Diabetes

Question 1

Define diabetes

Answer 1

• metabolic disorder
• chronic hyperglycemia
• disturbances of CHO/fat/prot
• defects in insulin secretion/action/both

Question 2

How do you assess glycaemia?

Answer 2

BGL
- gives you a snapshot in time

HbA1c

• reflects the glucose binding to Hb - more you have the more complications you can have
• shows glucose levels of the preceding 2-3 months
• more used for DIAGNOSIS

OGTT
- blood taken; 75g glucose bolus; blood taken again

Question 3

What are S/Sx of diabetes

Answer 3

• polydipsia/polyuria
• PREDIABETES - HbA1c 5.7-6.4%
• T2D >6.5%
• Plasma glucose concentration
  > Normal = <5.6 (fasting); <7.8 (2hr)
  > IFG = 5.6-6.9 (fasting)
  > IGT = 7.8-11 (2 hr)
  > DM = > 7 (fasting) or >11 (2hr)

Question 4

Whats the incidence of diabetes in people that have prediabetes? How do you manage pre diabetes

Answer 4

10-20x greater incidence

Mx = diet, ex, education, monitoring, +/- education

Question 5

What is GDM?

Answer 5

• glucose intolerance diagnosed during pregnancy
• glycemia reverts back to normal shortly after delivery
• if you’re a woman who had GDM - then youd have 7x greater risk of T2D

Question 6

What are non modifiable risk factors for T2D?

Answer 6

• family history
• age
• ethnicity
• previous GDM!

Question 7

What are modifiable risk factors for T2D?

Answer 7

• OBESITY!**
• metabolic syndrome
• physical inactivity
• dyslipidemia
• hypertension
• SES
• smoking

Question 8

What are the effects of acute ex on BGL?

Answer 8

• usually reduces in T2D in single bouts or multiple bouts of 10 mins
• high intensity exercise can INCREASE BGL but this improves with training
• low risk of hypoglycemia unless using insulin or insulin secretagogue
• insulin sensitivity increased for ~72 hrs!
• ex also reduces HbA1c

Question 9

How do reductions in HbA1c affect mortality?

Answer 9

• decreasing HbA1c by 1% =
  > reduces diabetes related deaths 21%
  > reduces macrovascular disease 12-43%
  > reduces microvascular disease 37%

Question 10

List short term complications of diabetes?

Answer 10

• hyperglycemia + hypoglycemia
• infection, delayed healing (chronically delayed BGL)
• coma

Question 11

List long term complications of diabetes?

Answer 11

Macro vessel disease:

• CVD - heart attack/stroke
• PVD - claudication/ulcers

Question 12

What are examples of micro vessel disease?

Answer 12

Retinopathy (visual impairment/blindness)
Nephropathy (renal failure)
Neuropathy (peripheral neuropathy/impaired foot sensation)

Question 13

What clinical considerations (safety) should you keep in mind when prescribing ex?

Answer 13

MACROANGIOPATHY:

• careful with SBP increments
• monitor ECG, HR, BP
• monitor for claudication (PAD)
• PRT may be safer than higher intensity aerobic

MICROANGIOPATHY:

• avoid ex/postures that +++introocular pressure/SBP
• careful in environmetns with low vision
• avoid high impact
• monitor BP/HR

Neuropathy:

• ensure good foot wear/wear in slowly
• regular podiatry
• foot care education
• check feet daily! before and after exercise