1	Managing Teens and Insulin Resistance Henry Anhalt, DO, CDE Director, Pediatric Endocrinology and Diabetes Saint Barnabas Medical Center Livingston, NJ
2	WHAT IS INSULIN RESISTANCE? 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
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4	TYPE 2 DIABETES-A CARTOON REVIEW
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	Healthy Eating Finding the Right Balance
7	DIABETES “TRIAD” NUTRITION
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
12	General Guidelines Choose Healthy Foods 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
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	Exercise Moving Toward Better Blood Glucose Control
17	DIABETES “TRIAD” EXERCISE
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)
19	Why bother to exercise? Medical blood pressure, cholesterol, triglycerides, weight, A₁c Quality of life fitness, strength need for medication, sleep time Psychosocial stress, depression feel better
20	Why exercise? The main reason I am going to exercise is because I want to: ________________________ ________________________
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)
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
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
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: 4 to 5 times a week
26	My exercise plan… My goal is to exercise ____ times a week. I will start with ____ times a week.
27	How Long? For blood glucose control: 20 to 30 minutes For weight loss: 45 to 60 minutes
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.)
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.
31	Pre-exercise snack adjustments 30 minutes 15g Carb 30 - 60 minutes 15g Carb + 7-8g Protein Long duration 15g Carb per hour and > 2 hours decrease insulin
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.
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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