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
