Diabetes Mellitus

1. Diabetes Mellitus Barbara Schlichte

2. http://www.youtube.com/watch?v=MMRHGW_K-M8&feature=related

3. Why I Chose This Topic • Father diagnosed with Type 2 • Father-in-law died from complicationswith type 2 Genetics Dad

4. Outline • Definition of Diabetes Mellitis • Epidemiology • Clinical Aspects • Treatment • Effects of Exercise • Exercise Testing • Exercise Prescription • Summary • Conclusion

5. 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 don’t produce or respond to insulin. • Without effective insulin, hyperglycemia (elevated blood glucose) occurs.

6. Types of diabetes mellitus • Type 1 • Type 2 • Gestational • Other types

7. Type 1 • Absolute deficiency of insulin • Marked reduction of beta-cells in pancreas • Thought to involve an autoimmune response-no 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

8. 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

9. Type 2 con’t • 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!

10. 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 • Results from specific genetic syndromes, surgery, drugs, malnutrition, infections, or other illnesses • Depending on pathophysiology, may or may not require insulin Gestational Other types

11. 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

12. Diabetes Does Discriminate!

13. Symptoms • Frequent urination • Extreme thirst • Extreme hunger • Unusual weight loss • Extreme fatigue and irritability • 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 1 Type 2

14. Diagnosis

15. 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

16. High blood pressure • In 2005-2008, 67% of adults with diabetes had high blood pressure

17. Blindness • Diabetes is the leading cause of new cases of blindness in adults ages 20 to 74

18. 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 non-traumatic lower limb amputations occur in diabetics

19. Treatment • Insulin therapy • Type 1 • Some type 2 • Individual nutritional care plan • Exercise-especially for type 2 • Oral medication/type 2

20. Types of insulin

21. Oral agents used for treatment of type 2 diabetes

22. Oral agents-con’t

23. Other injectable meds

24. Effects of diabetes on ability to exercise Insulin and counter regulatory hormones don’t respond to exercise in the normal manner Balance between peripheral glucose utilization and hepatic glucose production may be disturbed= hypo/hyperglycemia

25. 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

26. 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

27. 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

28. 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

29. High risk for CAD testing

30. Exercise testing • People with diabetes who don’t 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

31. 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!!

32. 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

33. Exercise prescription

34. Exercise prescription

35. Summary • Diabetes song • http://www.youtube.com/watch?v=Ni8lwD7Z0c8

36. 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!!

37. 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.