http:www.udel.edubiologyWagshistopagecolorpagecpcpil1.GIF

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http//www.udel.edu/biology/Wags/histopage/colorpa
ge/cp/cpil1.GIF
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Meal Absorbed
? Plasma fatty acids
? Plasma glucose
? Plasma amino acids
No Insulin Released
? Glucose uptake (muscle and adipose)
? Glucose utilization
Brain interprets as starvation
Assuming Insulin-Dependent Type 1 Diabetic
Liver
Polyphagia
Hyperglycemia
Exceeds renal threshold for glucose
Glucosuria
Metabolic acidosis
? Ventilation
Osmotic diuresis and polyuria
? Thirst
Polydipsia
Dehydration
? ADH secretion
Lactic acid production
? Blood volume and ? Blood pressure
Attempted compensation by cardiovascular control
center
Anaerobic metabolism
compensation fails
Circulatory failure
Coma or death
3
http//cal.man.ac.uk/student_projects/2000/mnby7lc
2/metabolism.htmreceptor
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? Plasma glucose
ß cells of pancreas
? cells of pancreas
? Insulin
Muscle, adipose, and most other cells
Liver
? Glucose transport
? Glycolysis ? Glycogenesis ? Lipogenesis
? Plasma glucose
5
http//cal.man.ac.uk/student_projects/2000/mnby7lc
2/Ins_receptor.gif
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What are the primary targets of insulin?
1. Adipose tissue 2. Skeletal muscle
7
http//www.endotext.org/diabetes/diabetes14/diabet
es14.htm
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What are the primary targets of insulin?
3. Liver
hexokinase
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SUMMARY OF INSULIN INFLUENCES
10
http//cal.man.ac.uk/student_projects/2000/mnby7lc
2/glycogenesis.htm
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SUMMARY OF INSULIN INFLUENCES
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What tissues are NOT insulin-dependent?

• Brain

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NEUROPATHIES
Peripheral
Autonomic
pain or loss of feeling in the toes, feet, legs,
hands, and arms
changes in digestion, bowel and bladder function,
sexual response, and perspiration can also
affect the nerves that serve the heart and
control blood pressure can also cause
hypoglycemia (low blood sugar) unawareness, a
condition in which people no longer experience
the warning signs of hypoglycemia.
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What tissues are NOT insulin-dependent?
2. Transporting epithelia of the kidney
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What tissues are NOT insulin-dependent?
3. Transporting epithelia of the intestine
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SUMMARY OF GLUCAGON INFLUENCES
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Meal Absorbed
? Plasma fatty acids
? Plasma glucose
? Plasma amino acids
No Insulin Released
? Glucose uptake (muscle and adipose)
? Glucose utilization
Brain interprets as starvation
Assuming Insulin-Dependent Type 1 Diabetic
Liver
Polyphagia
Hyperglycemia
Exceeds renal threshold for glucose
Glucosuria
Metabolic acidosis
? Ventilation
Osmotic diuresis and polyuria
? Thirst
Polydipsia
Dehydration
? ADH secretion
Lactic acid production
? Blood volume and ? Blood pressure
Attempted compensation by cardiovascular control
center
Anaerobic metabolism
compensation fails
Circulatory failure
Coma or death
23

• American College of Sports Medicine and American
  Diabetes Association General Guidelines for
  Exercise and Type 1 Diabetes
• Metabolic Control Before Exercise
• Avoid exercising if fasting glucose levels are gt
  250 mg/dL and ketosis is present use caution if
  glucose levels are gt 300 mg/dL and no ketosis is
  present
• Ingest added carbohydrates if glucose levels are
  lt 100 mg/dL
• Blood Glucose Monitoring Before and After
  Exercise
• Identify when changes in insulin or food intake
  are necessary
• Learn the glycemic response to different exercise
  conditions
• Food Intake
• Consume added carbohydrate as needed to avoid
  hypoglycemia
• Carbohydrate-based foods should be readily
  available during and after exercise

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• Exercise Recommendations for Type 1 Diabetes
  Based on
• Preexercise Blood Glucose Levels
• Glucose Level Ketones Exercise Advised?
• lt 100 mg/dL - Yes, but carbohydrate
  snack may be needed first (allows
  for individual variation in response)
• 100-250 mg/dL - Yes
• 250 mg/dL No Yes
• gt 250 mg/dL Yes No
• gt 300 mg/dL No Use caution
• gt 300 mg/dL Yes No
• At these levels, some athletes may choose to
  inject a small dose of short-acting insulin prior
  to exercise.

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http//www.uscg.mil/pacarea/morgenthau/Picture20A
lbums/PIE20EATING20CONTEST.htm
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• Recommendations from experts agree that for
  better health, physical activity should be
  performed regularly. The most recent
  recommendations advise people of all ages to
  include a minimum of 30 minutes of physical
  activity of moderate intensity (such as brisk
  walking) on most, if not all, days of the week.
  It is also acknowledged that for most people,
  greater health benefits can be obtained by
  engaging in physical activity of more vigorous
  intensity or of longer duration.
• United States Department of Health and Human
  Services. Physical activity and health a
  report of the Surgeon General. Atlanta, GA US
  Department of Health and Human Services, Centers
  for Disease Control and Prevention, National
  Center for Chronic Disease Prevention and Health
  Promotion, 1999.

http//www.cdc.gov/nccdphp/sgr/sgr.htm
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PERCENTAGE OF ADULTS IN EACH STATE MEETING
PHYSICAL ACTIVITY RECOMMENDATIONS
http//apps.nccd.cdc.gov/PASurveillance/StateSumV.
asp?Year2001
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EXERCISE EFFECT UPON ENERGY EXPENDITURE
Expenditure of energy while the exercise is being
performed
Increase resting energy expenditure REE for a
period of time after the exercise is completed
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