Diabetes

Question 1

How is glycaemia assessed?

Answer 1

• BGL (immediate)
• Glycaemic response over 2 hours to an oral glucose load (OGTT)
• HbA1c (Gold standard for assessing BGL control over the preceding 2-3 months)

Question 2

What is the non-diabetic range for HbA1c?

Answer 2

3-6%

Question 3

What is HbA1c used for?

Answer 3

To monitor effectiveness of glycaemic therapy rather than for acute diagnosis

Question 4

What test values are used for diabetes diagnosis?

Answer 4

• Fasting venous plasma glucose (FPG)
• 2 hour PG, 2 hour value in OGTT
• IFG & IGT only diagnosed if diabetes is not diagnosed by the other test

Question 5

What is pre-diabetes?

Answer 5

• Either or both IFG & IGT (i.e. elevated BGL but not yet in diabetic range)

Question 6

What are the 4 WHO classifications of diabetes?

Answer 6

• T1DM
• T2DM
• Gestational
• Other specific types

Question 7

What are the clinical characteristics of T1DM?

Answer 7

• Destruction of pancreatic islets
• Absolute deficiency of insulin
• Prone to ketosis
• Usual onset early childhood
• If long-standing, may be insulin resistant

Question 8

What are the treatments for T1DM?

Answer 8

• Insulin

- Exercise for reducing CV risk

Question 9

What are the clinical characteristics of T2DM?

Answer 9

• Resistant to the action of insulin
• Fasting hyperglycaemia
• 90% of people with diabetes
• Impaired OGTT (higher glucose & insulin levels)

Question 10

What are the common co-morbidities of T2DM?

Answer 10

• Usually obese
• Often hypertensive, hyperlipidaemic
• Metabolic syndrome (diabetes, obesity, hypertension, dyslipidaemia) common

Question 11

What are the treatments for T2DM?

Answer 11

• Exercise
• Diet (low GI)
• Oral hypoglycaemics (+/- insulin)

Question 12

What are the risk factors for gestational diabetes?

Answer 12

• Glycosuria
• Age >30yrs
• Obesity
• Family history
• Past history GDM or IGT
• High-risk group: ATSI, Polynesian, Middle Eastern, Indian, Asian

Question 13

What are the short-term complications of diabetes (hours-days)?

Answer 13

• Hyperglycaemia and ketosis
• Hypoglycaemia (BGL<2.5mmol·l-1)
• Both of above may lead to coma if untreated
• Infection; delayed healing

Question 14

What are the symptoms of hyperglycaemia?

Answer 14

• Thirst +++
• Polyuria
• Fatigue
• Blurred vision
• Delayed healing of infections

Question 15

What are the symptoms of hypoglycaemia?

Answer 15

• Hunger
• Anxiety
• Trembling
• Blurred vision
• Confusion

Question 16

What are the long-term complications of diabetes?

Answer 16

• Macro/microvascular disease

- Elevated HbA1c associated with vessel disease

Question 17

What are the clinical characteristics of macrovascular disease?

Answer 17

• Large vessel disease
• CVD - heart attacks, stroke, artherosclerosis
• PVD (ischaemic pain, foot ulcers, amputations)
• Higher risk of infection

Question 18

What are the clinical characteristics of microvascular disease?

Answer 18

• Small vessel disease
• Retinopathy
• Neuropathy
• Nephropathy
• Alveolar microangiopathy

Question 19

What exercise testing should be completed for people with diabetes?

Answer 19

GXT with ECG monitoring recommended for pts who were previously sedentary with a 10 yr risk of a coronary event

Question 20

What are the factors that increase risk with exercise?

Answer 20

Age >40yr  
Age >30yrs &:
- T1D or T2D >10yr
- HT (>140/90)
- Cigarette smoker
- Dyslipidaemia
- Proliferative retinopathy
- Nephropathy (incl microalbuminuria)

Question 21

What does exercise response in T1DM depend on?

Answer 21

• Timing/dosage of last injection
• Prior metabolic control
• Presence/absence of complications
• Nutritional status
• Fitness
• Intensity, duration

Question 22

When can over-insulisation occur?

Answer 22

• Usually 30-40 mins mod exercise
• Insulin levels don’t fall with exercise
• Increased insulin sensitivity

Question 23

What are the prevention strategies for over-insulinisation?

Answer 23

• Reduce insulin dose 30-80% before exercise
• Inject away from active muscles
• Monitor BGL
• Exercise on ‘downswing’ of insulin curve
• Consume simple CHO during; complex CHO after exercise

Question 24

What are the characteristics of under-insulisation?

Answer 24

• Poor control at rest
• Hyperglycaemic, dehydrated, ketotic, hyperlipidaemic
• Exercise usually worsens metabolic condition if BGL >14-16

Question 25

What are the prevention strategies for under-insulinisation?

Answer 25

• Insulin

- Delay exercise until metabolic control has improved

Question 26

What are the acute effects of exercise in T2DM?

Answer 26

• Usually decreased BGL but may remain above normal
• May improve insulin sensitivity
• Resistance exercise causes decrease in OGTT in women

Question 27

What are the benefits of exercise in pre-diabetes?

Answer 27

• Reduce HbA1c
• Reduce macro- and microvascular complications
• Reduce/abolish need for medication
• If instituted early enough → remission
• Prevent diabetes in high risk subjects

Question 28

What are the metabolic contraindications & precautions during exercise?

Answer 28

• Hyperglycaemia, ketosis
• Hypoglycaemia (esp children) - type 1
• ‘False warnings’ - perceive BGL to be lower than it actually is
• Caution in hot weather

Question 29

What are the neurological contraindications & precautions during exercise?

Answer 29

• Autonomic neuropathy - use RPE - Peripheral neuropathy

Question 30

What are the vascular contraindications & precautions during exercise?

Answer 30

• Proliferative retinopathy
• Nephropathy
• Myocardial blood vessel changes
• Careful with SBP increments during exercise

Question 31

What are the orthopaedic contraindications & precautions during exercise?

Answer 31

• Ulcers
• Feet
• Obesity
• OA

Question 32

What are the other physio treatments in diabetes?

Answer 32

• Treat effects of angiopathy (CVD, PVD, amputations), OA, tissue stiffening
• Education (exercise, weight control foot care)