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Clinical Exercise Prescription > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the effect of insulin on: glycogenesis, glycogenolysis, gluconeogenesis, ketogenesis, lipolysis and lipogenesis?

A 
Increase
Decrease
Decrease
Decrease
Decrease
Increase
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2
Q

What is the mechanism of action of insulin?

A

Bind to insulin receptor opening GLUT4 channel via PI 3-kinase so glucose can enter cells

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3
Q

Define diabetes

A

Abnormal glucose metabolism resulting from defects in insulin release, action or both

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4
Q

What are some types of diabetes

A

T1DM - immune mediated
T2DM
Gestational diabetes
Nephrogenic diabetes insipidus

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5
Q

What are the effects of insulin lack/resistance on the liver, muscles and adipocytes?

A

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

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6
Q

Distinguish type 1 and 2 diabetes

A

1 - juvenile, abrupt onset, thin

2 - mature, gradual onset, overweight

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7
Q

What are modifiable risk factors for diabetes?

A

Obesity, inactivity, diet, smoking, metabolic syndrome

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8
Q

What are non modifiable risk factors for diabetes?

A

Ethnicity, family history, age, gender, gestational diabetes, inflammation

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9
Q

What blood test results diagnose diabetes?

A

HbA1c > 6.5%, fasting > 7mmol, 2hr > 11.1mmol

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10
Q

What blood tests diagnose pre diabetes?

A

HbA1c 5.7-6.4%, fasting 5.6-6.9 mmol, 2hr 7.8-11 mmol

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11
Q

What are the acute and chronic problems with diabetes?

A

Acute - hyperglycaemia and hypoglycaemia

Chronic - macrovascular disease and microvascular disease

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12
Q

Why may hyperglycaemia occur and what symptoms would there be?

A

Poor control of diabetes

High glucose leading to polyuria causing dehydration. Headaches, fatigue and weakness

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13
Q

What is HONK?

A

Hyperosmolar non ketotic syndrome - very severe hyperglycaemia causing decreased mental state and potentially coma

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14
Q

What is diabetic keto acidosis?

A

Mainly in type 1 the extreme lack of insulin causes production of acidotic ketones. Abdominal pain, vomiting, rapid breathing and fruity breath

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15
Q

How may a hypo occur in diabetics?

A

Excess exercise, too much medication, low CHO intake/missed meal,

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16
Q

What are the symptoms of a hypo?

A

Stress hormones - shaky, weak, sweat, nervous, tingling

Lack of glucose - headache, visual disturbance, confusion, amnesia, seizure, coma

17
Q

What are the macrovascular complications of diabetes?

A

Vascular injury and progression of atherosclerosis

CHD, stroke, peripheral artery disease (intermittent claudication)

18
Q

What are the microvascular complications of diabetes?

A

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

19
Q

What is the prevalence of diabetes (number and change in UK and % in England)

A

4.5 million (1.4 back in 1996)
8.7%
Millions undiagnosed/prediabetes

20
Q

What is the evidence for exercise preventing diabetes? 3 things

A

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

21
Q

What is the acute mechanism for benefits of exercise?

A

More translocation of GLUT4 to cell surface increasing blood flows and insulin sensitivity
Less time spent hyperglycaemic and lower blood glucose

22
Q

What are the chronic benefits of exercise?

A

More GLUT4 proteins (more transport), more muscle mass (more storage), increased capillary density (more delivery)
General improval of body composition, BP and vasomotor control

23
Q

What precautions should there be for diabetic exercise?

A

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

24
Q

What are the aerobic, resistance and flexibility recommendations for diabetes?

A

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

25
Q

What are some considerations you should have during exercise?

A

Supervise - glucose levels
Warm up and cool down very important
Consider modality - weight, mobility, neuropathy

26
Q

What is contraindicated in diabetes?

A

Resistance if high BP or retinopathy
Weight bearing if peripheral neuropathy
Retinopathy if very sever - don’t lower head or competitive sports

27
Q

Where is insulin and glucagon produced

A

Insulin in beta cells of islets of langerhans

Glucagon in alpha cells

Clinical Exercise Prescription (12 decks)

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