Participants: Don Morgan
Series Code: WM
Program Code: WM000380
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00:01 The following program presents principles
00:03 designed to promote good health 00:04 and is not intended to take the place of 00:06 personalized professional care. 00:08 The opinions and ideas expressed are 00:10 those of the speaker. Viewers are encouraged 00:13 to draw their own conclusions about 00:15 the information presented. 00:37 Hello and welcome to "Wonderfully Made" 00:40 this program is designed to provide information 00:43 and encouragement and promoting 00:45 good health habits. My name is Don Morgan 00:49 and I teach in the department of Heath 00:51 and Human Performance at Middle Tennessee 00:53 State University. This is the seventh 00:57 in a series of programs focusing on the health 01:00 benefits that come from begin physically 01:02 active on a daily basis. In today's program 01:06 we are going to be talking about the 01:08 growing epidemic of diabetes in the 01:11 United States, and the positive role that 01:14 physical activity and exercise can play 01:18 and helping to treat and manage this disease. 01:22 Let's first define what is meant by the term 01:25 diabetes. Diabetes is a group of diseases 01:30 that are characterized by high levels of sugar 01:33 or glucose in the blood. Glucose is used by 01:38 the body to provide energy to power many 01:41 body functions. People with diabetes have 01:45 increased levels of blood glucose 01:47 because of a lack of insulin or resistance 01:51 to insulin effects. Now what is insulin? 01:57 Well, it's simply a hormone release by the 02:00 pancreas gland that helps glucose to enter 02:04 into many body tissues, hence when there are 02:08 defects in either insulin production 02:11 or insulin action glucose can build up 02:15 in the blood and spill into the urine, 02:18 as a result the body can lose a main 02:22 source of fuel. How many people in the 02:26 United States have diabetes? 02:30 According to the Center for Disease Control, 02:33 nearly 21 million people or 7 percent 02:37 of the US population have diabetes, 02:41 defined as a fasting blood glucose levels 02:44 of at least a 126 mg/dl, over 14 million people 02:51 have been diagnosed with diabetes 02:54 while more than 6 million have the disease 02:56 but have not yet been diagnosed. 03:00 Another 41 million Americans have a 03:03 condition called pre-diabetes in which 03:07 blood glucose levels are higher than 03:09 normal but are not high enough to warrant a 03:13 diagnosing of diabetes. Based on information 03:18 from the National Institute of health, 03:19 having pre-diabetes can predisposed you 03:24 to a greater risk of developing diabetes 03:27 and the higher incidence of heart attack 03:29 and stroke. In 2005, 1 ½ million new cases of 03:36 diabetes were diagnosed in people aged 03:39 20 years and older, and by the year 2025, 03:44 it is estimated that diabetes will affect 03:47 nearly 9 percent of the US population. 03:52 The following graphic shows the spread of 03:55 diabetes in the United States over the 03:57 past decade. What is of interest to note is that 04:02 in 1994, only the Louisiana 04:06 and Mississippi pictured in dark blue 04:09 only these two states exhibited 04:13 an age-adjusted diabetes rate 04:15 of at least 6 percent. However, in 2004, 04:20 39 states were colored in dark blue, 04:24 reflecting a startling increase in the 04:28 National Insurance of Diabetes. 04:30 Over 200,000 people die each year from diabetes 04:35 related complications, and the overall risk 04:38 of death among people with diabetes is about 04:42 twice that a person of similar age 04:45 who do not have this disease. 04:48 From an economic prospective, 04:50 the estimated annual financial burden of 04:53 diabetes in the United States is 04:55 132 billion dollars while the prevalence 05:01 of diabetes is highest in adults who are 05:04 60 years and older. The greatest number of 05:07 new cases has been observed among 05:10 middle aged adults. It is also important 05:15 to note that diabetes is not just an 05:17 adult disease but is also being diagnosed 05:21 with greater frequency in children 05:23 and teenagers. As shown in the next graphic, 05:28 the Center for Disease Control estimated 05:31 that 1 out of 3 children born in the 05:34 United States in the year 2000 could develop 05:38 diabetes in their life time. 05:43 Diabetes can be classified is either 05:46 Type 1 or Type 2. In Type 1 diabetes, 05:51 little or no insulin is available as a result of 05:55 genetic or environmental factors that destroy 05:58 cells in the pancreas gland that is where 06:01 insulin is made. Hence persons with 06:05 Type 2 diabetes must take insulin daily 06:08 to function and live. Type 1 diabetes accounts 06:14 for about 5 to 10 percent of diagnosed 06:17 cases in the US and develops most often 06:21 in children and young adults. 06:23 The onset of Type 1 diabetes is usually 06:27 abrupt and it's generally accompanied 06:30 by frequent urination, constant hunger, 06:35 excessive thrust and unexplained weight loss. 06:40 Type 2 diabetes on the other hand is the 06:44 most common form of diabetes 06:46 and accounts for 90 to 95 percent of 06:49 diagnosed cases. This type of diabetes 06:53 can developed at any age even during childhood. 06:58 In this form of diabetes the pancreas usually 07:01 produces enough insulin but the body 07:04 can't use it effectively, 07:06 and develops what is known as 07:08 insulin resistance. To overcome 07:12 this resistance, the pancreas attempts 07:15 to make more insulin to facilitate 07:18 the entry of glucose into the body cells. 07:22 Unfortunately, overtime insulin production 07:27 may begin to diminish. The result is the 07:31 same as what happens for those individuals 07:33 with Type 1 diabetes, glucose levels 07:36 in the blood can increase to abnormally 07:39 high levels. Lifestyle factors can play 07:44 an important role in the development of diabetes. 07:48 In the United States approximately 07:52 85 percent of individuals with Type 2 07:55 diabetes are obese at the time of diagnosis. 07:58 This is led to the coining of the phrase 08:02 diabesity, to describe the close association 08:07 between Type 2 diabetes and elevated 08:11 levels of body fat. In a five years 08:15 study of 20,000 men, the risk of Type 2 08:19 diabetes was tripled at a body mass index 08:22 that exceeded overweight standards. 08:26 A similar trend linking increases in body 08:29 mass index to a greater age-adjusted risk in 08:32 Type 2 diabetes was also observed 08:36 then a group of 114,000 women who were 08:40 studied for 14 years. The risk of developing 08:44 Type 2 diabetes also arises with an increase 08:48 in waist circumference. In one study of 08:52 more than 43,000 women, it was found 08:55 that a 10 inch difference in waist 08:57 circumference in this case going from 08:59 a 28 inch weight size to a 38 inch 09:03 waist size that 10 inch difference translated 09:07 into a 6 fold increase in the risk of 09:10 developing Type 2 diabetes. 09:13 Other evidence indicates that when body weight 09:16 and abdominal fat are lost, 09:18 there is less resistance to the effects of 09:21 insulin and levels of blood glucose 09:24 or either reduced or return to normal. 09:29 What is the role of physical activity in 09:33 treating diabetes? In discussing this topic, 09:37 it's important to recognize that 09:39 physical activity has been used to treat 09:42 diabetes for 1000 of years. 09:46 Moreover, even after insulin was isolated in 09:50 1922, exercise was considered along 09:55 with diet and insulin as an important part 09:58 of the treatment regimen for diabetes. 10:02 Before we delve into exactly how 10:04 physical activity can impact the management of 10:08 diabetes, I want to look first at the overall 10:12 relationship between physical activity 10:15 and the risk of developing diabetes. 10:19 Data from a number of studies have provide 10:21 a convincing evidence for the role that 10:24 regular exercise can play in reducing 10:26 the risk of Type 2 diabetes. 10:29 In one study, the risk of Type 2 diabetes 10:33 increased as physical activity levels declined 10:37 and time spend watching TV increased. 10:42 In another study, it was demonstrated that person 10:45 with low levels of leisure time 10:47 physical activity were at the highest risk of 10:50 developing Type 2 diabetes. 10:54 While the lowest risk of Type 2 diabetes 10:57 was observed in the most active group. 10:59 Those individuals who displayed moderate 11:02 levels of physical activity demonstrated 11:05 marked reductions in disease risk compare 11:09 to the least active group. This finding is 11:13 consistent with what we have talked about 11:16 in earlier programs that is that numerous 11:21 health benefits can be gained by performing 11:23 moderate physical activity on a 11:26 regular basis. Exactly how does 11:32 physical activity aid in transporting blood sugar 11:36 into your muscles. When physical activity is 11:40 performed your muscles contract 11:43 and when they do, an insulin like 11:46 effect is created. What that means is that 11:50 when you are physical active glucose intake 11:53 into your muscles increases by 11:55 7 to 20 fold compared to resting conditions. 12:00 Within in the cell, muscle activity singles 12:03 what are known as glucose transporters 12:06 to migrate to the cell membrane 12:08 and usher glucose in. Since muscle activity 12:14 produces in insulin like effect, 12:17 less insulin is require to move glucose 12:20 into your muscles conversely during 12:24 and following exercise skeletal muscle 12:27 display an increase sensitivity to the 12:29 available insulin. What this means is that 12:34 for any given level of insulin? 12:36 More blood glucose can be moved into 12:38 the muscle and this effect can last anywhere 12:42 from several hours to a few days. 12:46 With training insulin sensitivity is elevated 12:51 due to an increase in the total content of 12:53 glucose transporters and the stronger insulin 12:56 effect at the cell level. This increase in 13:01 insulin sensitivity is what makes 13:04 physical activity so useful in treating 13:07 persons with diabetes, since it reduces 13:11 the need for insulin while helping to lower 13:14 blood glucose levels to more normal values. 13:19 Regular exercise and physical activity 13:22 can improve the health and quality of 13:24 life of both Type 1 and Type 2 diabetics. 13:30 Regular aerobic and resistance training 13:33 combine with dietary therapy can result in 13:37 better aerobic function, favorable changes 13:40 in cholesterol profiles, decreases in weight, 13:44 and blood pressure, and greater lean body mass. 13:49 In addition, daily physical activity 13:52 can help to improve the psychological 13:55 state of the diabetic by raising self esteem 13:59 and lowering depression and anxiety. 14:05 Regular physical activity can decrease 14:08 the insulin requirements of well controlled 14:12 Type 1 diabetics by 30 to 50 percent. 14:17 With each bout of exercise, 14:19 the improvement in insulin sensitivity 14:21 can last for 1 or 2 days before returning to 14:25 pre-exercise values. This finding highlights 14:30 the importance of being active on a daily basis, 14:34 so that you can take full advantage 14:36 of the enhancement in insulin sensitivity 14:39 that comes from engaging in single bouts 14:42 of physical activity and exercise. 14:46 Before starting an exercise program, 14:49 the Type 1 diabetic should undergo a 14:51 comprehensive medical screening, 14:54 since strenuous exercise can aggravate eye, 14:57 kidney or nerve problems that may already exist. 15:03 While the risk of hyperglycemia 15:05 or high blood sugar can be present in some 15:09 Type 1 diabetics who are not in good control of 15:11 their blood glucose levels. 15:14 The primary concern for these individuals 15:16 is to avoid hypoglycemia or low blood sugar 15:21 which may occur when exercise is prolong 15:24 or too intense or when blood glucose levels 15:28 are low prior to the start of exercise. 15:32 Given the insulin like effect created by muscle 15:36 contraction, individuals with Type 1 diabetes 15:39 who exercise regularly will require smaller 15:43 then normal insulin doses or will need to 15:46 increase food intake to maintain appropriate 15:49 levels of blood glucose. For the Type 1 diabetic, 15:55 exercise should be performed at the 15:57 same time everyday at about the 16:00 same intensity and for the same length of time. 16:05 The overall goal is to strive for regularity 16:08 and to avoid unplanned exercise 16:11 as much as possible. The most appropriate 16:15 exercises for Type 1 diabetics are those with 16:20 predictable levels of activity like walking 16:23 and cycling. They should also avoid heavy 16:27 resist of exercise or prolonged intense 16:30 aerobic activity that may exacerbate eye 16:34 and kidney problems due to marked increase 16:36 in blood pressure. It is strongly recommended 16:41 that Type 1 diabetics adopt a regular pattern 16:44 of exercise and diet with frequent 16:47 blood glucose measurements to test 16:50 the body's response to a given exercise load. 16:54 Each person with Type 1 diabetes is unique, 16:58 and will need to discover to frequent 17:01 and routine blood glucose monitoring. 17:05 The optimal schedule of diet, 17:07 physical activity, and insulin dosage 17:10 that produces a blood glucose range allowing 17:14 for safe exercise participation. 17:18 In summary, the individual with Type 1 17:22 diabetes has much to gain from engaging 17:25 in daily physical activity because of the 17:28 potential to enhance cardiovascular fitness, 17:32 control disease risk factors, 17:34 heighten psychological well being 17:38 and improve overall quality of life. 17:43 For the individual with Type 2 diabetes, 17:46 physical activity and exercise can enhance 17:50 long term diabetic control by reducing 17:54 insulin resistance and improving insulin 17:57 sensitivity. As with Type 1 diabetics, 18:01 persons with Type 2 diabetes should 18:04 undergo a thorough medical examination 18:07 to uncover previously undiagnosed medical 18:10 complications that may have risen as a result 18:14 of the disease. A number of risk factors are 18:19 associated with Type 2 diabetes. 18:21 As shown in the following graphic 18:24 they include age being 45 years or older, 18:28 having a body mass index of 25 kg/m2 18:33 or more which would suggest the presence of 18:36 overweightness or obesity, 18:39 having a parent, brother or sister with diabetes, 18:43 having a family background that is 18:46 African-American, American Indian, 18:48 Asian American, Pacific Islander, 18:51 or Hispanic American. Gestational diabetes 18:56 or giving birth to at least one baby 18:59 weighing nine pounds or more, 19:02 having a blood pressure reading that is 19:04 greater than or equal to 140/90 19:08 or being told that you do have 19:11 high blood pressure. Exhibiting HDL 19:15 cholesterol reading that are less than 19:17 35 mg/dl and triglyceride readings 19:21 greater than 250 mg/dl. Displaying 19:26 low physical activity levels and exhibiting 19:31 pre-diabetes, defined as having a fasting 19:34 glucose reading that is between 19:36 100 and 125 mg/dl. Near daily physical activity 19:45 performed at a comfortable intensity 19:48 and lasting between 20 to 45 minutes is 19:52 recommended for the Type 2 diabetic. 19:55 The importance of performing physical 19:57 activity as part of a regular routine 20:00 cannot be over emphasized since the 20:04 residual effects of a single exercise about 20:07 on insulin sensitivity and glucose control last 20:12 for only 1 to 2 days. Moreover, 20:16 weigh loss which can spur improvement 20:19 in insulin sensitivity is promoted with 20:23 daily exercise. Both large muscle 20:27 aerobic activities like walking, cycling 20:30 and swimming and high repetition resistance 20:33 training, both of these can enhance insulin 20:37 sensitivity and the overall management of 20:40 blood glucose levels. Interestingly, 20:44 skeletal muscle is the largest mass of insulin 20:48 sensitive tissue in the body. 20:51 Thus exercise training and daily physical 20:54 activity can help to alleviate insulin 20:57 resistance by preventing muscle atrophy 21:01 and building muscle mass. What is the 21:06 combined effect of diet and exercise 21:11 for the person with Type 2 diabetes? 21:14 This question was addressed in a report 21:16 published in 1994 that involve 652 patients 21:21 with Type 2 diabetes. Study participants 21:25 were part of a 26 day program 21:28 that featured a low fat, low salt, 21:31 low cholesterol, high fiber, 21:33 high carbohydrate primarily vegetarian 21:37 diet that was combined with walking 21:40 exercise lasting 1 to 2 hours per day. 21:45 Results from this study indicated that in 21:47 less than 1 month 39 percent of the 21:51 participants were able to stop their 21:53 insulin therapy in addition nearly 3/4 21:57 of the patients taking all hypoglycemic agents 22:01 were able to discontinue their use. 22:05 As shown in the following graphic 22:07 the program produced on average of 5 percent 22:12 loss in body weight, a 7 percent decrease 22:15 in systolic blood pressure, a 15 percent 22:19 reduction in fasting glucose levels, 22:22 a 22 percent reduction in total cholesterol 22:25 values and a 33 percent decrease in 22:28 triglyceride levels while it's difficult to 22:32 determine whether diet, physical activity 22:34 or weight loss was the primary factor 22:37 responsible for these improvements 22:39 and fitness status. These findings provide 22:42 clear support for the notion that positive 22:46 changes in lifestyle can improve the 22:49 health profile of Type 2 diabetics. 22:52 And in a more recent study published 22:54 in the New England Journal Medicine, 22:56 over 3200 persons with pre-diabetes 22:59 were assign randomly to 1 of 3 groups. 23:03 A placebo group, which received 23:05 standard lifestyle recommendations, 23:07 a medication group that received 23:10 standard lifestyle information 23:12 and an oral drug that increased insulin 23:15 sensitivity and a lifestyle modification 23:18 group that combined a healthy low calorie, 23:21 low fat diet with moderate physical 23:24 activity like brisk walking that was 23:27 performed for at least 150 minutes 23:29 per week which would translate into 23:32 30 minutes of activity, 5 days a week. 23:36 Data from this study revealed that persons 23:38 in the lifestyle modification group 23:41 exhibited a much greater change in weight 23:44 compare to the drug or placebo group. 23:48 Furthermore, the incidence of diabetes 23:51 was 58 percent lower in the lifestyle group 23:54 verses the placebo group and 39 percent 23:58 lower in the lifestyle group compare 24:00 to the medication group. Clearly, this study 24:05 demonstrates that simple lifestyle changes 24:07 can be quite effective in preventing the 24:10 onset of Type 2 diabetes among individuals 24:13 who are pre-diabetic. In earlier programs, 24:19 we've talked about the many health benefits 24:21 that come from walking. In a recent 24:25 investigation published in the Journal Archives 24:28 of Internal Medicine, the relationship between 24:31 physical activity and mortality was examined 24:34 in nearly 2900 adults with Type 2 diabetes. 24:39 Compared with inactive individuals 24:42 those who walk at least 2 hours per week 24:45 displayed a 39 percent lower death rate 24:48 from all causes and a 34 percent reduction 24:51 in mortality due to cardiovascular disease. 24:55 In those persons who walked at moderate 24:58 pace for 3 to 4 hours per week 25:01 or about 30 minutes per day, 25:03 mortality from all causes was reduced by 25:07 54 percent. This protective affect of 25:11 physical activity was observed for person 25:13 of varying sex, raise body mass index, 25:17 diabetes duration and physical limitation. 25:21 In an editorial that accompanied the article 25:24 Dr. Frank Hu from the Harvard School of Public 25:27 Health concluded that walking is probably 25:30 the "Best Medicine" for preventing 25:36 and treating diabetes. While regular 25:40 physical activity can confirm many 25:42 health benefits. The presence of specific 25:44 clinical conditions must be considered 25:46 when designing an exercise plan for 25:49 diabetics. For those individuals with the 25:52 complication of retinopathy or damaged 25:54 to the tiny blood vessels of the eye, 25:56 it's important to avoid strenuous high intensity 26:00 activities that involve breath holding 26:02 or the lowering or joining of the head. 26:04 Neuropathy or nerve damage is another 26:08 potential medical condition that must be 26:10 considered when recommending exercise 26:13 for the diabetic. In the case of peripheral 26:16 neuropathy which effects the extremities 26:19 especially the legs and feet, 26:20 one should avoid exercises that can cause 26:23 foot trauma like prolonged hiking 26:26 and jogging or walking on uneven surfaces. 26:31 For these individuals non-weight 26:33 bearing activities like cycling 26:35 and swimming can be a useful alternative. 26:38 Keep the feet clean and dry, choosing shoes 26:42 that fit properly and visually inspecting 26:45 the feet on a regular basis or other steps 26:47 that can be taken to lessen the consequences 26:50 of this condition. For the diabetic 26:53 who has high blood pressure heavy weight 26:55 lifting and breath holding should be 26:56 avoided and low-to-moderate 26:59 intensity exercise involving large muscle 27:01 groups like walking and cycling should be 27:04 emphasized. Diabetics can also suffer from 27:08 nephropathy which involves damage to the 27:11 small blood vessels in the kidneys. 27:14 In this case, one should avoid exercises 27:17 like weight lifting and high intensity 27:19 aerobic exercise that can increase 27:22 blood pressure to high levels. 27:24 For the active diabetic, exercise induce 27:28 hypoglycemia can be prevented by 27:30 monitoring glucose levels prior to 27:33 and following activity and by decreasing 27:36 insulin dosages based on the duration 27:39 and intensity of exercise as well as by 27:43 personal experience. To end let me just 27:48 recount a statement that someone told me 27:51 once who had diabetes. He told me Don, 27:54 when I walk on a regular basis I don't have 27:57 diabetes but when I fail to walk because 28:00 I'm too busy my diabetes returns. 28:04 There is so much power contained in being 28:07 physically active, remember that 28:09 and I'll see you next time. Goodbye. |
Revised 2014-12-17