1. Dixie L. Thompson chapter 20 Exercise and Diabetes

2. Important Terms Insulin Glucose Hyperglycemia Hypoglycemia Diabetes mellitus Prediabetes Impaired fasting glucose Impaired glucose tolerance Insulin sensitivity Insulin resistance Metabolic syndrome

3. 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?

4. 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.

5. 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

6. Responses to Carbohydrate Intake

7. 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

8. 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.

9. 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.

10. Exercise Prescription for Clients With 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)

11. Exercise Prescription for Clients With 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.

12. Precautions for Avoiding Exercise-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)

13. Precautions for Avoiding Exercise-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.

14. Exercise Prescription for Clients With 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)

15. Exercise Prescription for Clients With 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.

16. 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