1. Southwest Healthcare Physical Therapy Department

3. Physical Activity Is Like Magic for Type 2 Diabetes

4. What Can Physical Activity Do For You? Give you more energy

5. What Can Physical Activity Do For You? Help you lose weight and keep it off

6. What Can Physical Activity Do For You? Increase flexibility and strength Slow bone loss Provide better quality of life

7. What Can Physical Activity Do For You? Build muscle

8. What Can Physical Activity Do For You? Improve your sex life

9. What Can Physical Activity Do For You? Lift your mood Treat depression

10. What Can Physical Activity Do For You? Reduce stress and anxiety

11. What Can Physical Activity Do For You? Improve blood glucose control (lowers A1C)

12. 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

13. What Can Physical Activity Do For You? Keep your heart healthy

14. Physical activity helps your heart by: Strengthening heart muscle Lowering resting heart rate Lowering blood pressure Improving cholesterol Reducing risk of heart attack and stroke

15. “Sitting” through life increases your risk of: heart disease high blood pressure high cholesterol overweight type 2 diabetes

16. We now must plan physical activity into our schedule

17. Getting Started Check with your doctor if you: Are over age 35 Have had diabetes more than 10 years Have high blood pressure, heart disease, poor circulation, or other diabetes complications

18. Aerobic Activity Walking briskly Dancing Bicycling Hiking Jogging/running Skating Stair climbing Swimming Water exercise

19. Resistance Activities “Push, Pull, and Lift” Activities increase muscle strength prevent falls increase mobility improve blood glucose control

29. Stretching Improves your balance and coordination Makes you more flexible Reduces stiffness Reduces your risk of injury

30. Stretching It is best to stretch your muscles after they are warm, that is, after about 10 minutes of easy walking, or just following your exercise session. Stretching your muscles before exercise can result in injury. Never bounce or jerk during the stretch; ease into it slowly just until you can feel it an hold for about 30 seconds.

38. 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

39. Start Slowly Set short-term goal for one week Do less than you think you can

40. Gradually Increase Activity Beginning Exercisers: First Week - 3 times a week Morning: Walk 5-10 minutes Lunch: Walk 5-10 minutes After dinner: Walk 5-10 minutes Keep track of how long and how far you walk each day

41. Keep Track of Your Steps Use a pedometer Keep track of how many steps you normally take in a day for one week Gradually add 500-1,000 steps a day Set a goal of at least 3,000 to 4,000 steps more than your baseline

42. If You’re Already Exercising Regularly: Make sure you are exercising at 70% of your maximum heart rate. Maximum heart rate is 220 – your age. If you are 40, your max heart rate is 180. 70% of 180 is 126, or your target heart rate.

43. Interval Training: To challenge yourself more and really increase your metabolism, try interval training. Exercise at your target heart rate for 3 minutes, then increase your pace to raise your heart rate to 80-90% of your max heart rate for 1 minute, then slow down and continue at your target heart rate. Continuing alternating target and 80-90% of max for as long as you are able.

44. Vary Your Activities MondayTuesdayWedThursdayFriday Exercise bike Dance class Exercise Bike Dance Class Exercise Bike MondayTuesdayWedThursdayFriday WalkSwim/ Water Aerobics WalkSwim/ Water Aerobics Walk

48. Reward Yourself Use non-food rewards for reaching goals such as: New book Ticket to a play or ballgame New clothes or walking shoes Bubble bath Get-away weekend

49. Beginning A Physical Activity Plan Type of activities List your long-term goal List your short term goal Barriers Rewards

50. Effect of Physical Activity on Blood Glucose Depends on: your blood glucose level before you exercise diabetes medication when and how much you ate last your physical fitness type of activity

51. Effect of Physical Activity on Blood Glucose Blood glucose checks before and after exercise are the key

52. 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

53. Physical Activity and Low Blood Glucose Low blood glucose can result from exercise only if you take: insulin oral diabetes medication (pills) sulfonylureas (DiaBeta, Amaryl, Glucotrol, micronase) nateglinide (Starlix) or repaglinide (Prandin )

54. What Has Happened to Goofy? Goofy takes insulin and is walking briskly in his neighborhood in the late afternoon. He becomes shaky, is unable to think clearly, and has changes in his vision. What should Goofy do?

55. 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

56. Physical Activity and Hypoglycemia More common after physical activity Body is replenishing stored carbohydrate (glycogen) Check your blood glucose after you exercise

57. How Can Goofy 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

58. Carbohydrate Snacks for Physical Activity IntensityTime (minutes) Carbohydrate MildLess than 30May not be needed Moderate30-6015 grams HighOver 6030-50 grams

59. Carbohydrate Snacks for Physical Activity Examples of 15 gram carbohydrate snacks 6 saltine-type crackers 1 cup yogurt 2 fig bars 1 ounce sport or energy bar 8 ounces sports drink - ideally with less than 8% carbohydrate

60. Beware of Too Many Snacks Avoid routinely eating extra food if you’re trying to lose weight ask about adjusting your medication dosages change the time of day you exercise

61. 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

62. 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

63. 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

64. 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

65. Exercising with Nephropathy (kidney disease) Caution Strenuous activity Choose Light to moderate activity like walking, light housework, gardening, water exercise

66. 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

67. 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

68. 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

69. Exercise Safely Wear diabetes identification Include warm-up and cool-down sessions Drink plenty of fluid

70. One step and another step. I am slow but I am steady.” “One step, another step. One step and another. Slow and steady.” “One step and another. I can do it!” “ I am slow but I am steady. And I am the winner !” Words of the Wise... The Tortoise in The Tortoise and the Hare

71. “ I can take a little rest.” “ Zzzzzzzzzzzzzzzzzzzz.” The Hare in The Tortoise and the Hare Words of the Unwise...

74. The foot is especially affected by diabetes because: Diabetes damages the nerves. Diabetes also affects the circulation. Diabetes can make the body more prone to infection. Diabetes can also affect the joints, causing stiffness. Other diabetes complications can also affect the foot, i.e., kidney disease and eye disease.

75. As a consequence of these factors a number of things can go wrong: The foot may get damaged without you being aware. Foot ulcers are common. Infections can spread. Amputation. Charcot foot.

76. Charcot Foot

77. Grandma used to say: An ounce of prevention is worth a pound of cure. We need to listen to grandma!

78. Daily Foot Care Wash your feet daily. Use mild soap and lukewarm water. Dry very carefully, especially between the toes. It often helps to use talcum powder to dust the foot to further reduce moisture; however, be certain to remove all the powder between the toes. If the skin is dry, use a good emollient – BUT not between the toes.

79. Daily Foot Care Inspect your feet daily. Check for sores, cuts, bruises, changes to the toenails; use a mirror to look under the foot is you cannot see it. Cut toenails straight across and never cut into the corners; use an emery board on sharp corners. Do not try to remove corns and calluses yourself – see a Podiatrist.

80. Daily Foot Care NEVER use commercial corn cures – they can easily damage the skin. Avoid going barefoot, even in your own home. See a Podiatrist at least annually.

81. Footwear Tips Poorly fitted shoes are a common cause of problems in the diabetic foot. Have your feet measured each time you buy new shoes. The “fitter” should be experienced in dealing with diabetic feet. New shoes should be comfortable when purchased and should not need a “break-in” period.

82. More Footwear Tips The shoes should fit both the length and width of the foot, with plenty of room for the toes. Avoid shoes with high heels, pointed toes or that are tight around the toes.

83. Even More Footwear Tips Consider fitted orthotics A podiatrist can fit you with shoe inserts called orthotics to support your feet if you have diabetic nerve pain or the muscles have become weak from nerve damage.

84. Foot and Ankle Exercises