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Managing Teens and Insulin Resistance

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

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



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

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