Healing and Hope

A Newsletter of the Diabetes Institutes Foundation

February 2006

A NOTE FROM THE EXECUTIVE DIRECTOR

Dear Reader,

Several weeks ago the New York Times published a superb three-part piece on how the surging rate of diabetes is threatening the health and welfare of New Yorkers, especially those citizens living in poorer areas. The personal attitudes and stories shared by New Yorkers are reflected in so many areas of the United States and around the world. I urge all of you to take the time and read this very sobering series. You can find it archived on the New York Times website.

Bad Blood: Living at an Epicenter of Diabetes, Defiance and Despair
Bad Blood: Diabetes and Its Awful Toll Quietly Emerge as a Crisis
Bad Blood: In the Treatment of Diabetes, Success Often Does Not Pay

Through research, patient care and education the Strelitz Diabetes Institutes is doing it all can to brighten the looming forecast posed by the diabetes epidemic.

Exercise and nutrition are essential components in successfully managing diabetes. This month, our e- newsletter features a new study conducted jointly by Dr. Henri Parson of the Institutes and Dr. Sheri Colberg-Ochs of Old Dominion University, which investigates how exercise affects diabetes complications. And the Institutes’ dietitian Phyllis Woodson gives an easy to understand list of important guidelines that will help you exercise safely.

Thank you to all of you who have written to tell us how much they’ve enjoyed our monthly newsletters and have shared them with friends and family. Our e- newsletter listserv is growing, and hopefully, helping everyone who receives it.

Best,
Anna Goldenberg
Executive Director
Diabetes Institutes Foundation

FOUNDATION NEWS

With Spring on the way, DIF Events are Blooming

Sponsorship opportunities are still available for the 8th Annual Mike Cavish Golf Tournament & Dinner Party, at Portsmouth's Bide A Wee Golf Course on Monday, April 24th.

For more information,visit our website.

Lights Camera Take Action Against Diabetes

On February 8th, Haynes Furniture, Cinema Cafe and local Entercom radio stations teamed up to present a special benefit movie theater night. That evening, for a special ticket price of $15 at each of Cinema Cafe's four Hampton Roads locations, moviegoers could see two movies and enter drawings for fabulous prizes. All proceeds benefited the Diabetes Institutes Foundation.

MEDICAL NEWS

Exercise Study to Examine Effect of Aerobics on Neuropathy

A sad fact - there are 85,000 amputations in the US each year, one every 10 minutes. 87% of the time, these are the result of diabetic nerve damage (neuropathy), which occurs when blood flow is impaired in the small blood vessels that provide nutrition to both the skin and nerves within the skin. Neuropathy leads to numbness and sometimes pain and weakness in the hands, arms, feet, and legs and can cause organ problems. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk.

An estimated 50 percent of those with diabetes have some form of neuropathy, but not all with neuropathy have symptoms.

In a series of studies funded by the American Diabetes Association, the Strelitz Diabetes Institutes is examining, in conjunction with how different combinations of drugs work along specific channels in the body, how exercise affects neuropathy. These investigations of how various factors work together to increase or impede blow flow could lead to significant gains in preventing or reducing this life spoiling complication. One important discovery by Dr. Henri Parson, Director of the SDI Neurovascular lab, is that African American diabetics suffer from a major defect in the blood flow to their feet that is far worse than in the rest of the population. Along with Dr. Sheri Colberg-Ochs of Old Dominion University, Dr. Parson recently completed the "resting phase" of a study using groups of sedentary and athletic diabetics, along with two control groups. During the next phase, exercise will be added to the mix. The two groups of sedentary study participants will be outfitted with heart monitors and begin 6 months of monitored aerobic activity at the YMCA in downtown Norfolk.

Since heart attacks are the leading cause of death among diabetics, cardiovascular health can be critical in determining quality of life. Dr. Parson hopes that participants enjoy taking part in the study as well as benefiting from regular workouts. Coming from a clinical background, she certainly enjoys interacting with humans rather than test tubes: "People are so interesting and come in with all types of stories. In a regular science lab, you don’t necessarily get to see your work come to fruition. But here you can directly affect people."

If you’re interested in participating in this aerobic training study, call 757-446-7047 or 757-446-7933 to learn more.

NUTRITION TOPICS

Rationale for Nutrition Recommendations For Exercise and Diabetes

Phyllis Woodson, MS, RD, CDE, Clinical Dietitian

Benefits from exercise include weight control; improved blood pressure, cholesterol, and blood glucose; and a sense of well being that can also improve your stress management and sleeping habits. The American Diabetes Association recommends gradually increasing the duration and frequency of exercise to 30-45 minutes of moderate aerobic activity a day, 3-5 days a week, when possible.

Exercise over extended periods of time requires carbohydrate intake as a source of fuel (blood glucose). Part of this requirement is met by stored glucose in the muscle (glycogen). Depletion of muscle glycogen over a period of 60-90 minutes of aerobic exercise can lead to fatigue. Lower intensity exercise over a longer period of time requires available blood glucose as an additional source of fuel. Hypoglycemia may occur after about 90 minutes (or sooner) of exercise when both muscle and liver glycogen stores are depleted and up to 24-36 hours later.

It is important before beginning lengthy exercise to plan for it, if you are taking insulin, you will need less of it and/or you can compensate with extra carbohydrate intake. Too much carbohydrate or food intake can lead to weight gain. Insulin or carbohydrate adjustments prior to, during, or after exercise can depend on many factors: intensity, duration, usual insulin regimen, and blood glucose patterns. Monitoring your blood glucose for these patterns can identify what type and how much carbohydrate you need.

The time of day that you exercise can make a difference. In the morning upon waking, when cortisol levels are high and insulin levels are low, you are less likely to experience low blood glucose when exercising. A balance of hormones is thus important for exercise. If there is too little insulin, blood glucose levels and ketone production can rise. During exercise, epinephrine increases fatty acid mobilization and muscle glycogen breakdown, and glucagon causes the liver to produce glucose. Balance is the key, it is more important to be consistent in your exercise program rather than to only exercise in the morning.

If you have type 1 diabetes , it is recommended to not exercise if your blood glucose is over 250and ketones are present and to use caution if blood glucose is over 300 and no ketones are present.

If you have type 2 diabetes, and your blood glucose is over 150, you may not need carbohydrate for moderate intensity and duration.

Generally, for 30 minutes of intense exercise, 15- 30 g of carbohydrate (fruit, yogurt; 1z2-1 sandwich; peanut butter with crackers, etc) may be needed pre exercise; however, experienced athletes may choose less or more depending upon the duration, their usual regimen of insulin, and blood glucose patterns. For up to 60 minutes of exercise, cool water is recommended. But for 60-90 minutes, water and carbohydrate will be needed (diluted fruit juice or some sports drinks may be used). It usually takes the body about 24 hours after exercise to replenish lost fluid. It has been suggested to drink 16 oz of water an hour prior to exercise, 8 oz 15 minutes before, and 4-6 oz every 15-20 minutes during exercise. Drink water before, during, and after exercise.

Insulin and carbohydrate recommendations for cycling (for insulin pump): -If cycling for less than 1 hour, consider reducing the basal rate by 25-50% about 11z2 hours before the exercise. If cycling in the am, less carbohydrate supplementation may be needed due to higher insulin resistance in the am.

-If cycling for 1-4 hours, reduce pre meal or bolus insulin by 30-50% at meals before and after the cycling, depending upon any basal rate reductions and food intake.

-A general rule is to consume about 15-30 g of carbohydrate for every 1z2 to 1 hour of cycling, depending upon the intensity. For longer duration of cycling, consider additional carbohydrate intake afterwards.

-For longer duration, consider reducing basal rates 30-60 minutes prior to cycling and even continuing several hours or overnight to avoid hypoglycemia. A bedtime snack may be needed. Basal rates can be reduced by 50% for 12-24 hours depending upon intensity, duration, and type of exercise.

Other considerations are temperature and altitude. Heat, cold, and higher altitudes all may cause hypoglycemia. Monitor your blood glucose.

The expression used by scuba divers, "Plan your dive and dive your plan", can also be applied to exercising with diabetes: "Plan your exercise and exercise your plan". When monitoring your blood glucose, know what you will do with the results.

It is our intention that this information will enable you to make better decisions when exercising regarding identifying blood glucose patterns and making any needed adjustments in food intake or insulin administration.

References:

Colberg, Sheri. (2001). The Diabetic Athlete. Illinois: Human Kinetics.

American Diabetes Association. (2006). Clinical Practice Recommendations. Diabetes Care, 29, Supplement 1.

With additional contributions by:

Rick Philbin, MED, ATC, CSCS National Board Member: Diabetes, Exercise & Sports Association National Presenter: "Children with Diabetes" Northeast Regional Manager, Animas Corporation

Katie Conschafter, MS, RD, LDN, CDE Clinical Manager, Virginia, Animas Corporation

Bon Appetit!

Yours in good health,
Phyllis Woodson, MS, RD, CDE
Dietitian

For more information