Diabetes Management with DHAC & the Joslin Clinic
A unique partnership to benefit people with diabetes
The Joslin Clinic, a worldwide leader in the study and care of diabetes is now working with Dedham Health & Athletic Complex to provide specially designed programs of exercise to benefit people living with diabetes.
People with diabetes, who exercise regularly:
• Gain better control over the disease
• Reduce feelings of depression and anxiety
• Help reduce blood pressure, cholesterol, and triglyceride levels
• May reduce or eliminate the need for other medications
Highlights of the program include:
• Training for DHAC staff regarding the disease of diabetes and how to
develop safe exercise prescriptions.
• Winter and Spring community lecture series at DHAC.
• Individual assessments performed to determine exercise needs and goals.
• Ongoing supervision of individual and group exercise programs.
This program represents our commitment to support the fitness recommendations of your physician in a safe, closely monitored environment. Call Dedham Health & Athletic Complex to find out about this approach to LIVING WELL WITH DIABETES!
DHAC Online Diabetes Center
Although diabetes has been recognized since antiquity, and treatments of various effectiveness have been known in various regions since the Middle Ages, the elucidation of the pathogenesis of diabetes occurred mainly in the 20th century. The discovery of the role of the pancreas in diabetes is generally ascribed to Joseph von Mering and Oskar Minkowski, European researchers who in 1889 found that when they completely removed the pancreas of dogs, the dogs developed all the signs and symptoms of diabetes and died shortly afterward. In 1910, Sir Edward Albert Sharpey-Schafer of Edinburgh suggested that people with diabetes were deficient in a single chemical that was normally produced by the pancreas. He proposed calling this substance insulin. The term is derived from the Latin insula, meaning island, in reference to the islets of Langerhans in the pancreas that produce insulin.
The endocrine role of the pancreas in metabolism, and indeed the existence of insulin, was not fully clarified until 1921, when Sir Frederick Grant Banting and Charles Herbert Best repeated the work of Von Mering and Minkowski, but went further and demonstrated that they could reverse induced diabetes in dogs by giving them an extract from the pancreatic islets of Langerhans of healthy dogs. Banting, Best, and colleagues (particularly the chemist Collip) went on to isolate the hormone insulin from bovine pancreases at the University of Toronto in Canada. This led to the availability of an effective treatment; insulin injections. The first clinical patient was treated in 1922. For this, Banting and MacLeod received the Nobel Prize in Physiology or Medicine in 1923, and both shared their Prize money with others in the team who were not recognized, in particular Best and Collip. Banting and Best made the patent available without charge and did not attempt to control commercial production. Insulin production and therapy rapidly spread around the world, largely as a result of this decision. (Adapted from Wikipedia 2006)
Currently in the United States, there are 20.8 million adults and children who have diabetes, and more men than women have the disease. It’s been estimated that 14.6 million people have been diagnosed; however there is an estimated 6.2 million people who are unaware that they have the disease. In 2005, there were 1.5 million new cases in people age 20 or older.
Based on death certificate data, diabetes contributed to 224,092 deaths in 2002. Studies indicate that diabetes is generally under-reported on death certificates, particularly in the cases of older persons with multiple chronic conditions such as heart disease and hypertension. Because of this, the toll of diabetes is believed to be much higher than officially reported.
The total annual economic cost of diabetes in 2002 was estimated to be $132 billion, or one out of every 10 health care dollars spent in the United States. (Adapted from the ADA 2006)
Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.
Type 1 Diabetes, also known as insulin-dependent diabetes, is an auto-immune disease in which the body’s immune system begins to attack the beta cells of the pancreas. These are the only insulin producing cells of the body. Insulin is then administered by either injection or a pump.
Type 2 Diabetes, also known as non-insulin dependent diabetes, accounts for 90-95% of all diabetes. It is caused by either an insulin resistance in the cell or the pancreas failing to secrete enough insulin. This form of diabetes is associated with old age, obesity, family history, impaired glucose metabolism, physical inactivity, and race. It can be controlled by oral medications, proper nutrition, and physical activity.
Gestational Diabetes affects women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy. Gestational diabetes affects about 4% of all pregnant women. Currently, the exact cause of gestational diabetes is unknown, but there are some clues. The hormones from the placenta which help the baby develop may block the action of the mother's insulin in her body. This makes it hard for the mother's body to use insulin, and as a result blood glucose levels rise and hyperglycemia develops.
Many women who have gestational diabetes go on to develop type 2 diabetes years later. There seems to be a link between the tendency to have gestational diabetes and type 2 diabetes. The good news is that certain basic lifestyle changes such as diet and exercise may help prevent diabetes after gestational diabetes. (Adapted from the ADA 2006)
Exercise is important for everyone; however being active on a regular basis can have a tremendous positive impact on people with diabetes. Some of the benefits of regular exercise are:
• Lower resting heart rate
• Lower resting blood pressure
• Lower “bad” cholesterol and increase “good” cholesterol
• Reduced risk for coronary artery disease
• Reduced body fat
• Better management of type I diabetes (decreased insulin requirements)
• Decreased risk for pre-diabetes and type II diabetes
• More energy throughout the day
• Reduction in stress and improved psychological well being
Prior to beginning an exercise regimen, a person with diabetes should have a complete medical evaluation including their cardiovascular, nervous, renal, and visual systems. A graded exercise test, or “stress test” may also be required. After physician approval, a progressive, low to moderate exercise regimen may be started.
The Highs and the Lows
Diabetics need to take some special precautions while exercising. Testing blood glucose before, after, and sometimes during exercise is a good way to avoid exercise in a hyper- or hypo-glycemic state.
Hyperglycemia refers to a high blood glucose reading that is >300 mg/dL. Symptoms of hyperglycemia are:
• Increased thirst
• Dry mouth
• Soft eyeballs
• Frequent urination
• Decreased hunger
Hypoglycemia refers to a low blood glucose reading that is < 80mg/dL. Symptoms of hypoglycemia are:
• Hand tremors
• Excessive hunger
Avoid exercise if resting blood glucose is above 300 mg/dL or below 100 mg/dL. Also, it is important to know that hypoglycemia can be harder to recognize when you are exercising because exercise can sometimes mimic hypoglycemic symptoms (i.e. sweating, dizziness, and fatigue). Be sure to take some quick-acting form of sugar with you when you exercise such as glucose tablets or gel, Life Savers® or fruit juice.
If you have Type 1 diabetes, exercise is always balanced with your meal plan and insulin to control your diabetes. Changes may have to be made in your insulin or food intake or both before and after exercise to prevent you from having hypoglycemia.
The general exercise prescription for someone with diabetes is not any different than it is for apparently healthy individuals. All components of fitness should be included in your program. They are:
• Cardiovascular or aerobic exercise
• Strength or resistance training
• Flexibility exercises
Cardiovascular or aerobic exercise refers to any activity that elevates the heart rate for an extended period of time. Activities such as walking, cycling, and swimming are all great forms of aerobic exercise. General guidelines recommend 20 to 60 minutes done 3 to 5 days per week. The intensity should feel “somewhat hard,” meaning you should always be able to talk to the person next to you at least in short sentences.
The strength or resistance training program should consist of various resistance exercises that incorporate all the major muscle groups. Performing 1-2 exercises for the upper body, lower body, and midsection will help strengthen muscles and bones. Flexibility exercises will reduce your chance of injury during other activities, improve your posture, and reduce your risk of low back pain. Just 5 to 10 minutes of gentle stretching on most days of the week is enough. (Adapted from the ADA and the ACSM 2006)
People with diabetes have the same nutritional needs as anyone else. Along with exercise and medications (insulin or oral diabetes pills), nutrition is important for good diabetes control. By eating well-balanced meals in the correct amounts, you can keep your blood glucose level as close to normal (non-diabetes level) as possible.
Knowing what to eat can be confusing. Everywhere you turn, there is news about what is or isn't good for you. Some basic principles have weathered the fad diets, and have stood the test of time. Here are a few tips on making healthful food choices for you and your entire family.
Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety. Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans with meals.
Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce.
Include dried beans (like kidney or pinto beans) and lentils into your meals.
Include fish in your meals 2-3 times a week.
Choose lean meats like cuts of beef and pork that end in "loin" such as pork loin and sirloin. Remove the skin from chicken and turkey.
Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese.
Choose water and calorie-free "diet" drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks.
Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats are high in calories. If you're trying to lose weight, watch your portion sizes of added fats.
Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream.
Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes.
(Adapted from the ADA 2006)