PET4551 Exam III Type I Diabetes Insulin Dependent Diabetes Mellitus IDDM An autoimmune disease affecting the beta cells of the islet of Langerhorns in which the body does not produce insulin occurring in children and young adults these individuals require regular insulin injections to stay alive Comprises 5 10 of all diatebes Type II Diabetes Non Insulin Dependent Diabetes Mellitus NIDDM A metabolic disease in which the body cannot make enough insufficiency or properly use insensitivity insulin many times the liver cells no longer responds to insulin so the body goes into overdrive trying to provide the much needed insulin and eventually shut down production in which case insulin injections are needed Comprises 90 95 of all diabetics Blood vessel damage in the feet may cause tissue damage such as sores or lesions poor circulation that can lead to amputation Renal Disease can occur dialysis at least two times a week to get blood removed cleansed put back because kidneys cannot function properly Gum disease prevalent in uncontrolled diabetics Goal for diabetic management is glycemic control using diet exercise medications such as insulin and hypoglycemic agents Tests to determine Diabetes 1 Fasting blood glucose 2 Oral glucose tolerance 3 Glycosylated hemoglobin HbA1C 2 3 months measurement of glucose status a Goal 7 Benefits of Exercise Conditioning Improvement in blood glucose control one bout of exercise can help glucose control for 24 48 hours Improvement in insulin sensitivity Reduction in medication requirements Reduction in body fat Improvement in physical fitness Reduction in coronary artery disease Reduction in blood pressure Reduction in triglycerides cholesterol Reduction in stress and improvement in self esteem Improvement in walking ability and functionality Structured Guidelines for Aerobic Exercise in the Diabetic Patient Intensity 60 75 of heart rate max 220 age RPE 12 16 Frequency daily or at least 4 days week Duration 20 60 minutes Best if activity can be quantified in energy expenditure kcal Activities a person enjoys such as walking cycling swimming ect No more than two days of consecutive physical inactivity should be allowed Special Precautions when Exercising Individuals with fasting plasma glucose over 250 mg dl should not exercise Make sure to have adequate fluid replacement Proper footwear and foot hygiene keep feet dry polyester or blend socks cycling Strenuous exercise needs to be avoided until diabetes is controlled may be better for some Slow and gradual process Proper warm up and cool down Try to exercise with a buddy Exercising at night is not recommended because the possibility of delayed hypoglycemia when sleeping is higher Special Precautions to Prevent Exercise Induced Hypoglycemia 70 mg dl Maintain consistency in life habits Careful self monitoring of blood glucose before and after exercise especially when Use abdominal site for injection of insulin other than extremities involved in changing prescriptions exercise Avoid exercising after insulin injection Exercise after a light meal or snack Have carbohydrate available while exercising 10 to 15 grams of carbohydrate for every 30 minutes of exercise Inform others of diabetic condition and wear medical bracelet Stop exercising if hypoglycemic and have a carbohydrate meal What is moderate physical activity Activity that burns roughly 150 kcal day or 1 000 kcal wk o Gardening for 30 45 minutes o Raking leaves for 30 minutes o Stair walking for 15 minutes o Walking two miles in 30 minutes o Pushing stroller 1 5 miles for 30 minutes Studies of Exercise Effects on Pregnancy Decrease in gestation length 40 weeks o Babies still healthy Decrease in maternal weight gain Decrease in birth weight Pain perception and stress may be reduced due to increase in beta endorphins No effect on course of labor or delivery dilation and body s preparedness is about the same as sedentary women Some show faster recovery time Physiological Changes That Occur During Pregnancy Increase in cardiac output by 30 50 Increase in resting heart rate by 16 b min Increase plasma volume going to need will have more blood flow Increase in oxygen consumption Redistribution of blood flow to uterus kidneys breasts skin Increase in peripheral venous compliance Increase in body mass Increase in ventilation Increase in metabolic rate Increase in heat production Increase in demands for energy substrate 500 1 000 kcals o Putting in good calories and being careful Exercise Precautions Proper footwear and supportive bra Proper nutrition with adequate calories and hydration Contact sports are not recommended Maternal core temperate should not exceed 101 F or 38 3 C The American College of Obstetricians and Gynecologists caution against heart rates Should avoid hot tubs and saunas over 140 b min Exercise activity should by discontinued if any unusual symptoms occur Concerns Related to Exercise During Pregnancy Decreased uterine blood flow could compromise fetal blood flow Fetal hyperthermia the baby will react more extremely than the mother Utero placental oxygen insufficiency Maternal or fetal hypoglycemia Increase risk of injury joint laxity is a major concern Prenatal Workout 5 to 10 minute warm up 15 to 30 minute low impact aerobics Careful heart rate monitoring Cool down with gentle stretching Workout components should include aerobics toning flexibility specific prenatal exercises and relaxation and breathing techniques Regular exercise at least 3 times week Age 20 20 29 30 39 40 Heart Rate Range Heart Rate 140 155 135 150 130 145 125 140 Examples of Some Exercises Upper back shoulder shrugs o Promotion of good posture Lower back pelvic tilts o Prevent low back pain strengthen muscles for labor and delivery o Promotion of bladder control prevention of urinary incontinence o Promotion of good posture Abdomen curl ups Pelvic floor kegels Upper body Lower body o Improve upper body strength o Improve lower body strength prevention of varicose veins Safety Considerations Obtain medical clearance Non weight bearing exercises are best such as cycling and swimming Avoid strenuous exercise during first trimester Should not increase exercise intensity or duration not a time to get in shape Avoid exercising in the supine position particularly in late gestation not recommended after four months of gestation Avoid exercise in hot environments and in hyperbaric environments Avoid Valsalva maneuver Make sure well hydrated Avoid ballistic movements and
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