tailieunhanh - Medical Management of Diabetes and Heart Disease - part 10

Cải thiện chất lượng cuộc sống và lòng tự trọng, và giảm căng thẳng tâm lý. Các tác dụng phụ chủ yếu của tập thể dục cấp là hạ đường huyết. Bệnh nhân cần phải hướng dẫn cụ thể hoặc là để tăng tiêu thụ carbohydrate | Nonpharmacological Risk Reduction 269 9. Improved quality of life and self-esteem and reduced psychological stress. The primary side effect of acute exercise is hypoglycemia. Patients require specific guidelines either to increase carbohydrate consumption or to decrease medication based on the intensity of exercise and relationship of the planned exercise to the timing of the next meal. For those attempting to lose weight medication adjustment is chosen over adding extra calories. For some exercise after a meal without medication adjustment is preferred. Postexercise late-onset hypoglycemia PEL occurs several hours following an exercise session and is a significant concern for those treated with insulin or insulin secretagogues. Postexercise late-onset hypoglycemia can be the result of acutely increased insulin mobilization and sensitivity increased glucose utilization replenishment of glycogen stores and defective counterregulatory mechanisms. Patients need to learn how to prevent PEL by remembering to supplement carbohydrates during the postexercise phase to reduce the dose of insulin that peaks during the postexercise phase and to monitor blood glucose frequently. The American Diabetes Association recommends a graded exercise test for patients at high risk for underlying cardiovascular disease based on the following criteria 16 age 35 years type 2 diabetes of 10 years duration type 1 diabetes of 15 years duration presence of any additional risk factor for coronary artery disease presence of microvascular disease including microalbuminuria peripheral vascular disease and autonomic neuropathy. Rhythmic exercises with the use of the lower extremities such as walking or cycling are safely recommended. Patients with established cardiovascular disease usually require supervision in a monitored cardiac rehabilitation program. Unfortunately little is known about how to increase or maintain participation in exercise programs. Relapse is common and all health care .