The following
program presents principles
00:00:01.98\00:00:02.95
designed to promote good health
00:00:02.96\00:00:04.41
and is not intended
to take the place of
00:00:04.42\00:00:06.32
personalized professional care.
00:00:06.33\00:00:08.30
The opinions and
ideas expressed are
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those of the speaker.
Viewers are encouraged
00:00:10.97\00:00:13.38
to draw their
own conclusions about
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the information presented.
00:00:15.06\00:00:16.64
Hello and welcome
to "Wonderfully Made"
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this program is
designed to provide information
00:00:40.09\00:00:43.09
and encouragement and promoting
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good health habits.
My name is Don Morgan
00:00:45.58\00:00:49.43
and I teach in the
department of Heath
00:00:49.44\00:00:51.33
and Human
Performance at Middle Tennessee
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State University.
This is the seventh
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in a series of
programs focusing on the health
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benefits that come
from begin physically
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active on a daily
basis. In today's program
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we are going to
be talking about the
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growing epidemic
of diabetes in the
00:01:08.65\00:01:11.63
United States, and
the positive role that
00:01:11.64\00:01:14.96
physical activity
and exercise can play
00:01:14.97\00:01:17.69
and helping to treat
and manage this disease.
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Let's first define
what is meant by the term
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diabetes. Diabetes
is a group of diseases
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that are characterized
by high levels of sugar
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or glucose in the
blood. Glucose is used by
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the body to provide
energy to power many
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body functions.
People with diabetes have
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increased
levels of blood glucose
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because of a lack of
insulin or resistance
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to insulin effects.
Now what is insulin?
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Well, it's simply a
hormone release by the
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pancreas gland that
helps glucose to enter
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into many body
tissues, hence when there are
00:02:04.31\00:02:08.47
defects in either
insulin production
00:02:08.48\00:02:11.00
or insulin action
glucose can build up
00:02:11.01\00:02:15.18
in the blood and
spill into the urine,
00:02:15.19\00:02:17.88
as a result the
body can lose a main
00:02:18.65\00:02:22.28
source of fuel.
How many people in the
00:02:22.29\00:02:26.78
United States have diabetes?
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According to the
Center for Disease Control,
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nearly 21 million
people or 7 percent
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of the US
population have diabetes,
00:02:37.41\00:02:40.47
defined as a
fasting blood glucose levels
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of at least a 126
mg/dl, over 14 million people
00:02:44.16\00:02:51.59
have been
diagnosed with diabetes
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while more than 6
million have the disease
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but have not yet been diagnosed.
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Another 41
million Americans have a
00:03:00.18\00:03:03.32
condition called
pre-diabetes in which
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blood glucose
levels are higher than
00:03:07.23\00:03:09.61
normal but are not
high enough to warrant a
00:03:09.62\00:03:13.24
diagnosing of
diabetes. Based on information
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from the National
Institute of health,
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having
pre-diabetes can predisposed you
00:03:19.88\00:03:24.12
to a greater risk
of developing diabetes
00:03:24.13\00:03:27.07
and the higher
incidence of heart attack
00:03:27.08\00:03:29.86
and stroke. In 2005,
1 ½ million new cases of
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diabetes were
diagnosed in people aged
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20 years and older,
and by the year 2025,
00:03:39.51\00:03:44.19
it is estimated
that diabetes will affect
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nearly 9 percent
of the US population.
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The following
graphic shows the spread of
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diabetes in the
United States over the
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past decade. What is of
interest to note is that
00:03:57.92\00:04:02.95
in 1994, only the Louisiana
00:04:02.96\00:04:06.41
and Mississippi
pictured in dark blue
00:04:06.42\00:04:09.74
only these two states exhibited
00:04:09.75\00:04:13.08
an age-adjusted diabetes rate
00:04:13.09\00:04:14.98
of at least 6
percent. However, in 2004,
00:04:14.99\00:04:20.92
39 states were
colored in dark blue,
00:04:20.93\00:04:24.25
reflecting a
startling increase in the
00:04:24.26\00:04:28.03
National Insurance of Diabetes.
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Over 200,000 people
die each year from diabetes
00:04:29.98\00:04:35.35
related complications,
and the overall risk
00:04:35.36\00:04:38.86
of death among people
with diabetes is about
00:04:38.87\00:04:42.28
twice that a
person of similar age
00:04:42.29\00:04:45.35
who do not have this disease.
00:04:45.36\00:04:47.18
From an economic prospective,
00:04:48.18\00:04:50.27
the estimated
annual financial burden of
00:04:50.28\00:04:53.32
diabetes in the United States is
00:04:53.33\00:04:55.93
132 billion dollars
while the prevalence
00:04:55.94\00:05:01.10
of diabetes is
highest in adults who are
00:05:01.11\00:05:03.99
60 years and older.
The greatest number of
00:05:04.00\00:05:07.67
new cases has
been observed among
00:05:07.68\00:05:10.62
middle aged adults.
It is also important
00:05:10.63\00:05:15.09
to note that
diabetes is not just an
00:05:15.10\00:05:17.59
adult disease but
is also being diagnosed
00:05:17.60\00:05:21.04
with greater
frequency in children
00:05:21.05\00:05:23.47
and teenagers. As
shown in the next graphic,
00:05:23.48\00:05:28.18
the Center for
Disease Control estimated
00:05:28.19\00:05:31.49
that 1 out of 3
children born in the
00:05:31.50\00:05:34.44
United States in the
year 2000 could develop
00:05:34.45\00:05:38.44
diabetes in their life time.
00:05:38.45\00:05:40.91
Diabetes can be
classified is either
00:05:43.66\00:05:45.97
Type 1 or Type 2.
In Type 1 diabetes,
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little or no insulin is
available as a result of
00:05:51.66\00:05:55.39
genetic or environmental
factors that destroy
00:05:55.40\00:05:58.44
cells in the
pancreas gland that is where
00:05:58.45\00:06:01.23
insulin is made.
Hence persons with
00:06:01.24\00:06:05.65
Type 2 diabetes
must take insulin daily
00:06:05.66\00:06:08.94
to function and live.
Type 1 diabetes accounts
00:06:08.95\00:06:14.36
for about 5 to 10
percent of diagnosed
00:06:14.37\00:06:17.85
cases in the US
and develops most often
00:06:17.86\00:06:21.40
in children and young adults.
00:06:21.41\00:06:22.92
The onset of Type
1 diabetes is usually
00:06:23.82\00:06:27.69
abrupt and it's
generally accompanied
00:06:27.70\00:06:30.81
by frequent
urination, constant hunger,
00:06:30.82\00:06:34.35
excessive thrust and
unexplained weight loss.
00:06:35.24\00:06:38.98
Type 2 diabetes on
the other hand is the
00:06:40.39\00:06:44.20
most common form of diabetes
00:06:44.21\00:06:46.20
and accounts for
90 to 95 percent of
00:06:46.21\00:06:49.55
diagnosed cases.
This type of diabetes
00:06:49.56\00:06:53.87
can developed at any
age even during childhood.
00:06:53.88\00:06:56.79
In this form of
diabetes the pancreas usually
00:06:58.27\00:07:01.74
produces enough
insulin but the body
00:07:01.75\00:07:04.79
can't use it effectively,
00:07:04.80\00:07:06.58
and develops what is known as
00:07:06.59\00:07:08.45
insulin resistance. To overcome
00:07:08.46\00:07:12.69
this resistance,
the pancreas attempts
00:07:12.70\00:07:15.55
to make more
insulin to facilitate
00:07:15.56\00:07:18.42
the entry of
glucose into the body cells.
00:07:18.43\00:07:21.39
Unfortunately,
overtime insulin production
00:07:22.32\00:07:27.28
may begin to
diminish. The result is the
00:07:27.29\00:07:31.13
same as what happens
for those individuals
00:07:31.14\00:07:33.27
with Type 1
diabetes, glucose levels
00:07:33.28\00:07:36.62
in the blood can
increase to abnormally
00:07:36.63\00:07:39.37
high levels.
Lifestyle factors can play
00:07:39.38\00:07:44.32
an important role in
the development of diabetes.
00:07:44.33\00:07:47.99
In the United
States approximately
00:07:48.94\00:07:52.02
85 percent of
individuals with Type 2
00:07:52.03\00:07:54.99
diabetes are obese at
the time of diagnosis.
00:07:55.00\00:07:58.75
This is led to the
coining of the phrase
00:07:58.76\00:08:02.45
diabesity, to
describe the close association
00:08:02.46\00:08:07.54
between Type 2
diabetes and elevated
00:08:07.55\00:08:11.27
levels of body
fat. In a five years
00:08:11.28\00:08:15.06
study of 20,000
men, the risk of Type 2
00:08:15.07\00:08:19.34
diabetes was
tripled at a body mass index
00:08:19.35\00:08:22.85
that exceeded
overweight standards.
00:08:22.86\00:08:24.86
A similar trend
linking increases in body
00:08:26.38\00:08:29.68
mass index to a
greater age-adjusted risk in
00:08:29.69\00:08:32.78
Type 2 diabetes
was also observed
00:08:32.79\00:08:35.99
then a group of
114,000 women who were
00:08:36.00\00:08:40.14
studied for 14 years.
The risk of developing
00:08:40.15\00:08:44.71
Type 2 diabetes also
arises with an increase
00:08:44.72\00:08:48.35
in waist
circumference. In one study of
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more than 43,000
women, it was found
00:08:52.07\00:08:55.66
that a 10 inch
difference in waist
00:08:55.67\00:08:57.48
circumference in
this case going from
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a 28 inch weight
size to a 38 inch
00:08:59.87\00:09:03.10
waist size that 10
inch difference translated
00:09:03.11\00:09:07.54
into a 6 fold
increase in the risk of
00:09:07.55\00:09:10.47
developing Type 2 diabetes.
00:09:10.48\00:09:12.27
Other evidence
indicates that when body weight
00:09:13.89\00:09:16.85
and abdominal fat are lost,
00:09:16.86\00:09:18.49
there is less
resistance to the effects of
00:09:18.50\00:09:21.61
insulin and
levels of blood glucose
00:09:21.62\00:09:24.50
or either reduced
or return to normal.
00:09:24.51\00:09:27.94
What is the role of
physical activity in
00:09:29.88\00:09:33.07
treating diabetes? In
discussing this topic,
00:09:33.08\00:09:37.09
it's important to recognize that
00:09:37.10\00:09:39.66
physical activity
has been used to treat
00:09:39.67\00:09:42.63
diabetes for 1000 of years.
00:09:42.64\00:09:44.94
Moreover, even after
insulin was isolated in
00:09:46.03\00:09:50.11
1922, exercise
was considered along
00:09:50.12\00:09:54.99
with diet and
insulin as an important part
00:09:55.00\00:09:58.11
of the treatment
regimen for diabetes.
00:09:58.12\00:10:00.57
Before we delve into exactly how
00:10:02.53\00:10:04.95
physical activity can
impact the management of
00:10:04.96\00:10:08.38
diabetes, I want to
look first at the overall
00:10:08.39\00:10:12.72
relationship
between physical activity
00:10:12.73\00:10:14.99
and the risk of
developing diabetes.
00:10:15.00\00:10:17.81
Data from a number
of studies have provide
00:10:19.68\00:10:21.77
a convincing
evidence for the role that
00:10:21.78\00:10:24.26
regular exercise
can play in reducing
00:10:24.27\00:10:26.64
the risk of Type 2 diabetes.
00:10:26.65\00:10:28.49
In one study, the
risk of Type 2 diabetes
00:10:29.23\00:10:33.37
increased as physical
activity levels declined
00:10:33.38\00:10:37.35
and time spend
watching TV increased.
00:10:37.36\00:10:40.74
In another study, it
was demonstrated that person
00:10:42.28\00:10:45.69
with low levels of leisure time
00:10:45.70\00:10:47.42
physical activity
were at the highest risk of
00:10:47.43\00:10:50.65
developing Type 2 diabetes.
00:10:50.66\00:10:52.81
While the lowest
risk of Type 2 diabetes
00:10:54.26\00:10:57.03
was observed in
the most active group.
00:10:57.04\00:10:59.14
Those individuals
who displayed moderate
00:10:59.95\00:11:02.71
levels of physical
activity demonstrated
00:11:02.72\00:11:05.61
marked reductions
in disease risk compare
00:11:05.62\00:11:09.88
to the least active
group. This finding is
00:11:09.89\00:11:13.80
consistent with
what we have talked about
00:11:13.81\00:11:16.94
in earlier programs
that is that numerous
00:11:16.95\00:11:21.08
health benefits can
be gained by performing
00:11:21.09\00:11:23.87
moderate physical activity on a
00:11:23.88\00:11:26.65
regular basis. Exactly how does
00:11:26.66\00:11:32.01
physical activity aid
in transporting blood sugar
00:11:32.02\00:11:36.00
into your muscles.
When physical activity is
00:11:36.01\00:11:40.01
performed your muscles contract
00:11:40.02\00:11:42.96
and when they
do, an insulin like
00:11:43.49\00:11:46.37
effect is created.
What that means is that
00:11:46.38\00:11:50.52
when you are
physical active glucose intake
00:11:50.53\00:11:53.58
into your muscles increases by
00:11:53.59\00:11:55.82
7 to 20 fold compared
to resting conditions.
00:11:55.83\00:11:59.35
Within in the cell,
muscle activity singles
00:12:00.24\00:12:03.86
what are known as
glucose transporters
00:12:03.87\00:12:06.34
to migrate to the cell membrane
00:12:06.35\00:12:08.82
and usher glucose
in. Since muscle activity
00:12:08.83\00:12:14.23
produces in insulin like effect,
00:12:14.24\00:12:16.53
less insulin is
require to move glucose
00:12:17.42\00:12:20.02
into your
muscles conversely during
00:12:20.03\00:12:24.20
and following
exercise skeletal muscle
00:12:24.21\00:12:27.61
display an
increase sensitivity to the
00:12:27.62\00:12:29.91
available insulin.
What this means is that
00:12:29.92\00:12:34.16
for any given level of insulin?
00:12:34.17\00:12:35.87
More blood
glucose can be moved into
00:12:36.84\00:12:38.91
the muscle and this
effect can last anywhere
00:12:38.92\00:12:42.47
from several
hours to a few days.
00:12:42.48\00:12:44.64
With training insulin
sensitivity is elevated
00:12:46.05\00:12:50.23
due to an increase
in the total content of
00:12:51.07\00:12:53.59
glucose transporters
and the stronger insulin
00:12:53.60\00:12:56.95
effect at the cell
level. This increase in
00:12:56.96\00:13:01.54
insulin
sensitivity is what makes
00:13:01.55\00:13:04.21
physical activity
so useful in treating
00:13:04.22\00:13:07.31
persons with
diabetes, since it reduces
00:13:07.32\00:13:11.03
the need for insulin
while helping to lower
00:13:11.04\00:13:14.33
blood glucose levels
to more normal values.
00:13:14.34\00:13:17.59
Regular exercise
and physical activity
00:13:19.92\00:13:22.85
can improve the
health and quality of
00:13:22.86\00:13:24.63
life of both Type 1
and Type 2 diabetics.
00:13:24.64\00:13:28.78
Regular aerobic
and resistance training
00:13:30.30\00:13:33.06
combine with dietary
therapy can result in
00:13:33.37\00:13:37.44
better aerobic
function, favorable changes
00:13:37.45\00:13:40.67
in cholesterol
profiles, decreases in weight,
00:13:40.68\00:13:44.43
and blood pressure,
and greater lean body mass.
00:13:44.44\00:13:48.58
In addition,
daily physical activity
00:13:49.46\00:13:52.94
can help to
improve the psychological
00:13:52.95\00:13:55.51
state of the diabetic
by raising self esteem
00:13:55.52\00:13:59.00
and lowering
depression and anxiety.
00:13:59.01\00:14:03.24
Regular physical
activity can decrease
00:14:05.59\00:14:08.58
the insulin
requirements of well controlled
00:14:08.59\00:14:12.09
Type 1 diabetics
by 30 to 50 percent.
00:14:12.10\00:14:15.57
With each bout of exercise,
00:14:17.12\00:14:19.27
the improvement in
insulin sensitivity
00:14:19.28\00:14:21.70
can last for 1 or 2
days before returning to
00:14:21.71\00:14:25.54
pre-exercise values.
This finding highlights
00:14:25.55\00:14:30.35
the importance of being
active on a daily basis,
00:14:30.36\00:14:33.71
so that you can
take full advantage
00:14:34.54\00:14:36.48
of the enhancement
in insulin sensitivity
00:14:36.49\00:14:39.33
that comes from
engaging in single bouts
00:14:39.34\00:14:42.24
of physical
activity and exercise.
00:14:42.25\00:14:45.12
Before starting
an exercise program,
00:14:46.75\00:14:49.04
the Type 1
diabetic should undergo a
00:14:49.05\00:14:51.76
comprehensive medical screening,
00:14:51.77\00:14:53.51
since strenuous
exercise can aggravate eye,
00:14:54.33\00:14:57.85
kidney or nerve
problems that may already exist.
00:14:57.86\00:15:01.48
While the risk of hyperglycemia
00:15:03.19\00:15:05.33
or high blood sugar
can be present in some
00:15:05.34\00:15:09.23
Type 1 diabetics who
are not in good control of
00:15:09.24\00:15:11.90
their blood glucose levels.
00:15:11.91\00:15:13.44
The primary concern
for these individuals
00:15:14.22\00:15:16.94
is to avoid
hypoglycemia or low blood sugar
00:15:16.95\00:15:21.23
which may occur
when exercise is prolong
00:15:21.95\00:15:24.84
or too intense or
when blood glucose levels
00:15:24.85\00:15:28.38
are low prior to
the start of exercise.
00:15:28.39\00:15:31.42
Given the insulin like
effect created by muscle
00:15:32.84\00:15:36.23
contraction,
individuals with Type 1 diabetes
00:15:36.24\00:15:39.91
who exercise
regularly will require smaller
00:15:39.92\00:15:43.35
then normal insulin
doses or will need to
00:15:43.36\00:15:46.40
increase food intake
to maintain appropriate
00:15:46.41\00:15:49.80
levels of blood glucose.
For the Type 1 diabetic,
00:15:49.81\00:15:54.26
exercise should
be performed at the
00:15:55.12\00:15:57.05
same time everyday at about the
00:15:57.06\00:16:00.01
same intensity and for
the same length of time.
00:16:00.02\00:16:03.60
The overall goal is
to strive for regularity
00:16:05.08\00:16:08.76
and to avoid unplanned exercise
00:16:08.77\00:16:11.81
as much as
possible. The most appropriate
00:16:11.82\00:16:15.69
exercises for Type 1
diabetics are those with
00:16:15.70\00:16:19.98
predictable levels
of activity like walking
00:16:19.99\00:16:23.23
and cycling. They
should also avoid heavy
00:16:23.24\00:16:27.36
resist of exercise
or prolonged intense
00:16:27.37\00:16:30.81
aerobic activity
that may exacerbate eye
00:16:30.82\00:16:34.24
and kidney problems
due to marked increase
00:16:34.25\00:16:36.67
in blood pressure. It
is strongly recommended
00:16:36.68\00:16:41.14
that Type 1 diabetics
adopt a regular pattern
00:16:41.15\00:16:44.61
of exercise and
diet with frequent
00:16:44.62\00:16:47.62
blood glucose
measurements to test
00:16:47.63\00:16:50.05
the body's response
to a given exercise load.
00:16:50.06\00:16:52.84
Each person with
Type 1 diabetes is unique,
00:16:54.63\00:16:58.03
and will need to
discover to frequent
00:16:58.88\00:17:01.87
and routine blood
glucose monitoring.
00:17:01.88\00:17:04.50
The optimal schedule of diet,
00:17:05.33\00:17:07.27
physical
activity, and insulin dosage
00:17:07.28\00:17:10.71
that produces a blood
glucose range allowing
00:17:10.72\00:17:14.35
for safe exercise participation.
00:17:14.36\00:17:16.80
In summary, the
individual with Type 1
00:17:18.28\00:17:22.14
diabetes has much
to gain from engaging
00:17:22.15\00:17:25.41
in daily physical
activity because of the
00:17:25.42\00:17:28.59
potential to enhance
cardiovascular fitness,
00:17:28.60\00:17:31.16
control disease risk factors,
00:17:32.08\00:17:34.44
heighten
psychological well being
00:17:34.45\00:17:37.24
and improve
overall quality of life.
00:17:38.15\00:17:40.95
For the individual
with Type 2 diabetes,
00:17:43.56\00:17:46.07
physical activity
and exercise can enhance
00:17:46.96\00:17:50.13
long term diabetic
control by reducing
00:17:50.14\00:17:54.08
insulin resistance
and improving insulin
00:17:54.09\00:17:57.33
sensitivity. As
with Type 1 diabetics,
00:17:57.34\00:18:01.28
persons with
Type 2 diabetes should
00:18:01.29\00:18:04.66
undergo a thorough
medical examination
00:18:04.67\00:18:07.07
to uncover
previously undiagnosed medical
00:18:07.08\00:18:10.56
complications that
may have risen as a result
00:18:10.57\00:18:14.45
of the disease. A
number of risk factors are
00:18:14.46\00:18:19.07
associated with Type 2 diabetes.
00:18:19.08\00:18:21.10
As shown in the
following graphic
00:18:21.89\00:18:24.11
they include age
being 45 years or older,
00:18:24.12\00:18:28.83
having a body
mass index of 25 kg/m2
00:18:28.84\00:18:33.62
or more which would
suggest the presence of
00:18:33.63\00:18:36.62
overweightness or obesity,
00:18:36.63\00:18:38.47
having a parent,
brother or sister with diabetes,
00:18:39.53\00:18:43.04
having a family
background that is
00:18:43.05\00:18:46.14
African-American,
American Indian,
00:18:46.15\00:18:48.86
Asian American,
Pacific Islander,
00:18:48.87\00:18:51.76
or Hispanic
American. Gestational diabetes
00:18:51.77\00:18:56.80
or giving birth
to at least one baby
00:18:56.81\00:18:59.54
weighing nine pounds or more,
00:18:59.55\00:19:01.26
having a blood
pressure reading that is
00:19:02.19\00:19:04.51
greater than or equal to 140/90
00:19:04.52\00:19:08.03
or being told that you do have
00:19:08.87\00:19:11.09
high blood
pressure. Exhibiting HDL
00:19:11.10\00:19:15.22
cholesterol
reading that are less than
00:19:15.23\00:19:17.31
35 mg/dl and
triglyceride readings
00:19:17.32\00:19:21.30
greater than 250
mg/dl. Displaying
00:19:21.31\00:19:26.34
low physical
activity levels and exhibiting
00:19:26.35\00:19:31.15
pre-diabetes,
defined as having a fasting
00:19:31.16\00:19:34.74
glucose reading that is between
00:19:34.75\00:19:36.78
100 and 125 mg/dl.
Near daily physical activity
00:19:36.79\00:19:45.14
performed at a
comfortable intensity
00:19:45.94\00:19:48.11
and lasting
between 20 to 45 minutes is
00:19:48.12\00:19:52.17
recommended for
the Type 2 diabetic.
00:19:52.18\00:19:54.22
The importance of
performing physical
00:19:55.80\00:19:57.67
activity as part
of a regular routine
00:19:57.68\00:20:00.86
cannot be over
emphasized since the
00:20:00.87\00:20:04.47
residual effects of
a single exercise about
00:20:04.48\00:20:07.15
on insulin sensitivity
and glucose control last
00:20:07.16\00:20:12.01
for only 1 to 2 days. Moreover,
00:20:12.02\00:20:15.87
weigh loss which
can spur improvement
00:20:16.65\00:20:19.59
in insulin
sensitivity is promoted with
00:20:19.60\00:20:23.14
daily exercise.
Both large muscle
00:20:23.15\00:20:27.07
aerobic activities
like walking, cycling
00:20:27.08\00:20:30.15
and swimming and
high repetition resistance
00:20:30.16\00:20:33.67
training, both of
these can enhance insulin
00:20:33.68\00:20:37.62
sensitivity and the
overall management of
00:20:37.63\00:20:40.56
blood glucose
levels. Interestingly,
00:20:40.57\00:20:44.56
skeletal muscle is the
largest mass of insulin
00:20:44.57\00:20:48.45
sensitive tissue in the body.
00:20:48.46\00:20:50.11
Thus exercise
training and daily physical
00:20:51.28\00:20:54.95
activity can help
to alleviate insulin
00:20:54.96\00:20:57.94
resistance by
preventing muscle atrophy
00:20:57.95\00:21:00.97
and building
muscle mass. What is the
00:21:01.72\00:21:06.95
combined effect
of diet and exercise
00:21:06.96\00:21:11.16
for the person
with Type 2 diabetes?
00:21:11.17\00:21:13.20
This question was
addressed in a report
00:21:14.08\00:21:16.48
published in 1994
that involve 652 patients
00:21:16.49\00:21:21.84
with Type 2
diabetes. Study participants
00:21:21.85\00:21:25.76
were part of a 26 day program
00:21:25.77\00:21:28.24
that featured a
low fat, low salt,
00:21:28.25\00:21:31.43
low cholesterol, high fiber,
00:21:31.44\00:21:33.86
high carbohydrate
primarily vegetarian
00:21:33.87\00:21:37.70
diet that was
combined with walking
00:21:37.71\00:21:40.54
exercise lasting 1
to 2 hours per day.
00:21:40.55\00:21:43.88
Results from this
study indicated that in
00:21:45.31\00:21:47.82
less than 1
month 39 percent of the
00:21:47.83\00:21:51.40
participants were
able to stop their
00:21:51.41\00:21:53.27
insulin therapy in
addition nearly  3/4
00:21:53.28\00:21:57.75
of the patients taking
all hypoglycemic agents
00:21:57.76\00:22:01.07
were able to
discontinue their use.
00:22:01.08\00:22:03.83
As shown in the
following graphic
00:22:05.30\00:22:07.07
the program produced
on average of 5 percent
00:22:07.08\00:22:12.06
loss in body
weight, a 7 percent decrease
00:22:12.07\00:22:15.56
in systolic blood
pressure, a 15 percent
00:22:15.57\00:22:19.24
reduction in
fasting glucose levels,
00:22:19.25\00:22:21.47
a 22 percent
reduction in total cholesterol
00:22:22.49\00:22:25.36
values and a 33
percent decrease in
00:22:25.37\00:22:28.42
triglyceride levels
while it's difficult to
00:22:28.43\00:22:32.01
determine whether
diet, physical activity
00:22:32.02\00:22:34.74
or weight loss
was the primary factor
00:22:34.75\00:22:37.69
responsible for
these improvements
00:22:37.70\00:22:39.64
and fitness status.
These findings provide
00:22:39.65\00:22:42.84
clear support for
the notion that positive
00:22:42.85\00:22:46.23
changes in
lifestyle can improve the
00:22:46.24\00:22:49.04
health profile
of Type 2 diabetics.
00:22:49.05\00:22:51.93
And in a more
recent study published
00:22:52.82\00:22:54.62
in the New
England Journal Medicine,
00:22:54.63\00:22:56.52
over 3200
persons with pre-diabetes
00:22:56.53\00:22:59.71
were assign
randomly to 1 of 3 groups.
00:22:59.72\00:23:02.36
A placebo group, which received
00:23:03.13\00:23:05.51
standard
lifestyle recommendations,
00:23:05.52\00:23:07.29
a medication group that received
00:23:07.30\00:23:10.34
standard lifestyle information
00:23:10.35\00:23:12.20
and an oral drug
that increased insulin
00:23:12.21\00:23:15.10
sensitivity and a
lifestyle modification
00:23:15.11\00:23:18.52
group that combined
a healthy low calorie,
00:23:18.53\00:23:21.65
low fat diet
with moderate physical
00:23:21.66\00:23:24.19
activity like
brisk walking that was
00:23:24.20\00:23:27.37
performed for at
least 150 minutes
00:23:27.38\00:23:29.49
per week which
would translate into
00:23:29.50\00:23:32.08
30 minutes of
activity, 5 days a week.
00:23:32.09\00:23:35.08
Data from this study
revealed that persons
00:23:36.35\00:23:38.96
in the lifestyle
modification group
00:23:38.97\00:23:41.42
exhibited a much
greater change in weight
00:23:41.43\00:23:44.77
compare to the
drug or placebo group.
00:23:44.78\00:23:47.69
Furthermore, the
incidence of diabetes
00:23:48.72\00:23:51.55
was 58 percent lower
in the lifestyle group
00:23:51.56\00:23:54.69
verses the placebo
group and 39 percent
00:23:54.70\00:23:58.29
lower in the
lifestyle group compare
00:23:58.30\00:24:00.58
to the medication
group. Clearly, this study
00:24:00.59\00:24:05.21
demonstrates that
simple lifestyle changes
00:24:05.22\00:24:07.57
can be quite
effective in preventing the
00:24:07.58\00:24:10.29
onset of Type 2
diabetes among individuals
00:24:10.30\00:24:13.81
who are pre-diabetic.
In earlier programs,
00:24:13.82\00:24:19.01
we've talked about
the many health benefits
00:24:19.02\00:24:21.64
that come from
walking. In a recent
00:24:21.65\00:24:25.90
investigation published
in the Journal Archives
00:24:25.91\00:24:28.66
of Internal Medicine,
the relationship between
00:24:28.67\00:24:31.89
physical activity and
mortality was examined
00:24:31.90\00:24:34.80
in nearly 2900
adults with Type 2 diabetes.
00:24:34.81\00:24:38.93
Compared with
inactive individuals
00:24:39.89\00:24:41.98
those who walk at
least 2 hours per week
00:24:42.64\00:24:45.27
displayed a 39
percent lower death rate
00:24:45.28\00:24:48.31
from all causes and
a 34 percent reduction
00:24:48.32\00:24:51.88
in mortality due to
cardiovascular disease.
00:24:51.89\00:24:54.80
In those persons
who walked at moderate
00:24:55.71\00:24:58.31
pace for 3 to 4 hours per week
00:24:58.32\00:25:01.03
or about 30 minutes per day,
00:25:01.04\00:25:02.96
mortality from all
causes was reduced by
00:25:03.66\00:25:06.99
54 percent. This
protective affect of
00:25:07.00\00:25:11.10
physical activity
was observed for person
00:25:11.11\00:25:13.75
of varying sex,
raise body mass index,
00:25:13.76\00:25:17.01
diabetes duration
and physical limitation.
00:25:17.02\00:25:20.49
In an editorial that
accompanied the article
00:25:21.29\00:25:24.42
Dr. Frank Hu from the
Harvard School of Public
00:25:24.43\00:25:27.91
Health concluded
that walking is probably
00:25:27.92\00:25:30.54
the "Best
Medicine" for preventing
00:25:30.55\00:25:36.24
and treating
diabetes. While regular
00:25:36.25\00:25:40.05
physical
activity can confirm many
00:25:40.06\00:25:42.02
health benefits.
The presence of specific
00:25:42.03\00:25:44.93
clinical
conditions must be considered
00:25:44.94\00:25:46.94
when designing
an exercise plan for
00:25:46.95\00:25:49.19
diabetics. For
those individuals with the
00:25:49.20\00:25:52.02
complication of
retinopathy or damaged
00:25:52.03\00:25:54.75
to the tiny blood
vessels of the eye,
00:25:54.76\00:25:56.75
it's important to avoid
strenuous high intensity
00:25:56.76\00:26:00.13
activities that
involve breath holding
00:26:00.14\00:26:02.54
or the lowering or
joining of the head.
00:26:02.55\00:26:04.84
Neuropathy or
nerve damage is another
00:26:04.85\00:26:08.71
potential medical
condition that must be
00:26:08.72\00:26:10.78
considered when
recommending exercise
00:26:10.79\00:26:13.33
for the diabetic. In
the case of peripheral
00:26:13.34\00:26:16.36
neuropathy which
effects the extremities
00:26:16.37\00:26:19.03
especially the legs and feet,
00:26:19.04\00:26:20.84
one should avoid
exercises that can cause
00:26:20.85\00:26:23.77
foot trauma
like prolonged hiking
00:26:23.78\00:26:26.25
and jogging or
walking on uneven surfaces.
00:26:26.26\00:26:30.29
For these individuals non-weight
00:26:31.41\00:26:33.56
bearing activities like cycling
00:26:33.57\00:26:35.38
and swimming can be
a useful alternative.
00:26:35.39\00:26:38.05
Keep the feet clean
and dry, choosing shoes
00:26:38.63\00:26:42.26
that fit properly
and visually inspecting
00:26:42.27\00:26:45.08
the feet on a
regular basis or other steps
00:26:45.09\00:26:47.69
that can be taken to
lessen the consequences
00:26:47.70\00:26:50.25
of this
condition. For the diabetic
00:26:50.26\00:26:53.11
who has high blood
pressure heavy weight
00:26:53.12\00:26:55.38
lifting and
breath holding should be
00:26:55.39\00:26:56.92
avoided and low-to-moderate
00:26:56.93\00:26:59.35
intensity exercise
involving large muscle
00:26:59.36\00:27:01.74
groups like walking
and cycling should be
00:27:01.75\00:27:04.45
emphasized.
Diabetics can also suffer from
00:27:04.46\00:27:08.06
nephropathy which
involves damage to the
00:27:08.07\00:27:11.32
small blood
vessels in the kidneys.
00:27:11.33\00:27:13.21
In this case, one
should avoid exercises
00:27:14.05\00:27:17.16
like weight
lifting and high intensity
00:27:17.17\00:27:19.56
aerobic exercise
that can increase
00:27:19.57\00:27:22.10
blood pressure to high levels.
00:27:22.11\00:27:23.89
For the active
diabetic, exercise induce
00:27:24.84\00:27:28.03
hypoglycemia can be prevented by
00:27:28.04\00:27:30.81
monitoring
glucose levels prior to
00:27:30.82\00:27:33.16
and following
activity and by decreasing
00:27:33.17\00:27:36.72
insulin dosages
based on the duration
00:27:36.73\00:27:39.57
and intensity of
exercise as well as by
00:27:39.58\00:27:43.11
personal
experience. To end let me just
00:27:43.12\00:27:48.61
recount a statement
that someone told me
00:27:48.62\00:27:51.04
once who had
diabetes. He told me Don,
00:27:51.05\00:27:54.31
when I walk on a
regular basis I don't have
00:27:54.32\00:27:57.77
diabetes but when I
fail to walk because
00:27:57.78\00:28:00.73
I'm too busy my
diabetes returns.
00:28:00.74\00:28:03.97
There is so much
power contained in being
00:28:03.98\00:28:07.87
physically active, remember that
00:28:07.88\00:28:09.81
and I'll see you
next time. Goodbye.
00:28:09.82\00:28:13.00