Exercise for a Diabetic Patient

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Exercise for a Diabetic Patient

• by
• Christina Mooney

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Diabetes Mellitus

• First described in India in 400 B.C.
• Interference with insulin production or insulin
  resistance
• Neuropathy
• Foot care

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Diabetes Mellitus (cont.)

• Type I
• Insulin-dependent-diabetes mellitus
• Type II
• Non insulin-dependent diabetes mellitus

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Diabetes Prevalence

• Increased in inactive societies
• 16 million Americans (6.5)

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Effects of exercise on Diabetes

• Initial lowering blood glucose levels
• increase in blood glucagons levels if exercise is
  prolonged or if stress hormones are released
• increase sensitivity of insulin receptors to
  decreased amounts of insulin for many hours - 2
  days
• Improvements in BG control for Type II and less
  so in Type I

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Benefits of Exercise

• Improvements in
• Skeletal muscle mass
• Blood supply
• Cardiovascular fitness
• Peripheral insulin sensitivity
• Weight control
• Psychological well-being
• Improve quality of life
• Decrease in insulin requirements for Type II

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Risk

• Injury (increased recovery time)
• Pre-existing complications
• proliferative retinopathy
• Foot problems
• Hyperglycemia
• Hypoglycemia

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Risk (cont.)

• Hyperglycemia
• Flushed dry skin
• Fruity breath
• Low BP
• Increase Pulse
• Confused
• Increase thirst

• Hypoglycemia
• Weakness
• Sweaty skin
• Rapid heartbeat
• Feeling shaky
• Dizzy
• hunger

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Hyperglycemic Prevention

• exercise not recommended if BG 240 mg/dL

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Hypoglycemia Prevention

• Insulin needs to be taken in abdomen
• Do not take insulin in extremity 1 hour prior to
  exercise
• Decrease insulin dosage or increase food intake
• Avoid exercising at peek insulin levels

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Hypoglycemia Prevention (cont.)

• Test Blood Glucose levels prior to and during
  exercise
• Eat carbohydrate if BG
• Eat before, during and after exercise
• Do not exercise in the evening
• Increase nocturnal hypoglycemia

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Exercise Testing

• Required physicians approval
• BG under good control
• Healthy feet
• Required exercise stress test rule out
  cardiovascular complication with ECG
• 35 years old

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Exercise Recommendations

• Types that require glucose and oxygen
• Increase HR and BP (unless proliferative
  retinopathy present)
• Consistent routine of exercise, eating and
  medication administration
• Carrying exercise kit

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Exercises not recommended

• High impact Exercises that cause jarring
• High intensity for prolonged time
• Contact sports

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Exercise Goals

• Increase control of BG levels
• Increase blood circulation
• Weight loss for Type II

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Exercise Prescription

• Low-intensity, long-duration (weight loss)
• Endurance
• 50-60 VO2 max
• Work up to 60-70 VO2 max
• 4-6 days/week (daily if low to moderate
  intensity)
• 20-30 min Type I
• 40-60 min Type II

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References

• Balady, G.J., et al., (2000) ACSM Guidelines for
  Exercise Testing and Prescription 6th ed. New
  York Wolters Kluwer
• Campaigne, B. N., (1994), Exercise in the
  Clinical Management of Diabetes. Champaign Human
  Kinetics
• Cotton, R. T., (1998), Exercise for Older Adults.
  San Diego American Council on Exercise
• Gordon, G. F., (1993) Diabetes, Your complete
  Exercise Guide. Dallas Human Kinetics Publishers
• International Diabetes Center Safe and Healthy
  Exercise for People with Diabetes 2001, ISBN
  1-885115-58-x
• McMurray, R. G., (1999), Concepts in Fitness
  Programming. New York CRC Press
• Roberts, S., Robergs, R., and Hanson, P., (1997).
  Clinical Exercise Testing and Prescription
  Theory and Application. New York, CRC Press,
• Roitman, J. L. (ed)., (1998), ACSMs Resource
  Manual for Guidelines for Exercise Testing and
  Prescription. (3rd ed). New York Lippincott
  Williams Wilkins
• Skinner, J. S., (1993), Exercise Testing and
  Exercise Prescription for Special Cases.
  Baltimore Williams Wilkins