Diabetes Mellitus and Physical Therapy

EXERCISE & DIABETES MELLITUS

Presentation By:Deepanjali Sharma

&Adil Ali

- Jamia Hamdard University

“..In some people suffering from this affliction, exercise can improve the condition and should be done regularly. In more extreme cases its effects worsen the condition. These people should rest until the condition improves….”

-SUSHRUTA , 600 BC

UNDERSTANDING THE PANCREATIC HORMONES …

FUNCTIONS OF INSULIN

FUNCTIONS OF GLUCAGON

TYPES OF DIABETES MELLITUS1.Type 1 diabetes : results from the body’s failure to produce insulin. Between 5% and 10% of Americans diagnosed with diabetes have the type 1 subgroup.

2. Type 2 diabetes : refers to a relative insulin deficiency that results in hyperglycemia. Approximately 90% to 95% of Americans diagnosed with diabetes exhibit insulin resistance.

3. Gestational diabetes : affects about 4% of all pregnant women or about 135,000 cases in the United States each year.

4. Pre-diabetes : occurs when a person’s blood glucose reaches higher-than-normal levels but not high enough for diagnosis as type 2 diabetes.

DIABETES : SIGNS & SYMPTOMSTwelve diabetes signs and symptoms include:

1. Elevated blood glucose (hyperglycemia)2. Frequent urination (polyuria)3. Excessive thirst (polydipsia)4. Extreme hunger (polyphagia)5. High levels of blood ketones from reliance on excessive fat catabolism6. Unexplained weight loss7. Increased fatigue8. Irritability9. Blurry vision10. Numbness or tingling in the extremities (hands, feet)11. Slow-healing wounds or sores12. Abnormally high frequency of infection

DIABETES…. IN OUR GENES & LIFESTYLE..!!??

Most type 1 diabetics inherit risk factors from both parents, with inherited traits more common in whites than blacks or Asians. The most prominent “environmental triggers” include cold weather exposure (develops more often in winter than summer and more frequently in places with cold climates), viral infection, and early diet (less common in those who were breastfed and in those who first ate solid foods at a later age).

Type 2 diabetes has a stronger genetic basis than type 1, yet its occurrence also depends more on environmental factors. The disease most likely results from the interaction of genes and lifestyle factors, including physical inactivity, weight gain (>80% of type 2 diabetics are obese), aging, and possibly a high-fat diet.

….ITS ALL ABOUT THE BEST USE OF MUSCLES….

A dysregulation in glycolytic and oxidative capacities of skeletal muscle relates to insulin resistance in type 2 diabetes .

Experts estimate that up to 92% of type 2 diabetes can be changed by diet and lifestyle. Use the following Internet site to calculate your diabetes risk: www.diabetes.org/risk-test.jsp.

WHY PEOPLE WITH DIABETES EXERCISE??...

Exercise generally lowers blood glucose resulting in decreased insulin or OHA requirements.

CVD risk factors are potentially improved by regular exercise.

Exercise may prevent or delay the progression of diabetes related complications.

Exercise improves general health.

• To survive, people in early times had to have genes that permitted the body to store fuel in times of excess so that they would have a source of energy during times of famine.

• These genes that permit efficient food storage are termed, “Thrifty Genes”. They cause rapid weight gain in times of abundant food supply.

• The advantage of this trait is that the bearer is much more likely to survive in the absence of food.

…THUS..PEOPLE NEED TO BE PHYSICALLY ACTIVE…

The problem is that in a society where food is always plentiful and physical activity is not a part of the lifestyle, thrifty genes cause obesity, diabetes and related problems.

In the absence of the need to hunt and gather and with food always available we need to make an effort to incorporate physical activity in our lives.

……. BECAUSE OF THE HUMAN GENOME , IT IS NECESSARY TO RE-INTRODUCE PHYSICAL ACTIVITY IN OUR ROUTINE….

REGULATION OF GLUCOSE FLUXES DURING EXERCISE...

PROPOSED MEACHANISM BY WHICH ACUTE EXERCISE ENHANCES INSULIN SENSITIVITY

• Increased muscle blood flow

• Increased capillary surface area

• Direct effect on working muscles

• Indirect effect mediated by insulin-induced suppression of FFA levels

CVD RISK FACTORS ARE POTENTIALLY IMPROVED BY REGULAR EXERCISE

• Glucose Intolerance• Hyper-insulinemia• Hyperlipidemia• Coagulation Abnormalities• Hypertension• Obesity

EXERCISE INDUCED HYPOGYCEMIA

• While exercise-induced hypoglycemia is generally not common in non-insulin dependent diabetes, it is extremely prevalent in insulin dependent diabetes.

• Hypoglycemia may occur during exercise or after exercise (even up to 24 h following the cessation of an exercise session).

• Hypoglycemia can be prevented by eating more, taking less insulin, or both.

GENERAL CONSIDERATIONS IN DIABETIC PEOPLE PRIOR TO EXERCISE PRESCRIPTION

• Physical screening prior to starting an exercise program

• Metabolic control

• Blood glucose monitoring

• Food intake

• Insulin administration (when applicable)

• Make physical activity compatible with a person's lifestyle and interests

THE CONCEPT OF OBLA..

• If blood glucose <5 mM extra calories before exercise likely required.

• If blood glucose 5-12 mM extra calories probably not required.

• If blood glucose >12 mM measure urine ketones.

• If urine ketones negative, exercise can be performed and extra calories not required.

• If urine ketones positive, take insulin and delay exercise until ketones negative.

• A source of CHO should be readily available during and after exercise.

• Consume CHO as needed to avoid hypoglycemia.

• Consume proteins & fats for prolonged exercise in order to prevent post-exercise hypoglycemia.

THE 3 MOST IMPORTANT FACTORS IN DETERIMING THE SUCCESS OF ANY EXERCISE PROGRAM ARE…

COMPLIANCE

“Those who think they have no time to exercise will have to find time for illness..” - Edward Stanley,Earl of Derby (1826-1893)