UNIT ONE LESSON 3 OUTLINE Welcome participants and ask how they are doing supporting each other. Remind them: When a person has diabetes their blood glucose level is too high. Taking part in physical activity is one of the ways to manage your diabetes. Managing your diabetes will lower your risk for heart disease and problems with your kidneys, eyes, nerve, feet and teeth. Read and briefly describe objectives to participants. Distribute Factsheet
Ask participants if they are aware of all the benefits of physical activity. You can also mention that physical activity can help prevent type 2 diabetes. One particular study, by the Diabetes Prevention Program, showed that if a person who weighs 200 pounds loses 10 to 15 pounds, he or she could delay or even prevent the onset of type 2 diabetes. Tell participants they can look at Factsheet Physical Activity and Diabetes FCS3-541 as you go through the lesson. This should be in their folders. Let us look at the types of physical activity. These activities are lifestyle focused. They rarely require medical clearance from a doctor, and they do not require special training.
Ask which of these exercises participants prefer to do on a regular basis. Question: How do you know if an activity is of moderate endurance or intensity? Answer: The talk test is a simple way to measure relative intensity. As a rule of thumb, if you re doing moderateintensity activity you can talk, but not sing, during the activity. Remember to start slowly and build up your endurance. Question: How do you know if an activity is of vigorous endurance or intensity? Answer: The talk test is a simple way to measure relative intensity. As a rule of thumb, if you re doing vigorousintensity activity, you will not be able to say more than a few words without pausing for a breath. Strength-building exercises make it easier for you to do chores. These exercises strengthen your bones, and they improve balance and coordination. Some strength-building exercises, such as heavy lifting, can increase the blood pressure in the vessels of the eyes. You should check with your doctor before you begin these and other related exercises.
Read information on slide. Use Factsheet Don t Let a Fall Get You Down FCS7-193 as a reference. Demonstrate some of these balance exercises. Participants can find this factsheet in their folders. Stretching exercises help you to become more flexible, help lower stress levels and prevent muscles from becoming sore after you have exercised.
This could mean walking briskly for 30 minutes on five days of the week. On each of these five days you can divide your 30 minutes of physical activity into 15 minutes in the morning and 15 minutes in the evening or in a way that works best for you. Physical activity could also be broken up into 10-minute segments. Let participants know that some physical activity is better than no physical activity. True or false: If you have not been physically active before or if you have not been meeting these requirements, you can start out slowly. Answer: True Ask: How can you meet the requirement for physical activity? What barriers do you face when starting to become active and how can you overcome these? Read information on slide Read information on slide. Tell them: mm Hg = millimeters of mercury (standard unit for blood pressure)
Each person s plan needs to be individualized based on: (a) Age; (b) Weight; (c) Medical history; (d) Fitness level; (e) Personal goals. Work with your doctor to: (a) Select the type of exercises; (b) Set exercise schedule (how often). In a physical activity log, record the following information for each session: (a) Blood glucose level at 20 minutes before and after exercise; (b) Type, duration and intensity of exercise; (c) Any strange symptoms, such as: pain, dizziness or shortness of breath. Choose an activity you really enjoy so that you are more likely to continue with it. Walking, doing yard work and dancing are good ways to start exercising. Bring a friend or family member to make it more fun. Ask participants: How physically active they are at this present time? What are some of the consequences of not being physically active? What are your feelings related to starting an exercise plan? Ask participants why it is important to follow the safety tips for exercise.
If blood glucose is low you should wait until it is up to at least 100mg/dL before exercising. Ketones in the urine signal insulin deficiency. High blood glucose due to insulin deficiency may increase with exercise. This mainly occurs in type 1 diabetes. At this time, show the Diabetes Education Series CD and select the section on Physical Activity and Diabetes, or have participants share their experiences with physical activity. Allow time for participants to share their feelings and experiences.
1. Ask participants how they did in accomplishing their goal from last week. (a) For those who accomplished their goals, ask what actions were taken to be successful. Provide incentives for those who met their goals; (b) For those who did not accomplish their goals, ask if they took steps to meet their goals. If they did, acknowledge that they are moving in the right direction. 2. Move onto setting a new goal for this week. Talk with your participants about how goal setting can help them with diabetes management. 3. Tell participants to set a goal that they can accomplish in the upcoming week. 4. This week, the goal should be related to physical activity. 5. The participants can record their goals on the Goal Setting Worksheet (found in the Appendix for Lesson 1 and should be in their folders from last week). NOTE: Now is the time to introduce both the 9-Week Plan for Physical Activity and Physical Activity Record handouts. These will help participants achieve their goals for the upcoming week. 6. Discuss SMART goals. Is your goal Specific, Measurable, Action-oriented, and Realistic, and Time framed? 7. Select goals from some of the participants to share with the group. The answers to the PowerPoint questions can be found in the appendix for this lesson. Show the next slide as you read the story.
Cindy is 45 years old and has just been diagnosed with diabetes. She has not been feeling well for the last month. She realized that she had to get up in the night frequently to go to the bathroom and was always thirsty. Cindy always had a problem with her weight. In the past three years, she gained more than 45 pounds. She used to enjoy walking, but when her husband died she found herself not wanting to go out. She stays inside and watches television most of the day. Now that she has been told by her doctor that she has diabetes, she feels like it is a death sentence and at this point does not know how this could happen to her. What is Cindy s problem? Cindy: (a) has gained a lot of weight in the past three years; (b) has been diagnosed with diabetes; (c) seems to be in denial; and (d) is living a life of inactivity which is not helping with her diabetes. Why is this a problem for Cindy? Diabetes that is not managed could lead to complications such as eye disease, kidney disease, amputations, heart disease, and stroke. Being inactive could lead to chronic diseases such as diabetes, heart disease, hypertension and some types of cancers. Depression may also accompany the diagnosis leading to further inactivity and issues with blood glucose control. What are some things that Cindy needs to do to solve her problem? (List as many suggestions as possible.) Cindy should take steps to manage her diabetes. These steps could include: (a) healthy eating with attention to portion sizes; (b) being active; (c) monitoring blood glucose; (d) taking medications as prescribed; (e) problem solving; (f) reducing risky behaviors, such as smoking; and (g) healthy coping. Cindy could also: (a) find new friends; (b) join an exercise group; and (c) develop a diabetes health care team that includes a physician, registered dietitian, registered nurse, certified diabetes educator, pharmacist, eye specialist, foot specialist, dentist, and/or social and mental health workers. What might be the best way to solve her problem at this point? Why? This answer may vary with participants. The goal is to have participants be able to justify their answer.
The handout with completed answers can be found in the Appendix for this lesson. The handout for participants to complete will be in their folders. The questions can be completed as group work or takehome work. Tell participants to find the Recipe: Kentucky Breakfast Wrap. Breakfast is an important meal for everyone, especially so for a person with diabetes to break-the-fast. It is important to eat meals at regular times. Whole wheat tortillas add fiber, slowing down digestion, so spikes in blood sugar do not occur. Raw vegetables help to fill you up, making the meal more satisfying. Tips: Garnish with two tomato wedges and a sprig of curly parsley. Make wraps ahead of time. Cover each with plastic wrap as much as three days before using. Leave wrap on and microwave on high for 30 seconds to 1 minute. You may not want to be chopping vegetables in the morning as you are getting ready for work. Many of the vegetables can be chopped in advance then kept in sealable containers. By having veggies pre-chopped, you are ready to toss them into salads and other dishes when you cook or snack. Read about egg substitutes. American Egg Board Encyclopedia. Accessed on October 25, http://www. incredibleegg.org/e_egg_substitutes.html
Take some time to allow participants to share what they learned this week. Allow the group to discuss ways in which they can support each other.