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Overview of Diabetes Mellitus, Type 2

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This condition is due to cellular resistance to insulin and deficient insulin secretion, which results in a state of hyperglycemia. A fasting blood glucose level of >126 mg/dL indicates diabetes, with levels of 100 to 125 mg/dL possibly indicating a state of prediabetes.1 Age, obesity, and a sedentary lifestyle are the main risk factors for developing type 2 diabetes mellitus. The risk of atherosclerosis leading to cardiovascular and peripheral vascular disease is increased in this population, with long-term complications that include kidney damage, retinopathies, and neuropathies. The lack of physical activity is a key risk factor for these clients and is closely linked to their becoming deconditioned, overweight, or obese.2 This lack of physical activity diminishes clients' skeletal muscle ability to use glucose, and clients become more susceptible to chronic inflammatory conditions that will limit their mobility. Long-term control of hyperglycemia is assessed by the percentage of glycated hemoglobin, known as the A1C test. Hemoglobin A1C percentages should be assessed at least twice per year to determine the client's disease status.

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Benefits of Exercise for Clients With Type 2 Diabetes Mellitus

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Better glycemic control

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Improved body composition due to reduced visceral fat and increased muscle tissue

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Reduced hyperlipidemia and hypertension

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Changes to vascular endothelial lining and improved stroke volume

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Reduced development and advancement of cardiovascular diseases

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Comorbidities to Consider

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  • Risk of atherosclerosis leading to cardiovascular and peripheral vascular disease is increased in this population, with long-term complications that include kidney damage, retinopathies, and neuropathies.

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Client Examination

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Keys to Examination of Clients

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  • Discuss how well they are able to control their insulin levels and the type and scheduling of medications they use to control their insulin level.

  • Screen their overall mobility, vision deficits, and standing balance before starting an exercise program.

  • Inspect their shoes and feet to ensure proper support and health of the skin and nails.

  • Assess vital signs and circulation in the extremities to determine signs of coronary artery and peripheral vascular diseases.

  • Clients with an autonomic neuropathy may have significant increases or decreases of blood pressure with physical activities and are at increased risk for adverse cardiovascular events during exercise.2

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Recommended Baseline Testing of Fitness Levels

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  • Exercise tolerance can be assessed with a graded exercise test using a treadmill or cycle ergometer or the 6-minute walk test.

  • Strength of large muscle groups can be assessed with weight-lifting or resistive exercises using 1- or 10-repetition maximums.

  • Assess client's self-efficacy before and during exercise programs to promote progression to an independently maintained program.3

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Exercise Prescription

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Type: Aerobic, aquatic, resistive, and recreational activities

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Intensity: 60% ...

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