Ch.17 Flashcards
Diabetes
- hyperglycemia resulting from inadequate insulin secretion (type 1)
- reduced insulin action (type 2)
Diabetes is diagnosed on basis of
Plasma glucose criteria
- either based on fasting plasma PG>- 136 mg or two hour plasma glucose value after 75g oral glucose test
- or glycosylated hemoglobin criteria (PG >-6.5%
Diabetes are divided into two distinct groups on the basis of whether
Diabetes is caused by lack of insulin (type 1) or resistance to insulin (type 2)
Type 1 develop primarily in
- young people and is associated with viral infections
Warning signs for type 1 diabetes
- frequent urination/unusual thirst
- extreme hunger
- rapid weight loss, weakness, and fatigue
- irritability, nausea, and vomiting
Type 2 diabetes
- develop later in life and represents 90-95% of all diabetes cases
- linked to upper body or android obesity and physical inactivity
- increases production of pro inflammatory cytokines (TNF-A) and decreases antiinflammatory hormones like adiponectin
Ketosis
- metabolic acidosis resulting accumulation of too many ketone bodies
Why is exercise a good treatment of diabetes?
- Exercise increases rate at which muscle removes glucose from blood to provide energy for contraction
Beneficial effect of exercise is dependent on
- whether the individual with diabetes is in reasonable control before exercise begins
- control means that the blood glucose [] is close to normal
Those who have sufficient insulin such that glucose can be taken up into muscle during exercise and can counter the normal increase in glucose release from the liver due to the action of catecholamines and glucagon
Those who have sufficient insulin such that glucose can be taken up into muscle during exercise and can counter the normal increase in glucose release from the liver due to the action of catecholamines and glucagon
Why the difference in response between those who is in control and those who do not inject an adequate amount of insulin before exercise
Those who have sufficient insulin such that glucose can be taken up into muscle during exercise and can counter the normal increase in glucose release from the liver due to the action of catecholamines and glucagon
What causes dangerous hypoglycemic response?
If an individual with insulin dependent diabetes starts exercise with too much insulin, the rate at which plasma glucose is used by muscle is accelerated , while glucose release from liver is decreased
What is the greatest concern regarding diabetes 1
Possibility of hypoglycemia which can lead to insulin shock
Those who are diagnosed with type 1 diabetes and can partake in which kind of activity without medical clearance
- moderate intensity (40-60%) HRR exercise for 30 mins on at least 3 days a week
Primary concern to address when exercise is prescribed for individuals with type 1 diabetes is
The avoidance of hypoglycemia
- achieved through careful self monitoring of blood glucose [] before, during, and after exercise and varying carb intake and insulin depending on exercise intensity, duration, and fitness of individual
The concern for the retina, kidney, regarding the observation of strenuous exercise (type 1 diabetes)
Retina: Related to the higher blood pressures developed during exercise
Kidney: related to the decrease in blood flow to that organ with increasing intensities of exercise
Peripheral: peripheral nerve damage may block signals coming from the foot such that serious damage may occur before it is perceived
Things to make sure when prescribing exercise program type 1 diabetes
- Metabolic control before physical activity (avoid physical activity if fasting glucose levels are >250 mg/dl and ketosis. Is present)
- Blood glucose monitoring before and after physical activity
- Food intake (consume added carbohydrate as needed to prevent hypoglycemia, carb foot should be readily available during and after physical activity)
ACSM Redmond’s the following for type 1 diabetes aerobic training
Aerobic exercise training:
- 3-7 days per week
- work at 40 to 85% HRR
- 20-60 mins per session to get 150 min of moderate of 75 min of vigorous intensity activity
- use non weight bearing low impact activities
ACSM Redmond’s the following for type 1 diabetes resistance training
- Exercise 2-3 days per week
- work at 60-80%
- do 1-3 sets of 8-12 repetitions for major muscle groups avoiding valsalva maneuver
what is the most important variable in achieving blood glucose control as measured by hbA1C
Exercise volume
Given that many individuals with type 2 diabetes are overweight or obese
- focus should be on moderate intensity physical activity in which individual scan begin with 10 min bouts, with goal of 150 mins per week
- ## frequency should be 4-7 times a week to promote a sustain increase in insulin sensitivity in muscle
Exercise is only one part of treatment for type 2 diabetes what is the other
Diet
What are the four goals related to nutrition therapy for all people with diabetes
To achieve and maintain:
- blood glucose levels in normal range or as close to normal
- lipid and lipoprotein profile that reduces the risk for vascular disease
- blood pressure levels in normal range
- To prevent the rate of development of chronic complications of diabetes by modifying nutrient intake
- to address individual nutrition needs taking into account personal and cultural preferences and willingness to change
- to maintain the pleasure of eating by limiting food choices only when indicated by scientific evidence
Emphasis in achieving optimal nutrition is through
Benefits from proper exercise and dietary practices:
Lower body fat and weight, increased HDL cholesterol, increased sensitivity to insulin, improved capacity for work, and improved self concept
Those who are predisposed to have allergies B cells produce
IgE antibodies rather than IgG antibodies which attach to surface of mast cells lining the bronchial tubes
- upon reexposure, the allergen binds to these IgE antibodies on the mast cells and large amounts of various inflammatory mediators are released from mast cells
Mediators include and what do they cause following early phase reactions
Histamine, prostaglandins, and leukotrienes
- increased secretions of mucus
- increased blood flow
- swelling of epithelial linings
- contraction of smooth muscle surrounding airway
Immunotherapy
If a person cannot avoid contact with the allergen, immunotherapy can be helpful making the person less sensitive to the allergen while being treated
Chromodynamics sodium
Inhibits the chemical mediator resales from mast cell
Beta receptor agonists (B2 agonist)
Decrease chemical mediator release and cause relaxation of bronchioles smooth muscle
Chromodynamics sodium and B2 agonist are brought about through increase of
Adenylate Cyclades activity leading to elevation of cAMP
What is used for long term management of asthma?
Corticosteroid and leukotriene antagaonists which are used to reduce inflammation response
What % of Olympic team members won medal with EIA
61%
What is the focus of attention is now on what for exercise induced asthma
Cooling and drying of respiratory tract that occurs when large volumes of dry air are breathed during the exercise session
What is the proposed mechanism for how EIA is initiated
- when dry air removes water from surface of mast cell, increase in osmolarity occurs
- increase in osmolarity triggers the release of chemical mediators and narrowing of airways occur
Probability of of an exercise induced bronchospasm is related to
Type of exercise, the time since since the previous bout of exercise, the interval since medication was taken, and temperature and utility of inspired air
- running was observed to cause more attacks than cycling or walking which chased more than swimming
What is classified as a positive test for cool or dry air in elite athletes
10% or greater decrease in forced exploratory flow rate in one secon d
Aerobic exercise program recommendations for those with asthma
- frequency: at least 2 to 3 days per week
- intensity: 60% of Vo2 peak or the work rate at ventilators threshold
- time: at least 20 to 30 min/ day
Advise for exercising when having asthma
- use a scarf of facade mask which can be used when exercising outdoors in cold weather to help trap moisture
- participant should carry an inhaler with B2 agonist and use it at first sign of wheezing
A typical COPD rehabilitation center focuses on
Patient’s ability for self care
Global initiatives for chronic obstructive lung disease classify patients following 4 categories based on post bronchodilator FEV1
Gold I mildCOPD: FEV1 >-80%
Gold II Moderate COPD: 50%
In addition to using exercise to lower elevated blood pressure, it is recommended that individuals
- lose weight if overweight
- limit alcohol intake
- reduce sodium intake (1.5 a day)
- eat a diet rich in fruits, vegetables, low fat dairy products
- stop smoking
Nitroglycerin
Used to prevent an attack and or relieve the pain by relaxing the smooth muscle in veins to reduce venous return and the work of the heart
Those who have aging may be treated with
Beta blocker to reduce the HR and or blood pressure so that angina symptoms occur at a later stage into work
Myocardial infarction
- patients have actual heart damage due to a prolonged occlusion of one or more coronary arteries
- patients are on medication to reduce the work of heart and control the irritability of heart tissue so that arrhythmia do not occur
Coronary artery bypass graft surgery
- have surgery to bypass one or more blocked coronary arteries
- saphenous vein or an internal mammary artery from the patient is sutured onto the existing corral attires above and below the blockage
Percuatenous transluminal coronary angioplasty
- To open occluded arteries
- chest is not opened; instead a balloon tipped catheter is inserted into the coronary artery where the balloon is inflated to push the plaque back towards he arterial wall
