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Physical Activity and Diabetes


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Title: Physical Activity and Diabetes

Physical Activity and Diabetes
Physical Activity Is Like Magic for Type 2
What Can Physical Activity Do For You?
  • Give the patient more energy

What Can Physical Activity Do For You?
  • Help us lose weight and keep it off

What Can Physical Activity Do For You?
  • Increase flexibility and strength
  • Slow bone loss
  • Provide better quality of life

What Can Physical Activity Do For You?
  • Build muscle

What Can Physical Activity Do For You?
  • Lift your mood
  • Treat depression

What Can Physical Activity Do For You?
  • Reduce stress and anxiety

What Can Physical Activity Do For You?
  • 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

What Can Physical Activity Do For You?
  • Keep your heart healthy
  • Strengthening heart muscle
  • Lowering resting heart rate
  • Lowering blood pressure
  • Improving cholesterol
  • Reducing risk of heart attack and stroke

We now must plan physical activity into our
Getting Started
  • Check with your doctor if you
  • Are over age 35
  • Have had diabetes more than 10 years
  • Have 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 strength
  • prevent falls
  • increase mobility
  • improve blood glucose control

  • 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 medication
  • when and how much you ate last
  • your physical fitness
  • type 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
  • 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
  • Physical activity can raise your blood glucose
  • your BG is gt250 mg/dl before your exercise and
    you have ketones
  • youre starting a new vigorous exercise program

Physical Activity and Low Blood Glucose
  • Low blood glucose can result from exercise only
    if you take
  • insulin
  • oral 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

  • 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

  • People with diabetes should be advised
  • to perform at least 150 min/week of
  • moderate-intensity aerobic physical activity
  • (5070 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
  • 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
  • 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

  • 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
  • such as uncontrolled hypertension, severe
    autonomic neuropathy, severe peripheral
  • neuropathy or history of foot lesions, and
    unstable proliferative retinopathy.
  • The patients age and previous physical activity
    level should be considered.

Exercise in the presence ofnonoptimal glycemic
  • 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
  • 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
    nonweight-bearing exercise for patients with
    severe peripheral neuropathy.
  • However, studies have shown that
  • walking may not lead to increased risk of foot
    ulcers or reulceration in those with peripheral

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
    nonweight-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

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

Check your blood glucose after you exercise
How Can Sandra Prevent Low Blood Glucose Next
  • 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
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
  • Dont 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
  • 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 dont 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
  • Dont 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