Chapter 14 & 15 Flashcards
What is diabetes?
Type 1?
Type 2?
Abnormal glucose metabolism caused by
Defect in insulin release (Type 1) and/or
Defect in insulin action (Type 2)
What percent of diabetes is type 2? Who does it affect?
90-95% of all cases are Type 2
Affects both adults and children
Disproportionately affects minority population
What are long term complication of diabetes?
Long-term complications impact macrovascular, microvascular,
and neural function
What are diagnostic criteria for diabetes?
Diagnostic criteria: HbA1C ≥6.5%; fasting blood glucose ≥126 mg .
dl−1
What is key first step in diabetes managment?
Self-monitoring is key first step
What is HbA1C and what is its target?
HbA1C: Time-averaged blood glucose concentration over prior 2-3
months; target is <7.0%
What does exercise do for diabetics?
Exercise helps improve blood glucose control, esp. in Type 2
Improves insulin sensitivity of cells
Also reduces risk of CVD (common comorbidity) and BP
What are risks to consider for diabetes exercising? How to manage these risks?
Risks to consider
Hypoglycemia
Hyperglycemia
Acutely uncontrolled diabetes = contraindication for exercise!!!!
Self-monitoring before and after exercise is crucial
When should BG be monitored and what criteria are there?
Patient should check BG prior to beginning exercise
Postpone exercise if >250–300 mg ∙ dL−1 (>13.88–16.65 mmol ∙ L−1) and
ketones are present
If >250–300 mg ∙ dL−1 (>13.88–16.65 mmol ∙ L−1) without ketones, exercise
is okay but use caution;
If <100 mg ∙ dL−1 (5.55 mmol ∙ L−1) and using insulin, consume a
carbohydrate-based snack based on insulin regimen and circulating
insulin levels during exercise;
If 100–250 mg ∙ dL−1 (5.55–13.88 mmol ∙ L−1), exercise is recommended
without limitations
What is the recommended frequency for aerobic exercise for diabetic patients?
Recommended target for aerobic exercise: 150-300 min/wk of
moderate / 75-150 min/wk of vigorous
No more than 2 consecutive days w/o PA/exercise – maintain
heightened insulin action
Type 2 should target higher volume, similar to OWOB patients
Start low and go slow!
What are resistance training recommendations for diabetic patients?
Resistance Training:
Allow for adequate rest between sets
15-60 s for lower intensity; 2-3 mins. for higher intensity
Target 50-85% of 1RM
If joint or health complications are present, start with 1 set of 10-15 and
progress to 15-20 before adding sets
What can increased blood glucose put one at risk for?
Elevated blood glucose increases risk of dehydration
Effect can be exacerbated by heat – also increases glucose
metabolism
Need to monitor blood glucose throughout exercise
Avoid ____ ____when lifting (↑BP)
Break up sedentary time that is ____ minutes
Encourage ____ ____!
Avoid Valsalva maneuver when lifting (↑BP)
Break up sedentary time that is >90 minutes
Encourage active lifestyle!
What order should resistance training and aerobic training be performed in for those with diabetes?
For those on insulin, consider doing RT before aerobic training and
lowering dose around PA
Insulin and food use during diabetic exercise?
For those on insulin, consider doing RT before aerobic training and
lowering dose around PA
Also recommend whole milk or sports drink before, during and after 1
hour of exercise
Should have rapidly absorbed glucose source available during exercise
If post-exercise glucose levels are in excess of 250–300 mg · dL−1, conservative insulin use is recommended
Journal findings of exercise on type 2 diabetes?
Regular aerobic exercise improves overall QoL
Physical components improved but mental did not
RT training alone did not result in improvement
A1C improved by approx. 0.5%
What are the criteria for metabolic syndrome?
Metabolic syndrome diagnostic criteria: 3 or more of following
factors:
Hyperglycemia (or current medication use): FPG ≥ 100 mg ∙ dL−1
Hypertension (or current treatment for): SBP ≥130 mm Hg or DBP ≥85 mm
Hg
Dyslipidemia (or current treatment for): HDL-C <40 mg ∙ dL−1 in men or
<50 mg ∙ dL−1 in women;
Hypertriglyceridemia (or current treatment for): TG ≥150 mg ∙ dL−1
Central Adiposity: waist circumference ≥94 cm (≥37 in) in men or ≥80 cm
(≥31.5 in) in women; or WHR of >0.9 for males and >0.85 for females
What is the prevalence of metabolic syndrome?
Estimated prevalence of 34% in U.S. adults
What does metabolic syndrome increase the risk for?
2-3x higher risk for CVD morbidity and mortality
What are the lifestyle risk factor of Metsyn?
Lifestyle risk factors for Metsyn include
Low levels of PA and fitness
High consumption of soft drinks (including diet), fried foods, meat, and
carbs
Behaviors such as skipping breakfast and heavy alcohol use
Modifiable risk factors of Metsyn?
Modifiable risk factors:
Reduce BW by 7-10 %
Change diet
30 min. of activity 5 days per week
Consider medication as well (not instead)
What is the most important CVD risk factor?
Hypertension
What percent of deaths does hypertension account for?
Accounts for 40% of all CVD deaths
What are risk factors of hypertension?
Risk factors include
Age, race/ethnicity, family history, and genetic factors
Lower education and socioeconomic status
Greater weight and lower physical activity
Tobacco use
Psychosocial factors
Sleep apnea
Dietary factors: dietary fats, high sodium intake, low potassium intake, and
excessive alcohol intake
What are the most modifiable risk factors for hypertension?
Modifiable factors (diet & exercise) seem to be most important
How is dyslipidemia often managed?
Often managed
pharmacologically
Lifestyle changes are important
also
Primary goal of managing dyslipidemia? Percent increase in LDL associated with what percent increase of CVD?
Primary goal is typically to reduce LDL-C
10% increase associated with 20% increase in CHD risk
Majority of patients with Metsyn, hypertension, and dyslipidemia ____ medical clearance or exercise testing
Don’t require
Physician evaluation can be helpful for identifying ____ or
undiagnosed ____
Medical clearance recommended for ___________
Physician evaluation can be helpful for identifying comorbidities or
undiagnosed CVD
Medical clearance recommended for Stage 2 hypertension
Standard exercise testing protocol are ok for ____ and ____
For hypertension, consider:
1.
2.
3.
4.
Standard exercise testing protocol are ok for Metsyn & dyslipidemia
For hypertension, consider:
Magnitude
Controlled or uncontrolled?
Timing of medications
The need to monitor BP responses
Aerobic exercise for metsyn?
Aerobic exercise
Start 40-59% HRR; may progress over 60% if tolerated
Progress from 30 to 60 min. per day
Goal of 150-300+ minutes per week
Describe function of resistance training for Metsyn?
Resistance exercise is critical component
↑ metabolically active tissue
Attenuate hypoglycemic effects
Exercise prescription of hypertension?
Target frequency of 5-7 days per week
Gradual progression and smaller bouts adding up to >30 minutes
per day
Dynamic RT may be as or more effective at lowering BP than
aerobic exercise
Encourage morning exercise!
Exercise prescription of dyslipidemia? Additional consideration?
Maximize energy expenditure with whole-body, large-muscle
aerobic exercise
Combination with RT (2-3x per week) may be most effective
Statin drugs associated with muscle weakness, pain, and cramping
in 5-10% of patients
