Health Promotion: Diabetes - Essay Example

?HEALTH PROMOTION: DIABETES (school) Health Promotion: Diabetes Introduction Diabetes is a chronic disease which affects a huge portion of the population. It is a disease which occurs when the pancreas cannot adequately produce insulin to control blood sugar levels. This causes the increased level of glucose in the blood, otherwise known as hyperglycemia (WHO). Type 1 diabetes is known as insulin-dependent or childhood onset diabetes, characterized by the lack of insulin production; and Type 2 diabetes is known as non-insulin dependent adult-onset diabetes and is caused by the inadequate use of insulin by the body (WHO). Among children and adolescents, this disease seems to have increased in incidence in recent years. Many countries have also registered increased diagnosis of Type 1 diabetes, mostly among young children; and unfortunately, no known methods of prevention have been established for this health issue. Type 2 is a preventable type of diabetes through diet and exercise. Although its onset has been commonly seen among adults, its onset among children and adolescents has seen a recent rise (WHO). The increased inactivity and unhealthy diet among children and adolescents has also been apparent as the primary cause of this health issue. This paper aims to develop an understanding of the foundations which underlie the responses to diabetes among teenage girls. It also aims to develop an understanding of the strategies, activities, and processes employed in health promotion interventions which respond to diabetes among teenage girls. It shall first analyze the socio-ecological context of this health issue, and the intervention which can be applied to this issue. It shall also identify, analyze, and discuss the foundations underlying the selected intervention. And finally, it shall identify, analyze, and discuss the strategies, activities, and processes employed by the intervention in addressing the health issue. Body Socio-ecological context The worldwide epidemic of diabetes is largely based on adult and childhood obesity. Both genetic and environmental factors also seem to be playing an equally important role in the prevalence of this disease in our society. Studies also point out the disproportionate incidence of obesity among men and women, with women more likely to be obese during their childhood and teenage years, as compared to males (Kral). Genes which predispose a person to obesity have been identified by geneticists. These genes have been identified as related to functions which control hunger and satiety, as well as on the regulation of fat cell multiplication and cellular energy balance (Kral). Lifestyle factors are however the more common causes of obesity, which relate to high fat and cholesterol intake, as well as high sugar diet. The sedentary life of these adolescents also impact significantly on the prevalence of teenage obesity with most of their activities limited to watching TV, playing computer games, surfing the internet, and a limited involvement in physical education and sports activities in schools (Kral). Childhood and adolescent obesity, if unmanaged, can lead to adult obesity and to a host of other health issues. Childhood and adolescent obesity is especially disturbing as it has been known to cause various health issues including diabetes, hypertension, fatty liver disease, and various cardiovascular diseases. “The Centers for Disease Control and Prevention has predicted that diabetes will develop in one-third of all children born in 2000, related to the current prevalence of obesity” (Kral). Based on this context, one of the most appropriate ways to handle this health issue is to address the obesity and weight issues of teenage girls. Based on the discussion above, a significant contributor to adolescent diabetes is inappropriate diet and inadequate exercise. By reducing the weight of teenage girls, diabetes can be prevented and can be easily managed. An exercise support group can bring about an improved disposition among these teenage girls. Exercises and increased activity can reduce the risk of being afflicted with diabetes, and it can also assist in the adequate management of the disease. Foundations underlying selected intervention The underlying goal/objectives of the intervention would be to help the teenager lose weight, in order to reduce and maintain her blood sugar at acceptable and safe levels. The goals of the exercise group are also to increase the patient’s metabolism, to facilitate weight loss, and the burning of excess calories. Individuals can eat more and not gain weight – this is the general rule, however, metabolism usually decreases once a person reaches his 30s, and by then, a person also starts to gain weight (University of Utah). As was previously mentioned, the impact of diabetes has now been seen on, not just the older population, but the younger, teenage and childhood population as well. And increased activity can assist in weight control and maintenance with the continuous burning of excess calories. In a study by Boule, et.al., (p. 1218), exercise interventions were reviewed among diabetic patients with body mass indices measured among respondents. The study revealed that the HbA1c seen among these respondents was significantly lower as compared to control groups or non-exercise groups. Moreover, the weight loss of the respondents from exercise was not significantly affecting the respondent’s body weight. Weight loss is not therefore necessary in producing the improvements of decreased A1c levels among exercising diabetic patients. In effect, structured and well managed exercise programs have a better chance of producing a beneficial impact on blood sugar control, and this impact is not necessarily ushered in by weight loss (Boule, et.al., p. 1071). The Boule study also indicated that the intensity of the exercise is more important than the length and volume of the exercise in decreasing and managing blood sugar levels. Such results provide strong support for the importance of encouraging diabetic patients to exercise at a lower intensity to increase their exercise to intensive levels in order to gain the benefits in glucose control. Physical exercise is also an important element of diabetes management because it reduces the patient’s exposure to related risk factors including cardiovascular diseases and even death (Sigal, et.al., p. 1001). A report from the US Surgeon General recommend that people should accumulate more than 30 minutes moderate intensity exercise every day of the week; however, this cannot always be carried out as many individuals do not have the time to set aside time for each day to exercise. The report further noted that the three-times a week exercise is a much easier and much tolerable routine for most people, including diabetics (US Surgeon General). The impact of a single bout of exercise on insulin sensitivity is seen to last for about 24 to 72 hours, largely dependent on the duration and intensity of the exercise (Wallberg-Henriksson, et.al., p. 25). Since the increase in insulin sensitivity cannot last longer than 72 hours, experts recommend that there must not be more than two consecutive days without aerobic physical exercise. They also recommend that including resistance training to one’s physical activity can help improve and extend insulin sensitivity, most likely caused by the increase in muscle mass (Zachwieja, et.al., p. 254). These exercises form the basis of weight loss and increased insulin sensitivity which eventually assist in the maintenance and reduction of HbA1c levels. Exercise programs are intended for long-term weight control, and glucose level management. These programs have traditionally involved diet, exercise, and behavior modification (Wing, p. 355). Exercise without caloric restriction and behavior modification would not be able to produce the ideal weight loss levels for diabetic patients. Among obese patients, weight loss can be difficult and take longer because of the need to create a significant energy deficit to implement the desired weight loss levels. Therefore experts ideally recommend that calorie restriction and atleast an hour of moderate-intensity exercise daily can produce the desired improvement in insulin sensitivity (Ross, et.al., p. 92). The most favorable amount of exercise needed in order to secure sustained weight loss is much more significant than that needed in order to produce improved blood sugar control and cardiovascular gains. Studies of individuals successfully losing a significant amount of weight in the course of a year indicate that they carried out their exercise for more than 7 hours in a week, in moderate to vigorous intensity exercises (Sigal, et.al., p. 1001). In effect, higher intensity volumes, as well as increased intensity in these activities were able to create a more sustained weight loss program for the diabetic patients. The exercise support group for diabetic teenage girls would therefore bring forth significant benefits because a decrease in weight would be seen and an increased sensitivity to insulin would help decrease blood glucose levels. Evidence from various studies indicates that in addition to aerobic exercises, resistance training can also potentially improve a diabetic’s exercise program. Increased fat density and reduced muscle mass can cause sarcopenia and a decreased functional capacity, as well as decreased metabolism (American College of Sports Medicine, p. 992). Resistance activities can improve insulin sensitivity in a better extent as compared to aerobic exercises. Clinical trials have been carried out and have provided strong evidence reflecting the value of resistance training among type 2 diabetic patients (Sigal, et.al., p. 1433). With the application of a combination of these therapies within an exercise program for teenage diabetic patients, it is possible to achieve weight loss and maintain such loss, to reduce blood sugar levels, and to increase insulin sensitivity. Strategies, activities, processes in the diabetic control Strategies in the implementation of diabetic control would initially include the conceptualization of the plan either in the school or the community setting. The inclusion of this program in the school setting would require the assistance of the school nurse and the school psychologist who would identify the diabetic teenage girls who can be included in this program. The administrators of the school would also have to coordinate with health authorities, including exercise and diet experts who would build and create the exercise program. After the diabetic obese girls are identified, communication with their parents as well as the girls themselves has to be set-up. This meeting would include the school psychologist and the school nurse and the diabetic teen as well as her parents or guardians. The program shall be explained to them, and their consent on the inclusion of the teen in the program shall be sought. Those agreeing to enter in the program shall be noted and identified. A schedule for the first meeting shall be set. Those included in the program shall be ensured confidentiality and assured of their choice to leave the program any time they want. Planned exercises and other activities shall then be scheduled with the trainers and health experts. In the community setting, an exercise group can be established in coordination with the community health center. The community health centers can coordinate with the local officials and other interested parents who are interested in entering their diabetic teenage daughters in the exercise group. This program shall also involve the health expertise of dieticians, nurses, and other health and exercise experts who shall plan the program and coordinate the implementation of the program with the community leaders, as well as the interested parents. The planning phase would also include the acquisition of health equipment, scheduling of work-outs in gyms and other fitness exercise centers, and similar other requirements which help secure the success of the strategy. Specific activities The more specific activities which would form part of the overall strategies would include 30 minutes of aerobic exercises daily, and 30 minutes of resistance training daily. Aerobic exercises would include warm-up stretching for five minutes, twenty-five minutes jogging or brisk walking, or any other suitable aerobic exercises recommended by the trainer or exercise expert. The choice of aerobic exercise would largely depend on the tolerance and preference of teenager involved (Jakicic, et.al., p. 1323). Strength and resistance training would include ten minutes of dumbbell or kettle bell swing exercises, whichever is preferred. Weight lifting for twenty minutes would also be carried out. These activities are meant to strengthen and build muscles, helping to facilitate insulin resistance and improved metabolism (Jakicic, et.al., p. 1323). A cooling down period shall end the exercise sessions. The conduct of these activities would be per group, depending on the preference of each individual. These activities shall be carried out as a group and be scheduled as a group, with the coordination of time and activities based on group preference and group availability. Other activities would also include group sharing atleast once a week where the members of the group would share with each other their experiences and feelings about the activities (Mo-Suwan, et.al., p. 1006). This group sharing would include a psychologist or a counselor who can facilitate the sharing process and assist the teenagers in wading through their feelings and in coping with the difficulties they may experience with the exercises and group activities. All in all, these group sharing activities serve to roundup each week of exercise and help reinforce the willpower of the diabetic teens. These strategies are to be developed based on the support group processes. Support groups help provide emotional support to the participants. The shared experience and emotions of the participants would help them identify with each other, and serve as each other’s support system (Mo-Suwan, et.la., p. 1006). They would also likely feel a better and stronger affinity and understanding of each other because of their shared experience. Compliance with the demands of the exercise regimen would therefore be higher in these exercise groups. The teens would be better engaged in the activities and would not feel ostracized or self-conscious about their weight or their health issue. The strategy of exercise groups work on the same concept as support groups for other addictions, including drug, alcohol, sex, anger, and similar mental health issues. By gathering the individuals who share the same health issues, it is possible to implement a common program which can address the issues faced by the patients under similar circumstances (Fraser and Spink, p. 233). These exercise groups would also help provide an easier and more supportive environment to carry out difficult exercises and similar tasks. The implementation of the exercises would be very challenging; it would test the patients physically, emotionally, and mentally. At various points during the exercise program, the teenage diabetics would likely feel like quitting the program or just absent themselves from the exercise sessions. The support group nature of the program would help ensure that the difficulties the patient would be experiencing would be shared with each other and would be managed as a group (Fraser and Spink, p. 233). Losing weight and keeping up with the demands of decreased blood sugar levels is an emotionally challenging undertaking. It can also be depressing for some teenagers. However, with the help of a group, of peers sharing the same problems, the teenagers would feel less depressed, and would develop a stronger morale for their challenge and planned exercise regimen. Exercise has long been considered the primary basis for diabetes management. Various studies have been undertaken throughout the years on the intensity as well as the type of activities needed in order to manage diabetes. As was previously mentioned resistance training is one of the recommended additional exercises in diabetes management (Sigal, et.al., p. 2518). Exercise causes a shift in the energy-fuel usage by the muscle from nonestrified fatty acids (NEFAs) to a combination of NEFAs, glucose and muscle glycogen (Sigal, et.al., p. 2518). Muscle glycogen is the main source of fuel in the initial stages of exercise, and as the duration of exercise progresses, the circulating glucose and NEFAS increase in usage as muscle glycogen is gradually utilized (Sigal, et.al., p. 2518). The source of blood glucose also changes from hepatic glyconenolysis to glyconeogenesis and with improved intensity of exercise, substrate usage changes to higher carbohydrate oxidation. Even as metabolic reaction to exercise is affected by various factors including nutrition, kind of activity, and physical condition, the most crucial elements impacting energy use are mostly based on work intensity and duration (Sigal, et.al., p. 2519). Energy mobilization is controlled by the neuroendocrine system during aerobic activities. When activity or exercise is sustained, there is a reduction in insulin secretion, and increase in glucagon, catecholamines, cortisol secretion, as well as other hormones. These hormones which impact on other hormones and nerve changes also affect decreased levels of fuel availability, feed-forward tools, as well as increased afferent nerve activity (Sigal, et.al., p. 2519). In effect changes in the metabolic state, as well as energy metabolism during exercise would be apparent. The exercise group program is an important part of diabetes management because it addresses not just the physical issues related to weight management, but it also addresses the emotional issues confronting teenage diabetics, especially those who are obese (Fraser and Spink, p. 234). There is a consonance between the exercise program and the exercise group because it ensures that the exercise process can be implemented under similar conditions which complement each other and help improves patient outcomes. Teenage girls are in a phase in their lives where they are very much self-conscious about their image and physical looks. They have the image of a thin model in their head and believe that that it how they should look like as well. However, due to the high cholesterol and high sugar diet of these teenagers, they are often at risk for obesity, and as a result expose themselves to health risks like cardiovascular diseases and diabetes (Fraser and Spink, p. 235). In order to manage the diabetes, exercise and diet can be implemented. Hence, the above program suggested for the teenage diabetics. Conclusion The above program is founded on health goals which help to manage a patient’s diet and exercise in order to prevent obesity or help the patient lose weight. In this case, diabetes is considered in the light of obesity and how the weight can be reduced or managed in order to reduce blood sugar levels and improve insulin sensitivity. The relevance of the exercise group all boils down to the establishment of a support group – one which would address the emotional issues which interfere with the exercise program. By addressing the emotional issues of an emotionally vulnerable teen, it is possible to build an exercise regimen which would be sustainable and which would last even beyond the exercise sessions with the group. Works Cited American College of Sports Medicine. 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