Diabetes Flashcards
What is the effect of insulin on: glycogenesis, glycogenolysis, gluconeogenesis, ketogenesis, lipolysis and lipogenesis?
Increase Decrease Decrease Decrease Decrease Increase
What is the mechanism of action of insulin?
Bind to insulin receptor opening GLUT4 channel via PI 3-kinase so glucose can enter cells
Define diabetes
Abnormal glucose metabolism resulting from defects in insulin release, action or both
What are some types of diabetes
T1DM - immune mediated
T2DM
Gestational diabetes
Nephrogenic diabetes insipidus
What are the effects of insulin lack/resistance on the liver, muscles and adipocytes?
Liver - Lack of suppression of gluconeogenesis, ketogenesis and lipolysis
Muscles can’t uptake and store glucose
Adipocytes can’t uptake/use glucose and they start to catabolise fats as no suppression
Causing increase in blood glucose
Distinguish type 1 and 2 diabetes
1 - juvenile, abrupt onset, thin
2 - mature, gradual onset, overweight
What are modifiable risk factors for diabetes?
Obesity, inactivity, diet, smoking, metabolic syndrome
What are non modifiable risk factors for diabetes?
Ethnicity, family history, age, gender, gestational diabetes, inflammation
What blood test results diagnose diabetes?
HbA1c > 6.5%, fasting > 7mmol, 2hr > 11.1mmol
What blood tests diagnose pre diabetes?
HbA1c 5.7-6.4%, fasting 5.6-6.9 mmol, 2hr 7.8-11 mmol
What are the acute and chronic problems with diabetes?
Acute - hyperglycaemia and hypoglycaemia
Chronic - macrovascular disease and microvascular disease
Why may hyperglycaemia occur and what symptoms would there be?
Poor control of diabetes
High glucose leading to polyuria causing dehydration. Headaches, fatigue and weakness
What is HONK?
Hyperosmolar non ketotic syndrome - very severe hyperglycaemia causing decreased mental state and potentially coma
What is diabetic keto acidosis?
Mainly in type 1 the extreme lack of insulin causes production of acidotic ketones. Abdominal pain, vomiting, rapid breathing and fruity breath
How may a hypo occur in diabetics?
Excess exercise, too much medication, low CHO intake/missed meal,
What are the symptoms of a hypo?
Stress hormones - shaky, weak, sweat, nervous, tingling
Lack of glucose - headache, visual disturbance, confusion, amnesia, seizure, coma
What are the macrovascular complications of diabetes?
Vascular injury and progression of atherosclerosis
CHD, stroke, peripheral artery disease (intermittent claudication)
What are the microvascular complications of diabetes?
Retinopathy - loss/blurred vision, spots in vision
Nephropathy - compromise kidneys ability to filter blood
Neuropathy - peripheral, pain loss of sensation and reflexes, atrophy, poorer healing
Autonomic neuropathy - GI/erectile/cardiac
What is the prevalence of diabetes (number and change in UK and % in England)
4.5 million (1.4 back in 1996)
8.7%
Millions undiagnosed/prediabetes
What is the evidence for exercise preventing diabetes? 3 things
Doing 21 METs a week - 0.74 risk
Having a fast walk - 0.59 risk
Doing 150 mins a week - 58% reduction in progression from pre diabetes
What is the acute mechanism for benefits of exercise?
More translocation of GLUT4 to cell surface increasing blood flows and insulin sensitivity
Less time spent hyperglycaemic and lower blood glucose
What are the chronic benefits of exercise?
More GLUT4 proteins (more transport), more muscle mass (more storage), increased capillary density (more delivery)
General improval of body composition, BP and vasomotor control
What precautions should there be for diabetic exercise?
Make sure glucose over 5.5 and symptom free if hyper
Screen for vascular, neuro and retina complications
Stress test if CHD/> 35/diabetes >15/microvascular and autonomic neuropathy
What are the aerobic, resistance and flexibility recommendations for diabetes?
Aerobic - 150 mins, 3-7 days, 50-80HRR
Resistance - 15 reps, 8-10 exercises, 1-3 sets, 2-3 days
Flexibility - 2-3 days, 10-30s, 2-4 reps
What are some considerations you should have during exercise?
Supervise - glucose levels
Warm up and cool down very important
Consider modality - weight, mobility, neuropathy
What is contraindicated in diabetes?
Resistance if high BP or retinopathy
Weight bearing if peripheral neuropathy
Retinopathy if very sever - don’t lower head or competitive sports
Where is insulin and glucagon produced
Insulin in beta cells of islets of langerhans
Glucagon in alpha cells
