Diabetes

• Characterized by an absolute (type 1) or relative (type 2) insulin deficiency that results in hyperglycemia

• A major health problem and leading cause of death in the United States

• More than 17 million with diabetes, only 11.1 million are diagnosed

Diabetes

• Type 1– Lack of insulin– Develops early in life– 10% diabetic population

• Type 2– Resistance to insulin– Develops later in life– 90% diabetic population

Diabetes

CharacteristicsType 1Insulin-dependent

Type 2Non insulin-dependent

Another name Juvenile-onset Adult-onset

Proportion of all diabetics ~10% ~90%

Age at onset <20 >40

Development of disease Rapid Slow

Family history Uncommon Common

Insulin required Always Common, but not always

Pancreatic insulin None, or very little Normal or higher

Ketoacidosis Common Rare

Body fatness Normal/lean Generally obese

Exercise and the Diabetic

• Control of blood glucose is important• Adequate insulin is required• Ketosis

– Metabolic acidosis from accumulation of ketone bodies

– May result from a lack of insulin

Effect of Prolonged Exercise in Diabetics

Fig 17.1

Exercise and Type 1 Diabetes

• Pre-exercise blood glucose level– 80 to 250 mg•dl-1

• Timing with insulin– Should not exercise at time of peak insulin

action• Glucose monitoring

– During/after exercise• Carbohydrate intake

– During recovery

Effect of Plasma Insulin Levels in Type 1 Diabetics

During Exercise

Fig 17.2

Exercise and Type 2 Diabetes

• Blood glucose monitoring– In those taking oral hyperglycemic agents

• Exercise prescription– 4-7 times per week

• Promotes weight loss and sustained increase in insulin sensitivity

– Minimum of 1000 kcal/wk • From all physical activity

American Diabetes AssociationGoals for Nutrition Therapy

• Attain & maintain optimum metabolci outcomes:– Blood glucose levels in normal range– A lipid & lipoprotein profile that reduces the

risk of macrovascular disease– Blood pressure level that reduces risk of

vascular disease• Improve health through food choice & activity• Address individual nutritional needs