Managing Teens and
Insulin Resistance
Henry Anhalt, DO, CDE
Director, Pediatric Endocrinology and Diabetes
Saint Barnabas Medical Center
Livingston, NJ
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
TYPE 2 DIABETES-A CARTOON
REVIEW
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

Healthy Eating
Finding the
Right Balance
DIABETES
“TRIAD”
NUTRITION
Exercise
Medication
How do we choose our
food?
Taste and enjoyment
 Tradition and custom
 Convenience
 Mood
 Hunger
 Cost
 Health and nutrition

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?

Why is healthy
eating important?
Blood sugar control
 Reduces risks of complications

–
–
–
Cholesterol
Blood pressure
Kidney disease
Weight control
 Feel good

Meal planning questions:
True or False
You can’t eat any sugar
False
You must have 3 snacks a day
It is different for everyone
False
True
You don’t need special foods
It is complicated
True
False
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
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

What about “fast foods”?
Look for healthy choices
 Learn what is in the food
 Watch out for hidden fats

Exercise
Moving Toward Better
Blood Glucose Control
DIABETES
“TRIAD”
Nutrition
EXERCISE
Medication
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)

Why bother to
exercise?

Medical
–

Quality of life
–
–

blood pressure, cholesterol,
triglycerides, weight, A1c
fitness, strength
need for medication, sleep time
Psychosocial
–
stress, depression
feel better
Why exercise?
The main reason I am going to
exercise is because I want to:
________________________
________________________
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)
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
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
My exercise plan...
For my exercise program I will
____________________________
How Often?
For blood glucose control:
3 to 4 times a week
For weight loss:
4 to 5 times a week
My exercise plan…
My goal is to exercise ____ times a
week.
I will start with ____ times a week.
How Long?
For blood glucose control:
20 to 30 minutes
For weight loss:
45 to 60 minutes
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.)
What Time of Day?
Pick a time that fits into:
–
–
–
daily schedule
lifestyle
diabetes management plan
My exercise plan...
The time of day I will most likely
exercise will be ____ AM / PM.
Pre-exercise
snack adjustments
30 minutes
15g Carb
30 - 60 minutes
15g Carb +
7-8g Protein
Long duration
> 2 hours
15g Carb per hour and
decrease insulin
Summary

Review your reasons to exercise

Review your exercise plan

Be consistent

Enjoy your success!
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

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

Developing a clear and
realistic plan

Completing the three QuickPlans:
–
–
–
Monitoring
Meal Planning
Making time for exercise
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
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.

Obstacles to Exercise
Exercise is boring
 Too hard to find the time
 May cause hypoglycemia
 May cause too much pain/discomfort
 Too tired to exercise
 No one to exercise with

Overcoming Obstacles to
Exercise
Try something new
 Turn an unpleasant activity into a
pleasant one
 Modify environment to make exercise
more convenient

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

A Contract for Self-Care
Your action plan for diabetes success
 Expect the occasional problems
(ongoing problem solving is necessary)
 Stay in touch!

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

Forces that Threaten
Empowerment
Fear
 Anger
 Ignorance
 Hopelessness
 Misguided Help

4 Pillars of Empowerment
Awareness
 Chioce
 Freedom
 Resposibility
