Diabetes Flashcards
How is glycaemia assessed?
- 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)
What is the non-diabetic range for HbA1c?
3-6%
What is HbA1c used for?
To monitor effectiveness of glycaemic therapy rather than for acute diagnosis
What test values are used for diabetes diagnosis?
- 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
What is pre-diabetes?
- Either or both IFG & IGT (i.e. elevated BGL but not yet in diabetic range)
What are the 4 WHO classifications of diabetes?
- T1DM
- T2DM
- Gestational
- Other specific types
What are the clinical characteristics of T1DM?
- Destruction of pancreatic islets
- Absolute deficiency of insulin
- Prone to ketosis
- Usual onset early childhood
- If long-standing, may be insulin resistant
What are the treatments for T1DM?
- Insulin
- Exercise for reducing CV risk
What are the clinical characteristics of T2DM?
- Resistant to the action of insulin
- Fasting hyperglycaemia
- 90% of people with diabetes
- Impaired OGTT (higher glucose & insulin levels)
What are the common co-morbidities of T2DM?
- Usually obese
- Often hypertensive, hyperlipidaemic
- Metabolic syndrome (diabetes, obesity, hypertension, dyslipidaemia) common
What are the treatments for T2DM?
- Exercise
- Diet (low GI)
- Oral hypoglycaemics (+/- insulin)
What are the risk factors for gestational diabetes?
- Glycosuria
- Age >30yrs
- Obesity
- Family history
- Past history GDM or IGT
- High-risk group: ATSI, Polynesian, Middle Eastern, Indian, Asian
What are the short-term complications of diabetes (hours-days)?
- Hyperglycaemia and ketosis
- Hypoglycaemia (BGL<2.5mmol·l-1)
- Both of above may lead to coma if untreated
- Infection; delayed healing
What are the symptoms of hyperglycaemia?
- Thirst +++
- Polyuria
- Fatigue
- Blurred vision
- Delayed healing of infections
What are the symptoms of hypoglycaemia?
- Hunger
- Anxiety
- Trembling
- Blurred vision
- Confusion
What are the long-term complications of diabetes?
- Macro/microvascular disease
- Elevated HbA1c associated with vessel disease
What are the clinical characteristics of macrovascular disease?
- Large vessel disease
- CVD - heart attacks, stroke, artherosclerosis
- PVD (ischaemic pain, foot ulcers, amputations)
- Higher risk of infection
What are the clinical characteristics of microvascular disease?
- Small vessel disease
- Retinopathy
- Neuropathy
- Nephropathy
- Alveolar microangiopathy
What exercise testing should be completed for people with diabetes?
GXT with ECG monitoring recommended for pts who were previously sedentary with a 10 yr risk of a coronary event
What are the factors that increase risk with exercise?
Age >40yr Age >30yrs &: - T1D or T2D >10yr - HT (>140/90) - Cigarette smoker - Dyslipidaemia - Proliferative retinopathy - Nephropathy (incl microalbuminuria)
What does exercise response in T1DM depend on?
- Timing/dosage of last injection
- Prior metabolic control
- Presence/absence of complications
- Nutritional status
- Fitness
- Intensity, duration
When can over-insulisation occur?
- Usually 30-40 mins mod exercise
- Insulin levels don’t fall with exercise
- Increased insulin sensitivity
What are the prevention strategies for over-insulinisation?
- 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
What are the characteristics of under-insulisation?
- Poor control at rest
- Hyperglycaemic, dehydrated, ketotic, hyperlipidaemic
- Exercise usually worsens metabolic condition if BGL >14-16
What are the prevention strategies for under-insulinisation?
- Insulin
- Delay exercise until metabolic control has improved
What are the acute effects of exercise in T2DM?
- Usually decreased BGL but may remain above normal
- May improve insulin sensitivity
- Resistance exercise causes decrease in OGTT in women
What are the benefits of exercise in pre-diabetes?
- Reduce HbA1c
- Reduce macro- and microvascular complications
- Reduce/abolish need for medication
- If instituted early enough → remission
- Prevent diabetes in high risk subjects
What are the metabolic contraindications & precautions during exercise?
- Hyperglycaemia, ketosis
- Hypoglycaemia (esp children) - type 1
- ‘False warnings’ - perceive BGL to be lower than it actually is
- Caution in hot weather
What are the neurological contraindications & precautions during exercise?
- Autonomic neuropathy - use RPE - Peripheral neuropathy
What are the vascular contraindications & precautions during exercise?
- Proliferative retinopathy
- Nephropathy
- Myocardial blood vessel changes
- Careful with SBP increments during exercise
What are the orthopaedic contraindications & precautions during exercise?
- Ulcers
- Feet
- Obesity
- OA
What are the other physio treatments in diabetes?
- Treat effects of angiopathy (CVD, PVD, amputations), OA, tissue stiffening
- Education (exercise, weight control foot care)
