FINAL WEEK OF MATERIAL

What is diabetes?

• A group of metabolic diseases characterized by hyperglycemia

• Diagnostic tests: fasting blood glucose levels, oral glucose tolerance tests, hemoglobin A1C level

What differs the 2 types of diabetes?

T1: Deficiency of insulin attributable to autoimmune destruction of beta cells in the pancreas

T2: Insulin receptors on the cells of the body insensitive or resistant to insulin

• increased risk with age, obesity, and lack of PA

• Certain racial or ethnic groups also at higher risk

How does diabetes affect insulin production and function?

• When glucose in the blood stimulates the pancreas

  • The pancreas produces insulin, however…

    • The pancreas does not produce enough insulin in T1D or…

    • Insulin doesn’t adequately stimulate the cells to take up glucose in T2D affecting the reach of the target cells

What are the exercise considerations for Diabetes?

• Screening important as ACSM and American Diabetes Association offer different clearance recommendations

  • Aerobic 3 - 7 days per week, no more than 2 days to decrease insulin resistance

  • Resistance training, flexibility 2 to 3 days per week

  • Balance training for those 50 y/o or older recommended 2 to 3 times per week

What should be acknowledged for hypoglycemia?

• (blood glucose < 70 mg x dL; < 3.9 mmol/L)

• Prevention

  • Client can work with physician to adjust diet and insulin use

  • Activities may need to be adjusted within the workout session

• Minimize the risk of exercise induced nocturnal hypoglycemia

What should be acknowledged for hyperglycemia?

• can occur with exercise due to consuming too much CHO before or during exercise reducing insulin levels excessively

• Some types can promote: sprinting, brief intense exercise, heavy powerlifting

• If blood glucose is > 250 mg x dL; 14 mmol/L, ketones should be checked, if ketones are elevated, postpone or suspend exercise

What are the additional considerations for individuals who have had diabetes for several years?

• Peripheral, diabetic, autonomic neuropathy

• Nephropathy

What measures should be taken for diabetics?

• Use and type of medication to lower blood glucose (insulin or oral hypoglycemic agents)

• Timing of medication administration

• Blood glucose level prior to exericse

• Timing, amount and type of previous food intake

• Presence and severity of diabetic complications

• Use of other medications secondary to diabetic complications

• Intensity, duration and type of exercise

What is insulin therapy?

• Injected or pumped

  • amount of insulin used surrounding exercise will usually have to be decreased to prevent hypoglycemia

  • Various forms of insulin are available from rapid acting to long acting

What are the oral and injectable medications for diabetes?

• Biguanides

  • No concerns with exercise

• Glucosidase inhibitors, Meglitinides

  • May produce hypoglycemia with postpradial exercise

• Secretagogues

  • May produce hypoglycemia during or after exercise

• Thiazoladinediones

  • No hypoglycemia unless taken with another drug

• Exanitide, Plaminitide

  • May interfere with absorption of CHO when attempting to treat hypglycemia

What are the recommendations for exercise testing?

Populations at risk of CAD

• T1d over 30 y/o of age

• T1D longer than 15 yrs

• T2D longer than 35 yrs

• Have either T1D or T2D and one or more other CAD risks

• Have suspected or known CAD

• Have any microvascular or neurological diabetic complications

If they don’t meet any of the above criteria, exercise testing can be proceeded with.

What are the benefits of exercise training for Diabetes?

• Improved:

  • Insulin sensitivity, blood lipids and lipoproteins, physical fitness, flexibility and strength, wellbeing

• Decreased

  • risk of CVD, BP in hypertension

• Increased

  • Caloric expenditure

What is the exercise prescription for T2D (Aerobic)?

F: 3 - 7 days / week (no more than 2 days of consecutive rest)

I: 40 - 89% HRR (11- 17 / 20 Borg RPE Scale)

T: 150 - 300 min per week of moderate intensity; 75 - 150 min/week of vigorous intensity

T: any large muscle group and repetitive PA

What is the exercise prescription for T2D (Resistance)?

F: 2 -3 days/ wk

I: 50 - 85% 1RM

T: 1 - 3 sets x 6 -20 reps; 8 - 10 exercise w/ major muscle groups

T: Free weights, machines, elastic bands, body weight exercises

What is the exercise prescription for T2D (Flexibility)?

F: 2 -3 days / week

I: to point of slight discomfort or tightness

T: 10 - 30 sec per stretch x 2 -4 reps / stretch

T: static, dynamic, PNF

What is the exercise prescription for T2D (Balance)?

F: 2 -3 days / wk

I

T

T: balanced based exercises; core stability Tx, Tai Chi, Yoga

What are the key terms of diabetes?

• Hyper: >14 or 250 mg/dl

• Hypo: < 5.5 or 100 mg/dl

• Active retinal hemorrhage

• Illness or infection present

• Severe complications (neuropathy,nephropathy, evidence underlying CVD)