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Type I Diabetes

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Boxing Heavy competitive sports. 2-4 months (may require laser surgery) PDR ... Intermediate-acting insulin decrease by 30-35% on the day of exercise ... – PowerPoint PPT presentation

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Title: Type I Diabetes


1
Type I Diabetes
  • Kris Hinnerichs

2
Diabetes Mellitus
  • A condition where the body is no longer able to
    control the glucose levels in the blood stream
  • 16 mill. cases in the United States
  • 5-10 of those cases are type I
  • Half of these cases are under age 20

3
Physiology
  • Endocrine is Greek
  • Endo within
  • Krino to separate
  • Intercellular chemical signals are produced
    within and secreted from endocrine glands, but
    have an effect away from the gland
  • Only effects target cells

4
Negative Feedback
  • Homeostasis of blood glucose levels
  • Blood glucose levels increase after a meal ?
    Insulin is secreted
  • Insulin causes tissues to take up glucose ? blood
    glucose levels decline
  • Rate of insulin secretion declines too ? rate of
    blood glucose uptake decreases

5
Endocrine Part of Pancreas
  • Pancreatic islets (islets of Langerhans)
    dispersed among exocrine portion
  • Beta cells secrete insulin
  • Alpha cells secrete glucagon
  • Both work to regulate blood nutrient levels

6
Low Blood Glucose Levels
  • Nervous system malfunctions
  • Fats and proteins are broken down causing
    ketoacidosis
  • pH drops
  • Ketones enter the blood stream
  • Amino acids are broken down and used to
    synthesize glucose by the liver

7
High Blood Glucose Levels
  • Kidneys produce large volumes of urine
  • Urine is high in glucose molecules
  • Frequent urination can lead to dehydration

8
Insulin Secretion
  • Increase
  • Elevated blood glucose levels
  • Parasympathetic stimulation / digestion
  • Blood levels of certain amino acids
  • Decrease
  • Decreased blood glucose levels
  • Sympathetic stimulation / exercise

9
Target Cells / Tissues
  • Liver
  • Adipose tissues
  • Muscles
  • Satiety center of hypothalamus
  • Glucose is converted to glycogen or fat, and the
    amino acids are used to synthesize protein

10
Glucagon
  • Released from alpha cells when blood glucose
    levels are low
  • Bind to membrane-bound receptors in the liver to
    cause the conversion of glycogen stored in the
    liver to glucose
  • Glucose is then released into the blood to
    increase blood glucose levels

11
Effects of Insulin and Glucagon on Target Tissues
12
Blood Glucose-Raising Hormones During Exercise
13
Pathophysiology
  • Diabetes mellitus is characterized by glucose
    concentrations in the blood that are high enough
    to overwhelm the reabsorption capabilities of the
    kidneys
  • Glycosuriaglucose in urine
  • Polyuriaexcessive urine production
  • Other metabolic products are present in abnormal
    concentrations

14
Causes
  • Researchers are uncertain of causes
  • Possibilities
  • Genetic abnormalities
  • Pathological conditions
  • Injuries
  • Immune disorders
  • Hormonal imbalances
  • Secretion of too little insulin
  • Insufficient numbers of insulin receptors
  • Defective receptors

15
Without Insulin
  • Cells cannot absorb glucose
  • After meals, blood concentrations become so
    elevated that the kidneys cannot reclaim all the
    glucose
  • High urinary concentrations of glucose limit
    ability to conserve water
  • High urinary concentrations of glucose cause
    frequent urination and possible dehydration

16
Without insulin
  • Chronic dehydration can cause neural function and
    muscle weakness
  • Satiety center of brain responds with an
    exaggerated appetite
  • Endocrine tissues respond with more glucose
  • Ketoacidosis results

17
Long Term Therapy
  • Dietary control and insulin
  • Complications
  • Tissue glucose demands cycle
  • Meals
  • Physical activity
  • Emotional state
  • Stress
  • Other unpredictable factors

18
Diabetic Coma
  • Causeloss of NA, K, and ketone bodies through
    excessive urination
  • S/Slabored breathing, gasping for air, fruity
    smelling breath, nausea, vomiting, thirst,
    flushed skin, confusion, unconsciousness
  • Careearly detection of ketoacidosis, injection
    of insulin

19
Insulin Shock
  • Causetoo much insulin in the body results in
    hypoglycemia
  • S/Stingling sensations, physical weakness,
    headaches, abdominal pain, rapid HR, tremors,
    drowsiness
  • Careadhere to a carefully planned diet with a
    snack before activity, keep a sugar source
    available

20
Pharmacology
  • Insulin is the main drug
  • Insulin is a protein hormone and must be injected
  • Refer to charts in handout

21
Exercise and Type I Diabetes
  • Controversial
  • Does not improve glycemic control
  • Reduce the risk of complications due to diabetes
  • Before beginning any program, make sure to
    undergo a medical evaluation
  • Macrovascular complications
  • Microvascular complications

22
Cardiovascular System
  • A graded exercise test may be helpful
  • Age gt 35
  • Type I diabetes of gt 15 years
  • Presence of any additional risk factors for
    coronary artery disease
  • Presence of microvascular disease
  • Peripheral vascular disease
  • Autonomic neuropathy

23
PAD
  • Peripheral Arterial Disease
  • Evaluation is based on signs and symptoms
  • Intermittent claudication
  • Cold feet
  • Decreased or absent pulses
  • Atrophy of subcutaneous tissues
  • Hair loss

24
Retinopathy
  • The eye examination schedule should follow the
    ADAs Clinical Practice Guidelines
  • See chart
  • Those with proliferative diabetic retinopathy
    should avoid strenuous exercise
  • Anaerobic exercise
  • Exercise involving straining, jarring, or
    Valsalva-like maneuvers

25
Retinopathy
Considerations for Activity Limitation in
Diabetic Retinopathy (DR)
         NPDR nonproliferative diabetic
retinopathy          PDR Proliferative
diabetic retinopathy
26
Nephropathy
  • Specific exercise recommendations have not been
    developed for patients with incipient or overt
    nephropathy
  • High-intensity or strenuous exercise should be
    avoided

27
Peripheral Neuropathy
  • Loss of sensation in the feet
  • Limits weight-bearing exercises

Recommended Swimming Bicycling Rowing Chair
exercises Arm exercises Other non-weight bearing
exercises
Contraindicated Treadmill Prolonged
walking Jogging Step exercises
28
Autonomic Neuropathy
  • Cardiac Autonomic Neuropathy
  • Resting tachycardia
  • Orthostasis (fall in SBP gt20 mmHg upon standing)
  • Other disturbances in autonomic nervous system
    function involving the skin, pupils, GI, or
    genitourinary systems
  • Sudden death
  • Silent myocardial ischemia
  • Hypo/hypertension after vigorous exercise
  • Difficulty with thermoregulation

29
Effects of Diabetic Autonomic Neuropathy on
Exercise
  • Silent myocardial ischemia
  • Resting tachycardia and decreased maximal
    responsiveness
  • Decreased heart-rate variability
  • Orthostasis/hypotension with exercise
  • Exaggerated blood pressure responses with supine
    position and exercise
  • Loss of diuranal blood pressure variation

30
Effects of Diabetic Autonomic Neuropathy on
Exercise
  • Cardiovascular and cardiorespiratory instability
  • Abnormal systolic ejection fractions at
    rest/exercise
  • Poor exercise tolerance
  • Failure of pupil adaption to darkness
  • Gastroparesis and diabetic diarrhea
  • Hypoglycemia
  • Decreased hypoglycemia awareness

31
Effects of Diabetic Autonomic Neuropathy on
Exercise
  • Hypoglycemia unresponsiveness
  • Heat intolerance due to defective sympathetic
    thermoregulation and sweating
  • Susceptibility to foot ulcers and limb loss due
    to disordered regulation of cutaneous blood flow
  • Incontinence

32
Exercise Precautions
  • Postpone exercise if blood glucose gt300mg/dL or
    gt240 mg/dL with urinary ketone bodies
  • Especially when beginning a program, monitor
    blood glucose before, during, and after exercise
    if taking insulin or oral agents
  • Adjustments in carbohydrate intake and/or insulin
    may be needed before testing and training ingest
    carbohydrate if blood glucose is lt80-100 mg/dL

33
Exercise Precautions
  • Select proper footwear and follow appropriate
    foot care steps to prevent ulcerations and other
    lesions of the foot
  • Wear shoes with silica gel or air mid-soles
  • Wear polyester or blend (cotton/polyester) socks
    to prevent blisters
  • Keep the feet dry
  • Ensure proper fitting footwear

34
Exercise Precautions
  • Wear a diabetes identification bracelet or shoe
    tag when exercising, and it should be clearly
    visible at all times
  • Avoid extremely hot or cold environments
  • Maintain proper hydration before, during, and
    after exercise

35
Exercise Precautions
  • High resistance exercise using weights are not
    acceptable for older individuals or those with
    long standing diabetes
  • Moderate weight training programs that utilize
    light weights and high repetitions can be used
    for all patients with diabetes

36
Guidelines for Avoiding Hypoglycemia
  • Consume carbohydrates (15-30 g) for every 30
    minutes of moderate-intensity exercise
  • Consume a snack of slowly absorbed carbohydrate
    following prolonged exercise sessions
  • Avoid exercising muscle that underlies the
    injection site of short-acting insulin for 1 hour
  • Avoid late evening exercise

37
Guidelines for Avoiding Hypoglycemia
  • Decrease the insulin does
  • Intermediate-acting insulindecrease by 30-35 on
    the day of exercise
  • Intermediate- and short-acting insulinomit the
    dose of short-acting insulin that precedes
    exercise
  • Multiple doses of short-acting insulinreduce the
    dose prior to exercise by 30-50 and supplement
    carbohydrates
  • Continuous subcutaneous infusioneliminate the
    mealtime bolus or increment that precedes or
    immediately follows exercise

38
Common Hypoglycemic Symptoms During Exercise
  • Double or blurred vision
  • Abnormally elevated pulse
  • Fatigue
  • Hand tremors / shakiness
  • Headache
  • Mental confusion
  • Poor physical coordination
  • Tingling of hands or tongue
  • Visual spots
  • Weakness

39
Refer to Charts
  • Factors affecting blood glucose management for
    acute and chronic exercise
  • Cardiopulmonary response to symptom-limited
    graded exercise in diabetics and controls
  • General Carbohydrate Increases for Endurance
    Activities

40
Preparing for Exercise
  • Proper warm-up of 5-10 minutes of aerobic
    activity at a low intensity level
  • Stretch for 5-10 minutes, primarily focusing on
    muscles that will be used during the exercise
    session
  • Cool down after the exercise session, taking
    about 5-10 minutes to gradually bring the heart
    rate down to its preexercise level

41
Exercise Prescription
  • Frequency 4-6 days per week or daily at low to
    moderate intensity
  • Duration 20-60 minutes per session
  • Intensity 50-85 VO2max
  • May need to use perceived exertion as an adjunct
    to heart rate for monitoring exercise intensity.
  • Exercising late in the evening increases risk of
    nocturnal hypoglycemia
  • Exercise caution when exercising in hot weather
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