Burn that Sugar Get Moving - Diabetes Education Services › wp-content › uploads › 2017 › 09...

Diabetes Education Services© www.DiabetesEd.net

Burn that Sugar

Get Moving

Beverly Dyck Thomassian, RN, MPH, BC-ADM, CDEPresident, Diabetes Education Services

Objectives

� Current state of exercise in

U.S.

� Benefits of exercise

� Re-igniting or finding the

spark

� Teaching strengthening

exercises

� Listening to the exercise

story

How most people regard exercise

Rabbits jump and they live for 8 years

Dogs run and live for 15 years

Turtles do nothing and live for 150 years

Lesson learned

www.facebook.com/humormeetscomic2


Quick Quiz

How many steps do Americans walk on average

a day?

A. 8,000 to 10, 000 steps

B. Less than 3000 steps

C. About 5000 steps

D. More than 10, 000 steps

Exercise Stats

� 75% of adults said being in shape and looking good are important

� 31% make exercise a regular habit

� Average walking steps per day4,700 (little over 2 miles)

� 20% of American meet the 150 min/week target

www.stateofobesity.org

Quick Quiz

How many hours a day do kids spend in front of

a screen?

A. About 3 hours

B. 5 hours a day

C. 7 hours a day

D. The number is on the decline


Physical Activity Stats – Kids

� 1 in 3 children are physically active

� 80% of kids do NOT meet aerobic, muscle-strengthening activities guidelines

� Children spend 7+ hrs a day in front of a screen

� 20% of homes have parks or recreation centers w/in ½ mile

� Only 6 states (Illinois, Hawaii, Massachusetts,

Mississippi, New York and Vermont) require PE President's Council on Fitness, Sports & Nutrition –www.HHS.gov 2013

Environment Influences Activity


Quick Quiz

What is the most active state in the country?

A. Colorado

B. Oregon

C. California

D. New Mexico

www.stateofobesity.org

Current State of InActivity

� Average sitting time a day –

“Sitting Disease”

� 10 hours a day (office

worker)

� Goal – stand up at work

for at least 2 hours a day,

then work up to light

activity 4 hours a day

� Metabolism slows down 90%

after 30 min sitting – just

getting up for 5mins helps

� WHO estimates 95% of

the world’s adult

population does NOT

meet target of 30mins

activity a day


Sitting Disease leads to

� 2xs risk of diabetes

� 15% increased risk of

cardiovascular disease


cancer


dying

Body Image and Keeping Healthy

� Body dissatisfaction is not the best motivator.� If that is motivator, most people

won’t stick with it.

�Keeping healthy is the BEST motivation� Better chance of sticking with it

� Poor body image can keep people from exercising, especially women

People are more likely to keep active

� Motivated by keeping healthy

� Benefits are beyond physical

� Host of psychological benefits� More energized

� Less stressed

� Encourage exercise to promote well being

� These effects keep people on track


A hard truth

� Exercise alone doesn’t cause weight loss

� But….� It helps keep weight off

� Decreases visceral fat

� Decreases CV Risk

� To combat obesity, we need to change the food environment

� “You cannot outrun a bad diet”.

Definitions

� Sedentary behavior� Little on no movement or physical activity

� Physical activity� Bodily movement produced by the

contraction of skeletal muscle that requires more energy than when resting

� Exercise� Subset of physical activity that is planned,

structured and includes repetitive body movements

� Performed to improve or maintain physical fitness

Where are (you) your patients on

this continuum?


After dinner stroll “Passegiatta”

� Walk 10-15 minutes after

dinner (and other meals if

possible)

� Maximize the walking benefit

� Get the most BG lowering

effect

� Especially after high carb meals

Diabetologia, Oct 2016.

Each minute of activity lowers

BG by 1 point

� Each minute of exercise lowers BG 1 point

� 15 minutes of walking drops BG 15 points

� 30 minutes of biking drops BG 30 points

� 40 minutes of housework drops BG 40 points

� 50 minutes of walking and window shopping lowers

BG 50 points

Good Exercise Info / Quotes

� “Passagiata” –

take an after meal

stroll

� Exercise decreases A1c 0.7%

� No change in body wt, but 48% loss in visceral fat

� ADA PostGrad 2010

“Every minute of

activity lowers blood

sugar one point.”

“I don’t have time to

exercise, I MAKE

time.” Mike Huckabee


What Medication works best to

prevent and treat type 2 Diabetes?

This medication has been around since beginning of time, but lost popularity due to new life styles, technology and public transportation.

Major side effects: sore muscles, improved energy, less depression, increased strength and balance.

Main action: improved insulin sensitivity and one dose can lower blood glucose for up to 48 hours.

Dosing: Patients can use treatment on most days with instruction to gradually increase dose as tolerated.

What Medication works best to

prevent and treat type 2 Diabetes?

Cost: Free with or without a prescription. Actually, due to its effect on blood pressure and lipid reduction, it may end up saving money as the need for other medications diminishes.

Safety: Safe and effective for those at risk for diabetes and those diagnosed with diabetes.

Availability: Generic - Walking 30 minutes on most days. Designer brands: Dancing, Water Aerobics, Juggling, Gardening, Shopping ++

Benefits of Exercise and Diabetes

� Increase muscle glucose uptake 5-fold

� Glucose uptake remains elevated for 24 - 48 hours (depending on exercise duration)

� Increases insulin sensitivity in muscle, fat, liver.

� Reduce CV Risk factors (BP, cholesterol, A1c)

� Maintain wt loss

� Contribute to well being

� Muscle strength

� Better physical mobility


Exercise decreases:

� Sleep apnea

� Diabetic kidney disease, retinopathy

� Depression

� Sexual dysfunction

� Urinary incontinence

� Knee pain

� Need for medications

� Health care costs

Importance of Exercise with Diabetes

� Vital component of prevention as well of the management of type 2 diabetes

� Greatest impact in improving metabolic abnormalities when started early (prediabetes, diabetes)

� Type 1 – emphasis on adjusting insulin to allow for safe participation in all forms of activity.

Exercise Standards

� Adults – 150 min/wk moderate

intensity

� over 3 days a week.

� Don’t miss > 2 consecutive days w/out

exercise

� Get up every 30 mins - Reduce

sedentary time

� T1 and T2 – resistance training 2 -3 xs

a week

� Flexibility and balance training 2-3 xs

a week (Yoga and Tai Chi)


Physical Activity - Kids� Children should be

encouraged to engage

in at least 60 minutes

of moderate/vigorous

physical activity a day.

� Plus bone/muscle

strengthening 3 times

a week

Best Shake For People with Diabetes

From Debbie Nagata’s slide collection

Progressive Resistance exercise

� Improves insulin sensitivity

� Goal is 2 sessions a week

� Examples include:

� Exercise with free weights, wt

machines, resistance bands

� Each session consisting of

least:

� One set of five or more resistance

exercises using large muscle groups


Resistance Training Guidelines

General Rules of Thumb

� Perform 2-3 Sets of 8-12 Repetitions, 2-3 Days a week

� If it hurts, stop. Talk to a physical therapist.

� If difficulty with balance, use a chair to stabilize

� Start slow with eventual goal of moderate intensity

� The last few repetitions should be slightly difficult

� Have fun

Squats


Chicken wing

Flat Back Half Lift

Overhead punch


curls

standing Half

Lift

Tricep challenge


Quick Question

� Which of the following is an accurate exercise recommendations for people with diabetes?

� a. Exercise must be done daily for 30 mins to be effective

b. Must get stress test before starting an exercise program

c. Try not to miss more than 2 consecutive days of exercise

d. Incorporate resistance training 2 days a week

E. C and D

When to Consider Stress TestingPre-exercise medical clearance isgenerally unnecessary for asymptomaticindividuals prior to beginninglow- or moderate-intensityphysical activity not exceeding thedemands of brisk walking or everydayliving.


Pre-exercise evaluation T2� In asymptomatic pts, routine

screening for CAD is not recommended.� Does not improve outcome as long as CVD

risk factors are treated.

� Assess CV risk factors annually� Dyslipidemia, HTN, smoking, positive

family history of premature coronary disease, and + albuminuria

� Candidates for advanced or invasive cardiac testing include:� Typical or atypical cardiac symptoms

� Abnormal resting ECG

Patients to discuss symptoms with provider

before starting exercise

� Chest pain and/or shortness of

breath

� Leg cramps that go away with rest

� Head, shoulder, neck and or back

aches.

� Any unexplained pain above the belt

line should be considered cardiac in

origin until proven otherwise.

Quick Question

� What are some exercise precautions

for people with diabetes? (multiple)

a. Carry some for of ID on you at all times

b. Always have a snack if BG <100

c. Look for signs of hypo for up to 24 hrs

after exercise

d. Carry a snack with you during exercise.

e. Let someone know your route


Hypoglycemia Prevention Strategies

for Patients on Insulin/Secretagogues

� Carry carb snack

� Extra Carb in post exercise period

� Caution with alcohol post exercise

� Adjust carbohydrate prior to

planned activity:

� If using insulin and /or secretagogues

� BG < 90, consume 15 -30 gms

� BG 90-150, may need ~ 15gms(see ADA Exercise Position Statement, pg 2068)

Duration of Hypoglycemia Risk

� During exercise

� Immediately after exercise

� Post exercise late onset hypo

� More often in type 1

� More often at night

� Moderate to high intensity exercise

> 30 min

� 4 to 15 hours following an exercise

session

Hypoglycemia Prevention Strategies

� If planned activity, adjust insulin

in anticipation of activities

� Reduce insulin in post exercise

period

� Frequent monitoring in post

exercise period

� Pt to keep log to determine how

responds to different activities,

duration and intensity.


How Exercise Saved my Life

� A brief testimonial by Beverly

Dancing offers special benefits� Offers physical and

cognitive stimulation

� Improves

neuroplasticity

� Mentally stimulating

� Reduce onset of

dementia

� Increase chances of

winning a Nobel Prize


Exercise is best insurance policy� People who are active and

exercised regularly before their stroke were less likely to face disability after the attack, researchers say.

� “Body mass index was not a factor in predicting their level of disability after stroke”

� The research "provides additional evidence that regular exercise has health benefits that last into a person's future"

Andrew Rogove, M.D. Neurology, news release, April 5, 2017

Tips for Educators� Avoid use of the word,

“exercise”

� Help person identify how to get more active within the construct of their life

� Find a friend, a class, a gym

� Most popular activity (40%) training at a fitness center

� 30% jog, swim or play basketball

� 21% took yoga classes

� Do things that you enjoy

� Focus on your personal strengths

Behavior Change Strategies

� Five key techniques for success:

1. Prompt focus on past success

2. Barrier identification/problem-solving

3. Use of follow-up prompts

4. Provision of information on where & when to perform the behavior

5. Prompt review of behavioral goals.


Take Home Messages

� Make time for what’s really important

� Start your bucket list today

� Take risks

� Share your truth

� Walk into fear

� Do what you love

� Have fun

� Dance with your sword on

Thank You� Questions?

� Email [email protected]

� www.diabetesed.net

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