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The Diabetic Athlete. Case Study. Definition. Group of metabolic disorders characterized by hyper glycemia resulting from defects in insulin secretion, insulin action or both.

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Definition l.jpg
Definition

  • Group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both.

  • Chronic diabetes is associated with long term damage, dysfunction and failure of various organs especially the eyes, kidneys, nerves, heart and blood vessels


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Definition

  • Diabetes is caused by the relative lack of insulin secretion by the pancrease or by insulin resistance of target organs (usually muscle and liver where it is stored)


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CHO Metabolism

Secretion of insulin promotes storage of glucose

in MM and liver as glycogen

EAT

Consume CHO

Converted to glucose

Absorbed by SI sent to bloodstream


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CHO Metabolism

As blood glucose level rise

Pancrease secretes more Insulin

or

As blood glucose levels decrease

Pancrease secretes less Insulin


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Classification of Diabetes

  • 2 fasting blood plasma levels greater than 126 mg/dL

  • Two random draw blood plasma levels greater than 200 mg/dL

  • 2 hour post ingestion of glucose solution with blood plasma levels greater than 200 mg/dL

  • Normal=80-120 mg/dL

OR

OR


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Symptoms of diabetes

  • Hyperglycemia – blood sugar rises above normal levels

    • Leads to excretion of glucose in urine which requires a large amount of water

      • Polyurnia

      • Polydipsia

      • Nocturia

    • Other symptoms may include lethargy, blurred vision, & unexplained weight loss


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4 types of Diabetes

  • Type 1

  • Type 2

  • Gestational


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Type 1 diabetes

  • Also known as Juvenile onset diabetes or insulin-dependant diabetes

  • Results from the destruction of the pancreatic islet beta cells where insulin is produced

  • Usually occurs < 30 yo

  • Insulin injection is the only way to control the hyperglycemia


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TX for Type 1 Diabetes

  • TX with insulin and must keep tight glucose control in athlete

    • Blood glucose monitoring – QID

    • Insulin pump or insulin injections 3 or more times a day

  • Frequent adjustments needed based on glucose level, anticipated dietary intake and exercise


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Poor TX for Type 1

  • Can lead to:

    • Retinopathy

    • Neuropathy

    • Nephropathy


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Type 2 diabetes

  • Also known as adult onset or noninsulin dependent diabetes

  • Caused by insulin resistance plus a lack of insulin secretion

  • Occurs in 40+ yo

  • Can control with diet, exercise, weight loss or medications


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Gestational diabetes

  • Associated with pregagancy usually in the 5th or 6th month

  • Will resolve once pregnancy is over

    • 50% of women will get type 2 within 22-28 years after birth

  • Mothers glucose need to be WNL to protect baby

  • Nutritional counseling, diet and exercise are usually effective


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TX for Type 2 & Gestational Diabetes

  • Diet and exercise then oral meds then insulin injections

    • Sulfonylurea and insulin may cause hypoglycemia

  • Must be monitored frequently with blood glucose monitor and hemoglobin A1C test







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Hypoglycemia

  • Abnormal low level of glucose in the blood

  • S&S are varied and diverse

    • Irritability, trembling, hunger, sweating and apprehension

    • Severe symptoms could lead to shock, confusion, convulsions and coma


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Hypoglycemia

  • TX

    • Sugar cubes, orange juice, candy, fruit, glucose tablets or gels

  • Recovery is usually fast

  • Need to monitor exercise and diet to prevent further hypoglycemic attacks


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Ketacidosis

  • Occurs when the body cannot metabolize glucose and burns fat stores instead

  • End product of fat metabolism is ketone bodies which are acidic and increase in the body they raise the pH level

  • Usually occurs over a period of days and typically seen in Type 1 diabetes


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Ketacidosis

  • Precipitating factors include:

    • Severe infection, dietary indiscretions and failure to take insulin

  • S&S

    • Fruity breath, lethargy, confusion and somnolence and Kussmaul breathing



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Benefits of Exercise

  • Increases insulin sensitivity and lowers BP, weight, and lipid levels

  • In type 2 – improves glycemic control with change in diet, regular exercise and weight loss


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Benefits of Exercise

  • In type 1 – worsens blood glucose control and must take care to prevent both hypo and hyperglycemia


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Benefits of Exercise

  • Need to monitor exercise intensity, glucose levels and weight loss closely

  • Any change may present harm to athlete

  • Athlete and ATC must be vigilant


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General Guidelines for PreExercsie Caloric Intake

  • All blood glucose levels that are <80mg/dL requires caloric supplementation

  • If blood glucose level is <100mg/dL prior to exercise, a pre-exercise snack should be eaten that is high in CH and low in fat


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General Guidelines for PreExercsie Caloric Intake

  • If blood glucose 100-250mg/dL prior to exercise, exercise can continue and additional calories can be consumed during or after exercise – depending on duration of activity


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General Guidelines for PreExercsie Caloric Intake

  • If exercise lasts more than 1 hr, 15 g of CHO and 250 mL of fluid should be consumed every 15-20 minutes


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General Guidelines for PreExercsie Caloric Intake

  • If blood glucose is >250 ml/dL, the athletes urine should be checked for ketones.

  • If keytones are present, or if blood glucose is >300 mg/dL, exercise should be stopped and insulin should be adjusted for better glycemic control


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