1. 1 Diabetes Education Teaching Guide Exercise

2. 2 Question #1 True or False? Leading a sedentary lifestyle is one of the major risk factors for developing type 2 diabetes. Pre-Test Exercise

3. 3 Answer #1 Pre-Test Exercise True or False? Leading a sedentary lifestyle is one of the major risk factors for developing type 2 diabetes. True

4. 4 Question #2 Pre-Test When you exercise, you should test your blood sugar: A.Before you exercise B.During exercise C.After exercise D.All of the above Exercise

5. 5 Answer #2 Pre-Test Exercise When you exercise, you should test your blood sugar: A.Before you exercise B.During exercise C.After exercise D.All of the above

6. 6 Question #3 True or False? A diagnosis of diabetes disqualifies you from participating in organized sports. Pre-Test Exercise

7. 7 Answer #3 Pre-Test Exercise True or False? A diagnosis of diabetes disqualifies you from participating in organized sports. False

8. 8 Question #4 Pre-Test When participating in sports when you have diabetes, you need to: A.Push yourself to exhaustion B.Keep your blood sugar high so you have energy to burn C.Keep your blood sugar in a normal range while you participate in the game or activity D.Drink lots of water Exercise

9. 9 Answer #4 Pre-Test Exercise When participating in sports when you have diabetes, you need to: A.Push yourself to exhaustion B.Keep your blood sugar high so you have energy to burn C.Keep your blood sugar in a normal range while you participate in the game or activity D.Drink lots of water

10. 10 Question #5 True or False? You should consult your healthcare team before starting a new exercise program. Post Test Exercise

11. 11 Answer #5 Post Test Exercise True or False? You should consult your healthcare team before starting a new exercise program. True

12. 12 Question #6 Pre-Test Exercise can lower your blood sugar levels for up to: A.24 hours B.48 hours C.72 hours D.One week Exercise

13. 13 Answer #6 Pre-Test Exercise Exercise can lower your blood sugar levels for up to: A.24 hours B.48 hours C.72 hours D.One week

14. 14 Exercise is an essential part of controlling diabetes, so time to get moving! Regular physical exercise helps control blood glucose levels, increases energy levels, improves heart health and promotes emotional well-being. Barring other medical complications, the majority of people with type 1 and type 2 diabetes can participate in, and benefit from, at least 30 to 60 minutes of physical activity most days of the week. Always consult your healthcare team before starting a new exercise program. Exercise doesn’t have to mean organized sports, structured workouts at the gym, or running/jogging. Everyday activities like walking the dog, gardening, and playing with your children are all physical activity, and there’s a form of exercise for everyone. If you have joint problems, a low impact exercise like swimming is good. For those with limited mobility, chair exercise routines are ideal. Talk to your doctor or diabetes educator if you’re having trouble finding an activity that works for you. Thirty to sixty minutes of exercise can lower your blood sugar levels for up to 72 hours. Talking Points Exercise

15. 15 Talking Points Type 1 Diabetes Studies have not yet proven an association between improved long-term diabetes control and regular physical activity in type 1 diabetes. But exercise still has many positive health benefits, including short-term blood glucose control, and is recommended for most people with type 1 diabetes. Because exercise typically has a blood glucose lowering effect, people with type 1 diabetes need to pay particular attention to their blood glucose levels before, during, and after exercise. They should also take certain measures to prevent blood sugar emergencies. It is important to note that although exercise generally has a blood glucose lowering effect, for some people with type 1 diabetes an intensive workout can actually cause hyperglycemia, or high glucose levels before and after working out. Logging your glycemic response to different physical activities is an important tool for safe exercise with type 1 diabetes. Exercise

16. 16 Talking Points Type 2 Diabetes Leading a sedentary (or inactive) lifestyle is one of the major risk factors for developing type 2 diabetes, and the high incidence of obesity and being overweight among people with type 2 diabetes is also highly correlated with inactivity. Starting a workout program can lower body mass and consequently decrease the insulin resistance of type 2 diabetes. Studies have shown that people with type 2 diabetes who exercise regularly have better A1C profiles than those who don’t. Along with medical nutrition therapy, exercise is one of the first lines of defense in type 2 diabetes control. In addition, exercise is a key tool in preventing one of the leading complications of type 2 diabetes – cardiovascular disease. Studies have shown that regular activity lowers triglyceride levels and blood pressure. Exercise

17. 17 Talking Points Safe Exercise Once you’ve gotten the go-ahead to embark on a fitness program, you’ll need the appropriate gear and guidance to ensure a safe exercise session. Rules to follow: Check your levels. Self-test blood glucose levels before and after a workout. The ADA recommends avoiding exercise if fasting glucose levels are >250 mg/dl (13.89 mmol/l) and ketosis is present, and using caution if glucose levels are >300 mg/dl (16.67 mmol/l) and no ketosis is present. If levels are below 100 mg/dl (5.56 mmol/l) before exercise, have a snack and retest in 15 minutes. Keep a log. Tracking your blood sugar response to different activities and environments (e.g., hot walking track vs. cold ice skating rink) and food intake is important for recognizing trends and making treatment adjustments. Sweets for safety. Keep a source of fast acting carbohydrates (e.g., glucose gel or tablets; Sweet Tarts; juice box) on your person for hypoglycemic emergencies. No insulin before exercise. Muscles in action will metabolize insulin injections faster and enhance the glucose lowering effect of exercise even further, posing a very real risk for hypoglycemia. Stay hydrated. Staying well-hydrated before, during and after exercise is important for preventing erratic blood sugars and heat stroke. Exercise

18. 18 Talking Points You can excel in athletics even at an elite level if you maintain good control of your diabetes and test often. Elite athletes with diabetes include Adam Morrison (Charlotte Hornets, NBA); Kendall Simmons (Pittsburgh Steelers, NFL); Jason Johnson (Red Sox, MLB); Missy Foy (ultra-marathon runner); and Gary Hall, Jr. (Olympic gold medalist, swimming). Go to dLife.com to view profiles of these athletes and others in the dLifeTV viewing room. Exercise Identify yourself. Always wear a medical identification tag or bracelet in a prominent place on your body when you work out, so if you lose consciousness others will know how to help you. Warm up and cool down. The ADA recommends a warm-up of 5-10 minutes of aerobic activity (walking, cycling, etc.) at a low-intensity level and gentle stretching for an additional 5-10 minutes. The cool-down should also last 5-10 minutes until your heart rate has returned to pre-exercise levels. Dress appropriately. Well-fitting shoes and socks and breathable and weather- appropriate clothing are essential for preventing food problems and heat stroke.

19. 19 Question #1 Name three ways that regular physical exercise helps a person with diabetes remain healthy. Pre-Test Exercise

20. 20 Answer #1 Pre-Test Exercise Name three ways that regular physical exercise helps a person with diabetes remain healthy. 1.Lowers blood glucose levels 2.Increases energy levels 3.Improves heart health 4.Promotes emotional well-being

21. 21 Question #2 Exercise can __________ your blood sugar. Post Test Exercise

22. 22 Answer #2 Post Test Exercise Exercise can __________ your blood sugar. lower

23. 23 Question #3 True or False? Gardening and vacuuming are both forms of exercise. Post Test Exercise

24. 24 Answer #3 Post Test Exercise True or False? Gardening and vacuuming are both forms of exercise. True

25. 25 Question #4 Post Test Always carry ___________ when you work out. Exercise

26. 26 Answer #4 Post Test Exercise Always carry __________________________________ ________________ when you work out. glucose tablets, gel or another fast-acting carbohydrate

27. 27 Question #5 Post Test If you’re going to the gym or to work out, when should you test your blood sugar? Exercise

28. 28 Answer #5 Post Test Exercise If you’re going to the gym or to work out, when should you test your blood sugar? Before, during, and after

29. 29 Question #6 Pre-Test It is important to test for ketones if your blood glucose levels are over __________. A.240 mg/dl B.120 mg/dl C.321 mg/dl Exercise

30. 30 Answer #6 Pre-Test Exercise It is important to test for ketones if your blood glucose levels are over __________. A.240 mg/dl B.120 mg/dl C.321 mg/dl

31. 31 Question #7 Name three ways to keep yourself safe while exercising. Pre-Test Exercise

32. 32 Answer #7 Pre-Test Exercise Name three ways to keep yourself safe while exercising. 1.Check blood glucose levels 2.Keep a log 3.Have a source of fast acting carbohydrate handy 4.No insulin before exercise 5.Stay hydrated 6.Wear a medical ID 7.Warm up and cool down 8.Dress appropriately

33. 33 Question #8 True or False? It’s not important to have a 5-10 minutes warm up before you exercise. Post Test Exercise

34. 34 Answer #8 Post Test Exercise True or False? It’s not important to have a 5-10 minutes warm up before you exercise. False

35. 35 Related Activities 1.Have your patients keep an activity log for a week. Instruct them to write down everything they do that involves moving, then compare notes at your next meeting. Where they surprised at how little, or how much, activity they actually took part in? Talk about easy strategies for increasing activity, such as parking further away from the entrance at the supermarket, taking the dog for an extra walk a day, etc. 2.Issue a step challenge. Provide pedometers for your patients and ask them to target 10,000 steps a day (or less as appropriate). Encourage them to keep regular written blood glucose logs during the challenge so they can see the direct relationship between increased activity and lower blood sugar levels. 3.Go on a field trip. Take your class on a vigorous walk (as health- appropriate) and teach them how to use a pedometer, take their pulse, and measure their heart rate. Exercise

36. 36 Related Activities 4.Invite a certified fitness trainer to visit your group and demonstrate a range of exercises for people who are beginners, moderately active, or at a high level of fitness. If you’re feeling daring, hold your support group meeting at your local YMCA or a fitness center and try these exercises out first hand. 5.Think about food. Blood sugars can fluctuate during the course of an intense workout, so your group needs to know what food will work best for their routines. Invite a registered dietitian to your meeting to talk about what foods work best for different workout regimens. Have your group discuss what snacks they enjoy best for pre- and post-workouts. If you have other activities you’d like to share, email us at ercc@dlife.com. Exercise

37. 37 Additional Resources The 7 Step Diabetes Fitness Plan: Living Well and Being Fit with Diabetes, No Matter Your Weight. Sherry Colberg, PhD. (Copyright 2006, Marlowe & Company) The Diabetic Athlete. Sherry Colberg-Ochs, PhD. (Copyright 2001, Human Kinetics) Staying Healthy with Diabetes — Physical Activity & Fitness. Cathy Mullooly, MS, RCEP, CDE and the Staff of Joslin Diabetes Center. The Diabetes, Exercise and Sports Association (DESA). http://www.diabetes-exercise.orghttp://www.diabetes-exercise.org dLifeTV. The Athlete Show. Episode 122. To order, visit http://www.dlife.com/orderdLifeTVhttp://www.dlife.com/orderdLifeTV dLife.com “Famous Athletes with Diabetes.” http://www.dlife.com/dLife/do/ShowContent/inspiration_expert_advice/famous_people/spo rts.html http://www.dlife.com/dLife/do/ShowContent/inspiration_expert_advice/famous_people/spo rts.html “dLife Podcasts. A Conversation with Kendall Simmons.” http://www.dlife.com/dLife/do/ShowContent/dlife_media/downloads/podcasts.html http://www.dlife.com/dLife/do/ShowContent/dlife_media/downloads/podcasts.html Exercise