Diabetes Flashcards
What are the diagnostic criteria for pre diabetes and diabetes mellitus?
Normal:
- HbA1C: 5.7% (38 mmol)
- FPG 100 mg.dL (5.6 mmol/L)
- OGTT (75 gram): 140 mg.dL (7.8mmol/l)
Diabetes:
- HbA1C: 6.5%+ (48 mmol)
- FPG: 126 mg.dL (7.0 mmol/L)
- OGTT (75 gram) >200 mg.dL (11 mmol/ll)
Pre diabetes is any value between the two
Why are individuals with pre-diabetes very high risk to develop diabetes?
Capacity of the beta cells to hypersecrete insulin diminishes overtime and becomes insufficient to maintain blood glucose
What are the benefits of regular exercise for T2DM diabetes?
1) Improved glucose tolerance
2) Multiple CVD risk factors
3) Quality of life
4) Prediabetes: Prevent or delay transition
5) Reduced depressive symptoms with poor insulin control
What are the benefits of regular exercise for T1DM
1) Less need for insulin
2) Less risk of CAD with less insulin
What are the 3 exercise testing considerations for individuals with T2DM?
1) Exercise testing not necessary for light to moderate intensity
2) ECG stress for those wanting to participate in vigorous activity
3) Silent ischemia often goes unnoticed - annual CVD risk factor assessment is needed
What was the result of the DYNAMIT trial? (Detection of silent myocardial ischemia)
Detection of myocardial ischemia in asymptomatic individuals provided no benefit in predicting risk of future cardiac events
What was found in the journal of sports medicine relating to aerobic and resistance exercise in diabetes patients and by who?
Young 2014: Systematic review of 12 trials
- CV more beneficial but not statistically significant for HbA1C but better for CRF/BMI
- 8 weeks to 6 month studies
- Combination best showing -0.17% and 0.23% vs Resistance and aerobic exercise alone
What are the FIIT recommendations for aerobic exercise in diabetes
F: 3-7 days with no more than 2 consecutive days without activity
I: Moderate to vigorous based on subjective experience of moderate to very hard
T: 150 minutes/week at moderate to vigorous intensity
T: Prolonged rhythmic activities using large muscle groups (walking, cycling, swimming) - continuous or HIIT
What are the FIIT recommendations for resistance exercise in diabetes?
F: 2-3 non-consecutive days but preferably 3
I: 50-69% OF 1RM (moderate) to vigorous (70-85% 1RM) for strength
T: 8-10 exercises with 1-3 sets of 10-15 repetitions to near fatigue per set
T: Resistance, machines, free weights, resistance bands, body weight
What What are the first 6 of the 14 exercise training considerations in patients with DM
1) Tailor to comorbidities
2) Overweight and obese - use this section
3) Due to low initial fitness, most with T2DM require at least 150 minutes/week to MVPA to achieve CVD risk reduction and CRF improvement
4) Interspersing very high intensity interval with moderate recovery can lessen post-exercise blood sugar dip
5) Vigorous intensity for CRF given importance in this population
6) Resistance exercise encouraged if no complications (proliferative retinopathy, recent laser treatment, uncontrolled hypertension)
What are some resistance training considerations in patients with T2DM
1) Higher resistance may provide greater benefit for muscle strength, insulin action, and blood glucose
2) Increased risk tendinopathy so progress slowly
3) Increased resistance only after target number of repetitions can be exceeded
4) Increased number of sets and lastly training frequency
5) Resistance training prior to aerobic training may lower risk of post-exercise hypoglycaemia
6) Limited joint mobility due to process of glycation of collagen
What are some exercise training considerations related to diabetic retinopathy, autonomic and peripheral neuropathy and nephropathy and what should you do?
1) DM and retinopathy increases risk of vitreous haemorrhage - avoid vigorous activity, head down activity, jumping, jarring and Valsalva manoeuvre
2) Autonomic neuropathy may cause chronotropic incompetence, anhydrosis, dodgey VO2 kinetics
- Monitor for signs/symptoms of ischemia (unusual SOB, back pain)
- Monitor BP before and after exercise to manage hypotension and hypertension
- HR and BP responses may be blunted so use RPE to guide intensity
3) Peripheral neuropathy: Special precautions to prevent ulcers/amputation
- Keep feet dry and silica gel or air midsole as well as polyester or blend socks
- Non-weight bearing exercise
4) Nephropathy
- Kidneys are not further damaged but exercise should begin at a low intensity and volume if aerobic capacity and muscle function are reduced.
What are the considerations for individuals taking insulin or oral hypoglycaemic agents that increase insulin secretion and what can be done?
- Hypoglycaemia (<70 mg.dL, <3.9 mmol/L) - no exercise
- Hypoglycaemia symptoms if drop substantial but not below threshold value
- Blood glucose should be monitored before, during (if needed), and after exercises as needed to maintain euglycemia in conjunction with healthcare provider
- Hypoglycaemia occurs 12 hours after so consider medication adjustment
- Timing exercise to insulin, and increasing carbohydrate intake help reduce hypoglycaemia (peak insulin time 2-3 hours)
- Longer acting insulin (glargine and detemir are less likely cause exercise induced hypoglycaemia)
- Synthetic rapid-acting insulin analogs ) lispro, aspart) decrease insulin more rapidly need considering
What are the common symptoms of hypoglycaemia?
Moderate symptoms: Shakiness, Weakness, Abnormal Sweating, Nervousness, Anxiety, Tingling of mouth and fingers, and hunger
Severe symptoms: Headache, Visual disturbance, Mental dullness, Confusion, Amnesia, Seizures and Coma
What are the considerations for individuals taking sulfonyulurea and other compounds that enhance insulin secretion (glyburide, glipizide)
- Additive effect with exercise so blood glucose most be monitored to determine whether change in medication is needed
