suggests prediabetes • ≥126 mg/dL indicates diabetes

  3. Diagnosis of diabetes (cont'd) • Oral glucose tolerance test • Measures blood glucose after 8-hour fast • Give patient a liquid with 75 g of glucose • Measure blood glucose 2 hours after intake • Meaning of values • ≤139 mg/dL is normal • 140–199 mg/dL suggests prediabetes • ≥200 mg/dL indicates diabetes

  4. Diagnosis of diabetes (cont'd) • Random plasma glucose test • Measures blood glucose without requiring a fast • A reading of ≥200 mg/dL suggests diabetes if the patient also complains of frequent urination, excessive thirst, and unexplained weight loss • Follow with FPG or OGT test to confirm

  5. Anatomic and physiologic changes associated with diabetes • Role of the pancreas • Exocrine role • Produces digestive enzymes for digestion • 99% of its cells devoted to this role • Endocrine role • Releases hormones involved with blood glucose homeostasis • 1% of its cells devoted to this role

  6. Anatomic and physiologic changes associated with diabetes (cont'd) • Endocrine tissue of the pancreas • 4 types of cells produce 4 different hormones • Most important cells are the alpha and beta cells • Beta cells produce insulin • Alpha cells produce glucagon

  7. Anatomic and physiologic changes associated with diabetes (cont'd) • Insulin • Facilitates the movement of glucose into cells when blood levels are high • Binds to receptors on target cells to open glucose gates • Promotes glycogenesis with low energy demands

  8. Effects of insulin on muscle, liver, and fat cells

  9. Anatomic and physiologic changes associated with diabetes (cont'd) • Glucagon • Stimulates • Glycogenolysis • Gluconeogenesis • Lipolysis • Amino acid uptake • Ketone body formation

  10. Negative feedback loop for insulin and glucagon

  11. Hyperglycemia • Occurs when blood glucose levels remain elevated • Symptoms include • Sweating • Trembling • Rapid heart rate • Hunger • Frequent urination • Increased thirst

  12. Major types of diabetes • Type 1 diabetes mellitus • Autoimmune disorder in which immune cells attack beta cells in pancreas • Results in inability to produce insulin • Causes elevated blood glucose levels • Symptoms include hunger, severe systemic weakness, and weight loss

  13. Major types of diabetes (cont’d) • Type 2 diabetes mellitus • More common than type 1 • Pancreas continues to produce insulin, but insulin receptors on target cells are unresponsive • Blood glucose levels remain elevated, which promotes increased insulin production and release

  14. Risk factors for diabetes

  15. Diabetes-related complications • High blood pressure • Heart disease • Stroke • Liver damage • Retinopathy • Neuropathy • Nephropathy • Poor circulation

  16. Precautions during exercise • Increased risk for cardiovascular disease • Increased risk of hypoglycemia • Increased risk of dehydration • Increased risks associated with high-intensity resistance training • Increased risk of injury to the extremities

  17. Benefits of exercise • Improved insulin sensitivity and glucose tolerance • Reduced risk for cardiovascular disease and improved work capacity • Reduced need for medication • Improved mood and well-being • Better weight management

  18. Exercise testing • Diabetics should receive medical clearance owing to their increased risk for cardiovascular, renal, neurologic, and visual problems • If at low risk of a cardiac event, diabetics may begin a low-to-moderate exercise program without testing • If at high risk, obtain a medically supervised graded exercise test

  19. Exercise guidelines • Begin with 5–10 minutes of limbering movements followed by 5–10 minutes of stretching; end with a 5- to 10-minute cool down • Cardiovascular training • Perform for 20–60 minutes on 3–7 days per week at a moderate intensity of 50–80% VO2R (RPE of 12–16) • Encourage low-impact activities like walking, floor aerobics, water aerobics, or the elliptical trainer • If neuropathy of the feet is present, encourage nonimpact activities like swimming or cycling

  20. Exercise guidelines (cont'd) • Resistance training • Safe in the absence of retinopathy, recent laser treatment, or any other contraindications • Perform on 2–3 days per week at an intensity of 60–80% of 1 RM • Complete 2–3 sets, each consisting of 8–12 repetitions for 8–10 multijoint exercises • Rest at least 48 hours in between workouts

  21. Other special considerations • Hypoglycemia can occur during and after exercise • Hyperglycemia can occur in type 1 diabetics with poor blood glucose control • Those with neuropathy of legs and feet might have gait or balance problems; avoid quick changes • Participate in activity at the same time each day

  22. Other special considerations (cont'd) • Check blood glucose levels before exercising • If <100 mg/dL, consume small amount of carbohydrates • If 100–250 mg/dL, begin exercise • If >250 mg/dL, be careful; test for urine ketones and avoid exercise if ketone level is high • Have a source of carbohydrates available • Do not inject insulin into exercising limbs

  23. Other special considerations (cont'd) • Consume water before, during, and after exercise • Always exercise with a partner • Use perceived exertion to monitor intensity • Wear well-fitting, breathable shoes • Wear a medical ID bracelet

  24. Tips for the diabetic exerciser

  25. When diabetics should avoid exercise

  26. Sample exercises • Upper body • Chest press • Lateral pull-down • Seated row • Shoulder press • Biceps curl • Triceps dip

  27. Sample exercises (cont’d) • Lower body • Leg press • Squats • Lunges • Leg extension • Leg curl

  28. Nutritional considerations • Carbohydrates • Consume at least 130 grams/day • Include about 14 grams of fiber per 1000 kcal • Strive to consume a similar amount each day, at the same time each day, and evenly spaced out each day • Select high-fiber foods, whole grains, and vegetables • Carefully plan insulin injections to avoid hyperglycemia or hypoglycemia

  29. Nutritional considerations (cont'd) • Protein • Should constitute about 15–20% of a diabetic’s total energy intake (75–100 grams on a 2000-kcal diet) • If suffering from kidney disease, limit protein intake even more • Choose lean meats, chicken, and plant-based proteins like soy

  30. Nutritional considerations (cont'd) • Fat • Limit total daily fat intake to 20–35% of total kcal • Limit saturated fat intake to <7% of total daily kcal • Limit dietary cholesterol intake to 200 mg/day

  31. Nutritional considerations (cont'd) • Alcohol • Moderate alcohol consumption is safe • Consume with foods if taking insulin • Be aware that many drinks like wine coolers and mixed drinks contain juices that are high in carbohydrates

  32. Nutritional considerations (cont'd) • Vitamins and minerals • Needs match those of the general population (see Appendix B) • If at high risk for cardiovascular disease, limit sodium intake to <2000 g/day

  33. Nutritional considerations (cont'd) • Water • Recommendations resemble those for the general population • 2–3 eight-ounce glasses 2 hours before exercise • 1–2 cups 10–15 minutes before exercise • 1–1½ cups during exercise

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