Exercise for Special Pops- Case Study

W.G. is a 41-year-old white man who was diagnosed with diabetes 15 months ago. He is now

beginning diabetes education and medical nutrition therapy (MNT) to lose weight upon referral

from his primary care physician. His most recent hemoglobin A1c (A1C) was 8.5%. His current

diabetes medication is metformin (Glucophage), 500 mg with breakfast, and he started on

pioglitazone (Actos) 2 weeks ago. He takes no other medications; denies smoking, alcohol, and

drug use; and knows of no health problems other than diabetes.

His history revealed a blood glucose level >500 mg/dl at the time of diagnosis and the patient

states that his resting glucose values vary a lot. He complains of frequent urination, hunger,

and thirst, which leads to drinking more than 1 gallon of water daily. He is very concerned

because he is often agitated, anxious, and impatient to the point that it is affecting his family and

work life. He was employed as a technician but is on leave until he feels better. His physician

prescribed alprazolam (Xanax) for anxiety, but he did not fill the prescription.

Physical assessment reveals a height of 74 inches, and a weight of 274 lb. Resting HR of 88

bpm, and BP of 124/80 mmHg. He reports that he has always had trouble with his weight and

currently he walks casually around his neighborhood without complaints.

Assume that you are the Exercise Physiologist who directs the exercise portion of the diabetes

education program. Please answer the following questions:

1. What type of Diabetes Mellitus does this client most likely have? Why?

- Our client has Type II diabetes, this diabetes has occurred later in life as our client is 41.

The resting glucose is greater than 500 mg/dl. He is overweight as he comes in at 74 inches

and a whopping 274 pounds.

2. What is important to note about his given health history regarding Diabetes? What

additional questions might you want to ask this client?

- It is important to note that our client seems to have had a problem with weight control for

some time.

❖ Prior to 15 months ago, what was your lifestyle like?

❖ Have you met with an endocrinologist?

❖ Have you ever participated in exercise?

3. Prior to prescribing him an exercise prescription, what might you want to educate him

about prior to starting your program?

- How exercise will benefit him

- Possible restrictions from exercise

- Clearance issue, sore/cuts, high intensity, Blood sugar too high

4. Create a basic initial exercise prescription (FITT) that he would complete at home

including cardio, resistance, flexibility if applicable.

Cardio:

- 3-7 days/week, 50-80% VO2, about 30 minutes, Walking either on a treadmill or

outdoors

Resistance:

- 2-3 days/week, 2-3 sets of 8-12 repetitions(60-80% 1RM), Working mainly larger

muscle groups

Flexibility:
 - Done Daily for about 10 minutes per session

5. With exercise list at least 3 precautions or considerations you will need to discuss with

this client?

1. Illness/infection is present

2. Blood Glucose over 250 mg/dL

a. Need to monitor

3. Have a carb source available that does not contain fat