1. Managing Teens and Insulin Resistance
Henry Anhalt, DO, CDE
Director, Pediatric Endocrinology and Diabetes
Saint Barnabas Medical Center
Livingston, NJ

2. WHAT IS INSULIN RESISTANCE?
Long associated with type 2 diabetes
a known risk factor for heart disease
occurs when the body does not properly use insulin to metabolize blood glucose
when insulin fails to enable cells to admit glucose, necessary for cells' energy production.
glucose then builds up in the blood, and additional insulin is required

4. TYPE 2 DIABETES-A CARTOON REVIEW

5. Coping Skills Accept what I cannot change Strive to change what I can
Attempt to learn all I can
Set realistic goals
Seek support of others
Hope for new insight

6. Finding the Right Balance
Healthy Eating
Finding the
Right Balance

7. DIABETES “TRIAD”
NUTRITION
Exercise
Medication

8. How do we choose our food?
Taste and enjoyment
Tradition and custom
Convenience
Mood
Hunger
Cost
Health and nutrition

9. Ask Yourself... Are you at your best weight?
Are your blood sugars usually within target range?
Is your cholesterol below 200?
Do you have a meal plan which you usually follow?
Is your meal plan varied? Enjoyable?

10. Why is healthy eating important?
Blood sugar control
Reduces risks of complications
Cholesterol
Blood pressure
Kidney disease
Weight control
Feel good

11. Meal planning questions: True or False
You can’t eat any sugar
False
You must have 3 snacks a day
False
It is different for everyone
True
You don’t need special foods
True
It is complicated
False

12. General Guidelines Choose Healthy Foods Be Consistent
limit fat - especially saturated fat
follow the pyramid
Be Consistent
meal times -don’t skip meals
amount of food - have a balanced plate
types of foods - control carbohydrates

13. Fat / Alcohol
Protein
Carbohydrate

14. Your meal plan (carb goal) is….
Based on the way you usually eat
Designed to help improve your control
Planned to space out carbohydrates
Changeable… if it doesn’t work

15. What about “fast foods”?
Look for healthy choices
Learn what is in the food
Watch out for hidden fats

16. Moving Toward Better Blood Glucose Control
Exercise
Moving Toward Better
Blood Glucose Control

17. DIABETES “TRIAD” EXERCISE Nutrition Medication Point to discuss:
Exercise is ONE of the ingredients that contributes to diabetes management
EXERCISE
Medication

18. Exercise benefits for diabetes control
Weight loss / Weight control
Helps insulin work better
Uses glucose for energy
Lowers blood glucose (in minutes)
Improves A1c (in weeks)
Lead the class in a discussion on in how the benefits of exercise can also benefit diabetes control.

19. Why bother to exercise? Medical Quality of life Psychosocial
blood pressure, cholesterol, triglycerides, weight, A1c
Quality of life
fitness, strength
need for medication, sleep time
Psychosocial
stress, depression feel better
Lead the class in a discussion of OTHER benefits that can occur with exercise.

20. Why exercise?
The main reason I am going to exercise is because I want to:
________________________
WORKSHEET ASSIGNMENT
Prompt patient to identify their own individualized goals for exercise.

21. What type of exercise should I do?
Aerobic exercise
Strength training
Flexibility and stretching
Enjoyable and Convenient
SAFE
for diabetes (eyes, feet, kidneys)
for other health concerns (heart, lungs, aches and pains, etc)
1. Identify the components of fitness
a. aerobic exercise
b. strength training
c. flexibility
2. Discuss the need for exercise to be enjoyable, convenient and safe in order for it to be successful.

22. Aerobic exercise choices
Weight-bearing activities
walking, jog/run, aerobic dance, ballroom/folk/line dancing, sports
Non weight-bearing activities
biking, swimming, water exercise classes, rowing, armchair exercise, video
Help class to identify some of the more common forms of exercise activities.

23. Other options Strength training Flexibility and stretching
Exercise options to explore
join a health club; use exercise equipment; join an exercise program; call local schools, colleges, malls, clubs, etc. for more information on what is available
Strength training and flexibility - takes longer to show in BG control. Both are important for fitness, especially as we age.
Exercise options can be found in a variety of places.

24. My exercise plan... For my exercise program I will
____________________________

25. How Often? For blood glucose control: 3 to 4 times a week
For weight loss: to 5 times a week
Discuss why the exercise plan needs to be based on the patients identified exercise goals.
Consistent exercise performed every other day benefits blood sugar control.
Increased frequency of exercise burns more calories and helps to promote weight loss.

26. My exercise plan… My goal is to exercise ____ times a week.
I will start with ____ times a week.
WORKSHEET ASSIGNMENT
Prompt patient to identify their own individualized goals for frequency of exercise.

27. How Long? For blood glucose control: 20 to 30 minutes
For weight loss: to 60 minutes
Discuss why the exercise plan needs to be based on the patients identified exercise goals.
As little as 20 minutes of exercise can benefit cause an immediate drop in blood glucose and help to improve diabetes control.
Longer duration of exercise necessary to burn more calories and to help promote weight loss.

28. My exercise plan... My goal is to exercise for ____ minutes.
I will start with ____ minutes.
(Plus a ____ minute warm-up and a ____ minute cool down.)
WORKSHEET ASSIGNMENT
Prompt patient to identify their own individualized goals for duration of exercise.

29. What Time of Day? Pick a time that fits into: daily schedule lifestyle
diabetes management plan

30. My exercise plan...
The time of day I will most likely exercise will be ____ AM / PM.
WORKSHEET ASSIGNMENT
Prompt patient to identify their own individualized goals for when to exercise.

31. Pre-exercise snack adjustments
30 minutes g Carb
minutes g Carb g Protein
Long duration g Carb per hour and
> 2 hours decrease insulin
For unplanned exercise follow these snack guidelines

32. Summary Review your reasons to exercise Review your exercise plan
Be consistent
Enjoy your success!

33. Who Succeeds? Has a clear and realistic plan Is prepared for obstacles
Has a strategy for getting support
Knows exactly what the first steps will be

34. Who loses their way? Has goals that are too vague or rigid
Attempts too large of a lifestyle change
May be overly perfectionistic
Thinks that there will be no obstacles
Is not concerned about obtaining support

35. Developing a clear and realistic plan
Completing the three QuickPlans:
Monitoring
Meal Planning
Making time for exercise

36. Completing the QuickPlans
One self-care behavior at a time
A one month goal
Consider your obstacles
An immediate action plan to:
overcome obstacles
begin new behavior

37. Important principles for completing the QuickPlans
Realistic. Begin with small, achievable targets for change.
Action-oriented. Focus on new actions to begin, not old actions to stop.
Concrete. Know the exact actions which you will take.

38. Obstacles to Exercise Exercise is boring Too hard to find the time
May cause hypoglycemia
May cause too much pain/discomfort
Too tired to exercise
No one to exercise with

39. Overcoming Obstacles to Exercise
Try something new
Turn an unpleasant activity into a pleasant one
Modify environment to make exercise more convenient

40. Overcoming Obstacles to Exercise
Pay attention to how exercise positively affects blood glucose
Find an exercise partner / group
Seek out professional advice
Fight back against self-defeating thoughts

41. A Contract for Self-Care
Your action plan for diabetes success
Expect the occasional problems (ongoing problem solving is necessary)
Stay in touch!

42. Empowerment The granting of power or authority to oneself
People become empowered when they use all their resources, psychological, social, emotional and spiritual, to solve their own problems or achieve their own goals

43. Forces that Threaten Empowerment
Fear
Anger
Ignorance
Hopelessness
Misguided Help

44. 4 Pillars of Empowerment
Awareness
Chioce
Freedom
Resposibility