Physical Activity and Diabetes. Physical Activity Is Like Magic for Type 2 Diabetes

Physical Activity and Diabetes

Physical Activity Is Like Magic for Type 2 Diabetes

Physical Activity Is Like Magic for Type 2 Diabetes

What Can Physical Activity Do For You?

Give the patient more energy


Help us lose weight and keep it off


Increase flexibility and strength

Slow bone lossProvide better

quality of life


Build muscle


Lift your moodTreat

depression


Reduce stress and anxiety


Improve blood glucose control

(lowers A1C)

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


Keep your heart healthyStrengthening heart

muscleLowering resting heart

rateLowering blood pressure Improving cholesterolReducing risk of heart

attack and stroke

We now must plan physical activity into our schedule

We now must plan physical activity into our schedule

Getting Started Check with your doctor

if you:Are over age 35Have had diabetes

more than 10 yearsHave high blood

pressure, heart disease, poor circulation, or other diabetes complications

Aerobic Activity

Walking briskly Dancing Bicycling Hiking Jogging/running Skating Stair climbing Swimming Water exercise

Resistance Activities “Push, Pull, and Lift”

Activities increase muscle

strengthprevent falls increase mobility improve blood glucose

control

Stretching

Improves your balance and coordination

Makes you more flexible

Reduces stiffness Reduces your risk of

injury

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

Start Slowly

Set short-term goal for one week

Do less than you think you can

No Pain

No Gain

Effect of Physical Activity on Blood Glucose Depends on:

your blood glucose level before you exercise

diabetes medicationwhen and how much you ate last your physical fitnesstype of activity

Effect of Physical Activity on Blood Glucose

Blood glucose checks before and after exercise are the key

To increase compliance, the physician should help the patient choose a type of exercise he or she will enjoy, and offer regular encouragement and suggestions for overcoming barriers to exercise

A reasonable initial regimen is 10 minutes of stretching and warm-up, followed by 20 minutes of gentle aerobic exercise such as walking, cycling, or rowing.

The exercise should be performed regularly (at least 3 times per week) and preferably at the same time in relation to meals and insulin injections in patients treated with insulin.

The duration and intensity of exercise should be increased gradually as tolerated by the patient.

Fluid intake should be maintained at a relatively high level before, during, and after exercise.

For patients who take insulin (particularly those with type 1 diabetes), individual experimentation will be needed to make appropriate changes in the usual regimen when exercising.

General considerations include: Measure the blood glucose before, during and after exercise so that the changes in blood glucose can be documented and then predicted for subsequent exercise sessions]

If the blood glucose concentration is over 250 mg/dL (13.9 mmol/L), exercise should be delayed until a lower level is achieved.

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

Physical Activity and Low Blood Glucose Low blood glucose can result from

exercise only if you take:insulinoral diabetes medication (pills)

sulfonylureas repaglinide

short-term effects in type 2 diabetes

— The physiologic responses to exercise are modified in diabetes, depending upon the serum insulin concentration at the time of exercise and, for those treated with insulin, upon the site and timing of recent insulin injections.

Well-controlled insulin-treated diabetic patients with adequate serum insulin concentrations will usually have a fall in blood glucose concentrations that is much larger than that in normal subjects

1-Exogenous insulin cannot be shut off, thereby maintaining muscle glucose uptake and inhibiting hepatic glucose output.2-The increased temperature and blood flow associated with exercise may speed insulin absorption from subcutaneous depots, resulting in higher serum insulin concentrations.

3- This effect is most prominent if the injection was recent, was given into an arm or leg that is being exercised or was inadvertently given intramuscularly

in contrast, exercise can cause a paradoxical elevation in blood glucose concentrations in diabetic patients with poor metabolic control (blood glucose concentration above 250 mg/dL ,hypoinsulinemia, and some ketonuria.

In these patients, the following factors come into play: -The lack of insulin impairs glucose uptake by muscles and

cannot prevent an increase in hepatic glucose output that is mediated by counterregulatory hormones, particularly epinephrine, cortisol, and growth hormone.

These hormonal changes also lead sequentially to increased lipolysis and enhanced conversion of the free fatty acids to ketones

Recommendations People with diabetes should be advised

to perform at least 150 min/week of

moderate-intensity aerobic physical activity

(50–70% of maximum heart rate).

In the absence of contraindications,

people with type 2 diabetes should be

encouraged to perform resistance training

three times per week

Exercise is an important part of the diabetes management plan.

Regular exercise has been shown to improve blood glucose control, reduce cardiovascular risk factors, contribute to weight loss, and improve well-being.

Regular exercise may prevent type 2 diabetes in high-risk individuals

Structured exercise interventions of at least 8 weeks’→ lower A1C by an average of 0.66% in people with type 2 diabetes, even with no significant change in BMI

Higher levels of exercise intensity are associated with greater improvements in A1C and in fitness

suggest that adults over age 18 years do 150 min/week of moderate-intensity, or 75 min/week of vigorous aerobic physical activity, or an equivalent combination of the two.

the guidelines suggest that adults also do muscle-strengthening activities that involve all major muscle groups two or more days per week.

The guidelines suggest that adults over age 65 years, or those with disabilities, follow the adult guidelines if possible or (if this is not possible) be as physically active as they are able.

Studies included in the metaanalysis of effects of exercise interventions on glycemic control (146) had a mean number of sessions per week of 3.4, with a mean of 49 min/session

Progressive resistance exercise improves

insulin sensitivity in older men with type 2 diabetes to the same or even a greater extent as aerobic exercise

for an additive benefit of combined aerobic and resistance exercise in adults with type 2 diabetes

Evaluation of the diabetic patient before recommending an exercise program

Prior guidelines suggested that before recommending a program of physical activity, the provider should assess patients with multiple cardiovascular risk factors for coronary artery disease (CAD).

Coronary heart disease screening and treatment, the area of screening asymptomatic diabetic patients for CAD remains unclear, and a recent ADA consensus statement on this

issue concluded that routine screening is not recommended

High risk patients should be encouraged to start with short periods of

low intensity exercise and increase the intensity and duration slowly.

patients for conditions that might contraindicate certain types of exercise or predispose to injury,

such as uncontrolled hypertension, severe autonomic neuropathy, severe peripheral

neuropathy or history of foot lesions, and unstable proliferative retinopathy.

The patient’s age and previous physical activity level should be considered.

Exercise in the presence ofnonoptimal glycemic controlHyperglycemia.Hyperglycemia.

vigorous activity should be avoided in the presence of ketosis

Hypoglycemia. In individuals taking insulin and/or insulin secretagogues, physical activity can cause hypoglycemia if medication dose or carbohydrate consumption is not altered. For individuals

Carbohydrate should be ingested if pre-exercise glucose levels are 100 mg/dl (5.6 mmol/l).

Exercise in the presence of specificlong-term complications of diabetesRetinopathy.

In the presence of proliferative diabetic retinopathy (PDR) or severe nonproliferative diabetic retinopathy (NPDR), vigorous aerobic or resistance exercise may be contraindicated because of the risk of triggering vitreous hemorrhage or retinal detachment

Peripheral neuropathy

Decreased pain sensation in the extremities results increased risk of skin breakdown and infection and of Charcot joint destruction.

Prior recommendations have advised non–weight-bearing exercise for patients with severe peripheral neuropathy.

However, studies have shown that moderateintensity

walking may not lead to increased risk of foot ulcers or reulceration in those with peripheral neuropathy

Peripheral neuropathy

All individuals with peripheral neuropathy should wear proper footwear and examine their feet daily to detect lesions early. Anyone with a foot injury or open sore should be restricted to non–weight-bearing activities.

Autonomic neuropathy

Autonomic neuropathy can increase the risk of exercise induced injury or adverse event through decreased cardiac responsiveness to exercise, postural hypotension, impaired thermoregulation, impaired night vision due to impaired papillary reaction, and unpredictable carbohydrate delivery from gastroparesis predisposing to hypoglycemia

People with diabetic autonomic neuropathy should undergo cardiac investigation before beginning physical activity more intense than that to which they are accustomed.

Albuminuria and nephropathy.

Physical activity can acutely increase urinary protein excretion. However, there is no evidence that vigorous exercise increases the rate of progression of diabetic kidney disease, and there is likely no need for any specific exercise restrictions for people with diabetic kidney disease

What Is Happening to?

She takes insulin and is walking briskly in her neighborhood in the late afternoon. She becomes shaky, is unable to think clearly, and has changes in her vision.

What should Sandra do?

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

Physical Activity and Hypoglycemia

More common after physical activity

Body is replenishing stored carbohydrate (glycogen)

Check your blood glucose after you exercise

How Can Sandra 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

Carbohydrate Snacks for Physical Activity

Intensity Time (minutes)

Carbohydrate

Mild Less than 30 May not be needed

Moderate 30-60 15 grams

High Over 60 30-50 grams

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

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

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

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

Exercising with Nephropathy (kidney disease)

Caution Strenuous activity

Choose Light to moderate

activity like walking, light housework, gardening, water exercise

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

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

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

Exercise Safely

Wear diabetes identification Include warm-up and cool-down

sessions Drink plenty of fluid

Documents

Physical Activity and Diabetes. Physical Activity Is Like Magic for Type 2 Diabetes