Presentation on theme: "Managing Teens and Insulin Resistance"— Presentation transcript:
1Managing Teens and Insulin Resistance Henry Anhalt, DO, CDEDirector, Pediatric Endocrinology and DiabetesSaint Barnabas Medical CenterLivingston, NJ
2WHAT IS INSULIN RESISTANCE? Long associated with type 2 diabetesa known risk factor for heart diseaseoccurs when the body does not properly use insulin to metabolize blood glucosewhen 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
8How do we choose our food? Taste and enjoymentTradition and customConvenienceMoodHungerCostHealth and nutrition
9Ask 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?
10Why is healthy eating important? Blood sugar controlReduces risks of complicationsCholesterolBlood pressureKidney diseaseWeight controlFeel good
11Meal planning questions: True or False You can’t eat any sugarFalseYou must have 3 snacks a dayFalseIt is different for everyoneTrueYou don’t need special foodsTrueIt is complicatedFalse
12General Guidelines Choose Healthy Foods Be Consistent limit fat - especially saturated fatfollow the pyramidBe Consistentmeal times -don’t skip mealsamount of food - have a balanced platetypes of foods - control carbohydrates
14Your meal plan (carb goal) is…. Based on the way you usually eatDesigned to help improve your controlPlanned to space out carbohydratesChangeable… if it doesn’t work
15What about “fast foods”? Look for healthy choicesLearn what is in the foodWatch out for hidden fats
16Moving Toward Better Blood Glucose Control ExerciseMoving Toward BetterBlood Glucose Control
17DIABETES “TRIAD” EXERCISE Nutrition Medication Point to discuss: Exercise is ONE of the ingredients that contributes to diabetes managementEXERCISEMedication
18Exercise benefits for diabetes control Weight loss / Weight controlHelps insulin work betterUses glucose for energyLowers 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.
19Why bother to exercise? Medical Quality of life Psychosocial blood pressure, cholesterol, triglycerides, weight, A1cQuality of lifefitness, strengthneed for medication, sleep timePsychosocialstress, depression feel betterLead the class in a discussion of OTHER benefits that can occur with exercise.
20Why exercise?The main reason I am going to exercise is because I want to:________________________WORKSHEET ASSIGNMENTPrompt patient to identify their own individualized goals for exercise.
21What type of exercise should I do? Aerobic exerciseStrength trainingFlexibility and stretchingEnjoyable and ConvenientSAFEfor diabetes (eyes, feet, kidneys)for other health concerns (heart, lungs, aches and pains, etc)1. Identify the components of fitnessa. aerobic exerciseb. strength trainingc. flexibility2. Discuss the need for exercise to be enjoyable, convenient and safe in order for it to be successful.
22Aerobic exercise choices Weight-bearing activitieswalking, jog/run, aerobic dance, ballroom/folk/line dancing, sportsNon weight-bearing activitiesbiking, swimming, water exercise classes, rowing, armchair exercise, videoHelp class to identify some of the more common forms of exercise activities.
23Other options Strength training Flexibility and stretching Exercise options to explorejoin a health club; use exercise equipment; join an exercise program; call local schools, colleges, malls, clubs, etc. for more information on what is availableStrength 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.
24My exercise plan... For my exercise program I will ____________________________
25How Often? For blood glucose control: 3 to 4 times a week For weight loss: to 5 times a weekDiscuss 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.
26My exercise plan… My goal is to exercise ____ times a week. I will start with ____ times a week.WORKSHEET ASSIGNMENTPrompt patient to identify their own individualized goals for frequency of exercise.
27How Long? For blood glucose control: 20 to 30 minutes For weight loss: to 60 minutesDiscuss 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.
28My 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 ASSIGNMENTPrompt patient to identify their own individualized goals for duration of exercise.
29What Time of Day? Pick a time that fits into: daily schedule lifestyle diabetes management plan
30My exercise plan...The time of day I will most likely exercise will be ____ AM / PM.WORKSHEET ASSIGNMENTPrompt patient to identify their own individualized goals for when to exercise.
31Pre-exercise snack adjustments 30 minutes g Carbminutes g Carb g ProteinLong duration g Carb per hour and> 2 hours decrease insulinFor unplanned exercise follow these snack guidelines
32Summary Review your reasons to exercise Review your exercise plan Be consistentEnjoy your success!
33Who Succeeds? Has a clear and realistic plan Is prepared for obstacles Has a strategy for getting supportKnows exactly what the first steps will be
34Who loses their way? Has goals that are too vague or rigid Attempts too large of a lifestyle changeMay be overly perfectionisticThinks that there will be no obstaclesIs not concerned about obtaining support
35Developing a clear and realistic plan Completing the three QuickPlans:MonitoringMeal PlanningMaking time for exercise
36Completing the QuickPlans One self-care behavior at a timeA one month goalConsider your obstaclesAn immediate action plan to:overcome obstaclesbegin new behavior
37Important 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.
38Obstacles to Exercise Exercise is boring Too hard to find the time May cause hypoglycemiaMay cause too much pain/discomfortToo tired to exerciseNo one to exercise with
39Overcoming Obstacles to Exercise Try something newTurn an unpleasant activity into a pleasant oneModify environment to make exercise more convenient
40Overcoming Obstacles to Exercise Pay attention to how exercise positively affects blood glucoseFind an exercise partner / groupSeek out professional adviceFight back against self-defeating thoughts
41A Contract for Self-Care Your action plan for diabetes successExpect the occasional problems (ongoing problem solving is necessary)Stay in touch!
42Empowerment 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
43Forces that Threaten Empowerment FearAngerIgnoranceHopelessnessMisguided Help
444 Pillars of Empowerment AwarenessChioceFreedomResposibility