Diabetes Flashcards
What are the blood glucose level ranges for diabetes?
Above 7 mmol/L for fasting and above 11 mmol/L for post-prandial
These levels indicate diabetes according to testing standards.
What are the blood glucose level ranges for pre-diabetes?
Fasting: 5.6 to 7 mmol/L, Post-prandial: 9 to 10.9 mmol/L
These levels suggest a risk of developing diabetes.
What are the blood glucose level ranges for healthy individuals?
Fasting: 3.9 to 5.5 mmol/L, Post-prandial: 3.9 to 8.9 mmol/L
These levels indicate normal glucose metabolism.
Fill in the blank: A fasting blood glucose level above _______ indicates diabetes.
7 mmol/L
Fill in the blank: A healthy post-prandial blood glucose level should be below _______.
8.9 mmol/L
True or False: A fasting blood glucose level between 5.6 and 7 mmol/L indicates a healthy individual.
False
What is the HbA1c test?
The HbA1c test measures the average blood glucose levels over the past 2 to 3 months.
What does a high HbA1c level indicate?
A high HbA1c level indicates poor blood sugar control and a higher risk of diabetes complications.
What does a low HbA1c level indicate?
A low HbA1c level indicates good blood sugar control.
What is the Oral Glucose Tolerance Test?
A test used to diagnose diabetes by measuring the body’s response to sugar.
What are the types of Oral Glucose Tolerance Tests?
- 2-Hour Test - Adult
- 2-Hour Test - Child
- 3-Hour Test - Pregnancy
What is the procedure for the 2-Hour Test - Adult?
An 8 ounce solution with 75 grams of sugar is consumed. Blood is drawn before drinking and 2 hours after.
What is the procedure for the 2-Hour Test - Child?
1.75 grams of sugar per kilogram of body weight is consumed. Blood is drawn before drinking and 2 hours after.
What is the procedure for the 3-Hour Test - Pregnancy?
A solution with 100 grams of sugar is consumed. Blood is drawn before drinking and at 1, 2, and 3 hours after.
What is the glucose clamp method?
A method where insulin is infused at a constant rate while blood glucose is measured frequently to maintain glucose at a normal range.
How many cannulas are used in the glucose clamp method?
Two cannulas are placed in either hand; one for infusion and one for sample collection.
What is insulin sensitivity?
Insulin sensitivity is calculated as the glucose disposal rate divided by the steady-state blood glucose concentration.
What is the formula for calculating insulin sensitivity?
Insulin sensitivity = Glucose disposal rate / Steady-state blood glucose concentration.
What does the difference between fasting and steady-state plasma insulin indicate?
It is a component in assessing insulin sensitivity.
What is the C-peptide level for low C-peptide?
Less than 0.51 ng/ml
What is the C-peptide level for normal C-peptide?
Between 0.51-2.72 ng/ml
What is the C-peptide level for high C-peptide?
Greater than 2.72 ng/ml
What is the likely diagnosis with high blood glucose levels and low C-peptide?
Type 1 Diabetes
What is the likely diagnosis with high blood glucose levels and high C-peptide?
Type 2 Diabetes
What is the structure of proinsulin?
10 amino acids
What is the structure of insulin?
51 amino acids
What are these responses and when do they occur?
These responses vary based on the duration of exposure or action.
What happens immediately?
Immediate responses occur right after the action is taken.
What happens after a few days?
Responses evolve and may show initial adaptation after a few days.
What happens if we do it for a few weeks?
Continued action leads to more pronounced changes and adaptations.
What happens if we do it for a few years?
Long-term exposure results in significant and lasting effects.
Is there a legacy effect?
Yes, there can be lasting effects that persist beyond the period of action.
What is the HbA1c level for pre-diabetes classification?
HbA1c ≥ 42 mmol/mol
What is the fasting plasma glucose level for pre-diabetes classification?
Fasting plasma glucose level 5.6-6.9 mmol/L
What is the 2-hour plasma glucose level for pre-diabetes classification?
2-hour plasma glucose level 7.8-11.0 mmol/L
What is the HbA1c level criterion for a diagnosis of Type 2 diabetes?
HbA1c ≥ 48 mmol/mol
What is the fasting plasma glucose level criterion for a diagnosis of Type 2 diabetes?
Fasting plasma glucose level ≥ 7 mmol/L
What is the 2-hour plasma glucose level criterion for a diagnosis of Type 2 diabetes?
2-hour plasma glucose level ≥ 11 mmol/L
What are the classic symptoms and random plasma glucose level criterion for a diagnosis of Type 2 diabetes?
Classic symptoms + random plasma glucose levels ≥ 11 mmol/L
What is Type 2 Diabetes?
A metabolic disorder characterised by hyperglycaemia due to disorders of insulin secretion and insulin action or both.
(Alberti and Zimmet, 1998)
What is respiratory frequency?
The rate at which breathing occurs during exercise.
What is tidal volume?
The amount of air inhaled or exhaled in a single breath.
What is lung ventilation?
The total volume of air exchanged in the lungs per minute.
What is heart rate?
The number of heartbeats per minute.
What is stroke volume?
The amount of blood pumped by the heart with each beat.
What is cardiac output?
The total volume of blood the heart pumps per minute.
What is the role of cardiorespiratory function during exercise?
It enhances substrate and oxygen delivery to muscles.
What fuel source is oxidized at low exercise intensity?
Non-esterified fatty acids (NEFA).
What fuel source is referred to at high exercise intensities?
Glucose.
What is the role of the pancreas during exercise?
It regulates insulin and glucagon secretion.
What does the liver do during exercise?
It releases glucose into the bloodstream.
What happens to triacylglycerol in adipose tissue during exercise?
It breaks down to release NEFA.
How does participation in exercise affect the risk of Type 2 diabetes?
Participation in exercise reduces the risk of developing Type 2 diabetes, complications associated with Type 2 diabetes, and mortality.
What is the risk reduction for developing Type 2 diabetes for those moderately active for 150 minutes a week?
People who are moderately physically active for 150 minutes a week have a 26% lower risk of developing Type 2 diabetes than those who are inactive.
What is the risk reduction for developing Type 2 diabetes for those active for 300 minutes a week?
Achieving twice the level of activity (300 minutes/week) is associated with a 36% reduction in Type 2 diabetes.
Which studies support the benefits of exercise on Type 2 diabetes?
Schellenberg et al 2013 Ann Intern Med. and Blomster et al 2013 Diabetes, Obesity and Metabolism.
What is the core-clock?
The core-clock is a biological clock that regulates various physiological processes in the body.
How does diabetes affect the muscle clock?
People with diabetes have a dysregulated muscle clock.
What partly mediates the dysregulation of the muscle clock in diabetes?
The dysregulation is partly mediated by the inner-mitochondrial membrane.
Can exercise re-set the core-clock?
Yes, exercise can re-set the core-clock.
Can correctly timed exercise be a tool to treat metabolic disease?
Yes, correctly timed exercise can potentially be a tool to treat metabolic disease.
Difference between afternoon hiit and morning hiit in blood glucose?
It decreases in afternoon however increases in the morning
What is the treatment for Type 2 diabetes with a low risk of hypoglycaemia?
Metformin, DPPIV inhibitor, GLP-1, SGLT-2, Miglitoll, Rosiglitizone
What medications for Type 2 diabetes carry a higher risk of hypoglycaemia?
Glimepiride, Glipizide, Glyburide, Nateglinide, Insulin
What was the mortality rate for people who developed diabetes prior to the discovery of insulin in 1922?
Half of people who developed it died within two years; more than 90% were dead within five years.
What was the most effective treatment for diabetes before insulin was discovered?
The most effective treatment was to put patients on a very strict diet with minimal carbohydrate intake (<500kcal per day).
What was the experience of treating diabetes patients with strict diets before insulin?
“We literally starved the child and adult with the faint hope that something new in treatment would appear…It was no fun to starve a child to let him live”
What is the initial muscle energy source during exercise?
ATP from creatine phosphate (CP)
This is followed by glucose from muscle glycogen.
What are the subsequent sources of glucose during prolonged exercise?
Glucose from liver glycogen and then glucose from gluconeogenesis.
This process occurs after the initial ATP from CP.
What fuels are primarily used during prolonged aerobic metabolism?
Free fatty acids (FFA) and ketones.
How does glucose use change with increasing exercise intensity and duration?
Glucose use increases.
What hormonal changes mediate the increase in glucose use during exercise?
Falling insulin, increasing glucagon, catecholamines, and later growth hormone.
What are the implications of these metabolic changes for people with Type 1 diabetes?
These changes have significant implications for managing exercise in people with Type 1 diabetes.
What are barriers to exercise for people with new onset Type 1 diabetes?
Hypoglycaemia (both actual and fear of), lack of knowledge/confidence in managing diabetes, advice from healthcare professionals to stop exercising, planning (e.g. checking blood glucose), feeling overwhelmed by diagnosis.
What are barriers to exercise for people with established Type 1 diabetes?
Loss of control of diabetes, lack of knowledge on the management of diabetes for exercise.
What should you know about exercise for improving glycemia in Type I?
Know type, intensity, and duration of exercise.
What should you check before exercising?
Check glucose and trend arrows.
What should be considered regarding exercise timing?
Consider timing of exercise.
What is important to know about insulin before exercising?
Know how much insulin is on board.
What should you take if needed during exercise?
Take carbohydrates if needed.
What are the effects of resistance exercise on glucose levels during and immediately after exercise?
Resistance exercise was associated with stable post-exercise glucose levels.
Resistance exercise resulted in much smaller declines in blood glucose during exercise than aerobic exercise or no exercise in individuals with type 1 diabetes.
How does aerobic exercise affect glucose levels during early recovery?
Aerobic exercise was associated with greater increases in glucose levels during early recovery.
This resulted in a trend toward higher glucose concentrations in late recovery.
What was the comparison of glucose levels between aerobic and resistance exercise?
Resistance exercise resulted in stable glucose levels, while aerobic exercise led to higher glucose concentrations during early recovery.
What happens to blood glucose after one and two sets of resistance exercise (RE)?
Blood glucose significantly climbs above rest for 1 hour after one and two sets of RE.
What effect does a third set of resistance exercise have on blood glucose?
The inclusion of a third set attenuates the exercise-induced hyperglycaemia and returns blood glucose values to those of a control trial.
What was the significance of the study by Turner et al (2015)?
This was the first study to recognize the importance of exercise volume in determining the blood glucose responses to resistance exercise in type 1 diabetes.
What is the effect of performing resistance exercise before aerobic exercise for individuals with type 1 diabetes?
Individuals with type 1 diabetes should consider performing their resistance exercise first if they tend to develop exercise-associated hypoglycaemia.
This order of exercise could lead to a lower reliance on glucose supplementation during exercise and might also decrease the severity of potential nocturnal hypoglycaemia.
What does the graph in Fig 1 illustrate?
The graph illustrates plasma glucose levels during and following an exercise session.
What does the graph in Fig 2 show?
The graph shows blood glucose levels from continuous glucose monitoring (CGM) following an exercise session.
What is the effect of morning exercise on hypoglycemic episodes in Type 1 Diabetes patients?
Morning exercise results in significantly fewer hypoglycaemic events compared to afternoon exercise.
When do most episodes of post-exercise hypoglycaemia occur?
Most episodes occur between 15 and 24 hours after the cessation of exercise.
How does morning exercise affect metabolic control?
Exercise in the morning improves metabolic control on the subsequent day and maintains patients in the euglycemic range for a longer time.
What is depicted in Fig 1?
Fig 1 shows hourly hypoglycaemic episodes following morning (circles) or afternoon (squares) exercise.
How does intermittent high-intensity exercise (IHE) affect blood glucose levels compared to moderate exercise (MOD)?
The decline in blood glucose levels is less with IHE compared with MOD during both exercise and early recovery.
What is the relationship between heart rate and total work performed during high-intensity exercise (HIT)?
The lesser decline in blood glucose levels occurred despite a higher heart rate and greater total work performed during the HIT trial.
What is the risk of hypoglycaemia with moderate exercise compared to intermittent high-intensity exercise?
The risk of hypoglycaemia may be increased with MOD compared with IHE.
What is the effect of aerobic/sub maximal exercise on blood glucose?
Aerobic/sub maximal exercise causes blood glucose to fall rapidly.
What happens to blood glucose during intense exercise?
Intense exercise causes blood glucose to rise.
What is a risk associated with aerobic/sub maximal exercise?
Aerobic/sub maximal exercise increases risk of nocturnal hypoglycaemia.
What is the effect of repeated resistance exercise on blood glucose?
Repeated resistance exercise causes blood glucose to fall.
How does intermittent high intensity exercise affect hypoglycaemia?
Intermittent high intensity exercise protects against hypoglycaemia during exercise, but is more likely to cause nocturnal hypoglycaemia.
