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The Diabetic Athlete

The Diabetic Athlete. Case Study. Definition. Group of metabolic disorders characterized by hyper glycemia resulting from defects in insulin secretion, insulin action or both.

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The Diabetic Athlete

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  1. The Diabetic Athlete

  2. Case Study

  3. Definition • Group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. • Chronic diabetes is associated with long term damage, dysfunction and failure of various organs especially the eyes, kidneys, nerves, heart and blood vessels

  4. Definition • Diabetes is caused by the relative lack of insulin secretion by the pancrease or by insulin resistance of target organs (usually muscle and liver where it is stored)

  5. CHO Metabolism Secretion of insulin promotes storage of glucose in MM and liver as glycogen EAT Consume CHO Converted to glucose Absorbed by SI sent to bloodstream

  6. CHO Metabolism As blood glucose level rise Pancrease secretes more Insulin or As blood glucose levels decrease Pancrease secretes less Insulin

  7. Classification of Diabetes • 2 fasting blood plasma levels greater than 126 mg/dL • Two random draw blood plasma levels greater than 200 mg/dL • 2 hour post ingestion of glucose solution with blood plasma levels greater than 200 mg/dL • Normal=80-120 mg/dL OR OR

  8. Symptoms of diabetes • Hyperglycemia – blood sugar rises above normal levels • Leads to excretion of glucose in urine which requires a large amount of water • Polyurnia • Polydipsia • Nocturia • Other symptoms may include lethargy, blurred vision, & unexplained weight loss

  9. 4 types of Diabetes • Type 1 • Type 2 • Gestational

  10. Type 1 diabetes • Also known as Juvenile onset diabetes or insulin-dependant diabetes • Results from the destruction of the pancreatic islet beta cells where insulin is produced • Usually occurs < 30 yo • Insulin injection is the only way to control the hyperglycemia

  11. TX for Type 1 Diabetes • TX with insulin and must keep tight glucose control in athlete • Blood glucose monitoring – QID • Insulin pump or insulin injections 3 or more times a day • Frequent adjustments needed based on glucose level, anticipated dietary intake and exercise

  12. Poor TX for Type 1 • Can lead to: • Retinopathy • Neuropathy • Nephropathy

  13. Type 2 diabetes • Also known as adult onset or noninsulin dependent diabetes • Caused by insulin resistance plus a lack of insulin secretion • Occurs in 40+ yo • Can control with diet, exercise, weight loss or medications

  14. Gestational diabetes • Associated with pregagancy usually in the 5th or 6th month • Will resolve once pregnancy is over • 50% of women will get type 2 within 22-28 years after birth • Mothers glucose need to be WNL to protect baby • Nutritional counseling, diet and exercise are usually effective

  15. TX for Type 2 & Gestational Diabetes • Diet and exercise then oral meds then insulin injections • Sulfonylurea and insulin may cause hypoglycemia • Must be monitored frequently with blood glucose monitor and hemoglobin A1C test

  16. Medications

  17. Medications

  18. Medications

  19. Goals for Diabetic

  20. Problems Associated with Diabetes

  21. Hypoglycemia • Abnormal low level of glucose in the blood • S&S are varied and diverse • Irritability, trembling, hunger, sweating and apprehension • Severe symptoms could lead to shock, confusion, convulsions and coma

  22. Hypoglycemia • TX • Sugar cubes, orange juice, candy, fruit, glucose tablets or gels • Recovery is usually fast • Need to monitor exercise and diet to prevent further hypoglycemic attacks

  23. Ketacidosis • Occurs when the body cannot metabolize glucose and burns fat stores instead • End product of fat metabolism is ketone bodies which are acidic and increase in the body they raise the pH level • Usually occurs over a period of days and typically seen in Type 1 diabetes

  24. Ketacidosis • Precipitating factors include: • Severe infection, dietary indiscretions and failure to take insulin • S&S • Fruity breath, lethargy, confusion and somnolence and Kussmaul breathing

  25. Role of Exercise

  26. Benefits of Exercise • Increases insulin sensitivity and lowers BP, weight, and lipid levels • In type 2 – improves glycemic control with change in diet, regular exercise and weight loss

  27. Benefits of Exercise • In type 1 – worsens blood glucose control and must take care to prevent both hypo and hyperglycemia

  28. Benefits of Exercise • Need to monitor exercise intensity, glucose levels and weight loss closely • Any change may present harm to athlete • Athlete and ATC must be vigilant

  29. General Guidelines for PreExercsie Caloric Intake • All blood glucose levels that are <80mg/dL requires caloric supplementation • If blood glucose level is <100mg/dL prior to exercise, a pre-exercise snack should be eaten that is high in CH and low in fat

  30. General Guidelines for PreExercsie Caloric Intake • If blood glucose 100-250mg/dL prior to exercise, exercise can continue and additional calories can be consumed during or after exercise – depending on duration of activity

  31. General Guidelines for PreExercsie Caloric Intake • If exercise lasts more than 1 hr, 15 g of CHO and 250 mL of fluid should be consumed every 15-20 minutes

  32. General Guidelines for PreExercsie Caloric Intake • If blood glucose is >250 ml/dL, the athletes urine should be checked for ketones. • If keytones are present, or if blood glucose is >300 mg/dL, exercise should be stopped and insulin should be adjusted for better glycemic control

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