Diabetes

Question 1

Response on acute exercise

1. _________________ can lead to ________. This in turn lead to alteration in _____3_____ responses: (5)

Answer 1

Autonomic neuropathy.

Loss of parasympathetic activity with progression to loss of sympathetic.

HR, BP, VO2

1. Resting tachycardia (more 100)
2. Chronotropic incompetence (CI)
3. Delayed HR recovery
4. Possibility hypotensive response (if sympathetic dysfunction) or hypertensive response (if nephropathy)
5. Attenuated VO2 kinetics

Question 2

Response on acute exercise

2.

Answer 2

Compromised thermoregulation because anhydrosis (water deprivation)

Question 3

Response on acute exercise

3. __________: prevalence is _________ and ____________ vs those not taking insulin and who do no have retinopathy

Answer 3

Increased risk for silent ischemia

2x higher in diabetics vs non-diabetics

3x higher in insulin-dependent diabetics with retinopathy

Question 4

Response on acute exercise

4. ______________: exercise promotes ___________ (hypoglycemic effect) so, in individuals ___________ increases risk of hypoglycemia. Glucose should be ingested prior to exercise if glycemia _______.

Answer 4

Increased risk for hypoglycemia (defined as glycemia <3.9 mmol/L)

absorption of glucose

taking insulin and, to lesser degree, oral hypoglycemic agents,

< 5,6 mmol/L

Question 5

Response on acute exercise

Signs associated with hypoglycemia (14)

Answer 5

1. Shakiness, shivering
2. Weakness, sleepiness
3. Abnormal sweating
4. Nervousness, anxiety
5. Tingling (mouth, fingers)
6. Excessive hunger
7. Headaches
8. Troubled vision
9. Mental dullness, apathy
10. confusion, amnesia
11. Dizziness
12. Convulsions, seizures
13. Loss of consciousness
14. Coma

Question 6

Response on acute exercise

In obese patient: (2)

Answer 6

1. Possible orthopedic limitation (use of cycle or arm ergometer could increase performance)
2. Possible overestimation of BP if cuff size is too small (important to use proper cuff size)

Question 7

BENEFITS (8)

Answer 7

1. Improvement in glucose tolerance
2. Improvement in insulin sensibility in a dose-dependent manner
3. Improvement in glycemic control
4. Decreased insulin requirement (if taking insulin)
5. Improvement in exercise capacity or VO2 max
6. Improvement in CVD risks factors(improve lipid profil, resting BP in those with light to moderate HTN, body composition when combined with diet)
7. Improvement in well-being
8. Possible delay in transition to type 2 DM for individuals with pre-diabetes.

Question 8

Precautions (14)

Answer 8

1. Measure glycemia before and several hrs after each session, especially if taking insulin or oral hypoglycemic agents and when beginning or modifying an exercise program
2. Avoid exercising during peak hours of insulin activity
3. Plan exercise sessions and adjust food intake and medication dosage and timing accordingly
4. Carry source of rapid glucose (10-15g/30 min)
5. Avoid injecting insulin in active limbs
6. Avoid exercising late at night because risk of nocturnal hypoglycemia. If occurs, consume more glucose before going to bed
7. Monitor signs and symptoms of hypoglycemia
8. Exercise with partner to have help in case of severe hypoglycemia
9. Carry diabetic ID and cell phone
10. Monitor BP before and after exercise if possible
11. Hydrate well to prevent compromised thermoregulation
12. Avoid exercising in excessive heat or cold
13. Keep exercise log with info on exercise session, food intake, meds to understand exercise response. Allows future anticipation
14. Wear appropriate footwear to reduce risk of foot irritation and injury. Pay special attention to feet: check regularly for irritations to prevent infections (white socks)

Question 9

Exercise testing (3)

1. Exercise testing is generally not necessary for ?
2. However?
3. 8th edition: exercise test should be delayed if?

Answer 9

1. people with DM or prediabetes who are asymptomatic and “low risk” for CVD (as per Framingham risk calculator) and undertaking a light-to-moderate intensity exercise program
2. CET with ECG monitoring may be indicated for individuals with DM, especially if sedentary and undertaking a vigorous intensity exercise program
3. glycemia >13,9 mmol/L with ketones or >16,7 mmol/L without ketones

Question 10

Consideration

Diabetic patients with retinopathy (2)

Answer 10

1. Risk of retinal detachment and vitreous hemorrhage with vigorous intensity exercise.
2. If severe nonproliferative or proliferative retinopathy, avoid activities that BP (so anything vigorous), involve contact/high-impact/head-down movements, and/or Valsalva maneuver


Question 11

Consideration

Diabetic patients with nephropathy (1)

Answer 11

1. Should be encouraged to be active; begin at low intensity and volume if exercise capacity and muscle function are reduced

Question 12

Consideration

Diabetic patients with peripheral neuropathy (2)

Answer 12

1. Pay particular attention to foot hygiene and footwear to prevent foot ulcers and lower risk of amputation
2. Prevent blisters by keeping feet dry (midsoles and socks)

Question 13

Consideration

Diabetic patients with autonomic neuropathy (4)

Answer 13

1. Check for clinical signs of hypoglycemia and ischemia b/c patient may not perceive them
2. Check BP
3. Use Borg (RPE) scale b/c possibility of chronotropic incompetence (blunted HR response)
4. Avoid extreme climates b/c poor thermoregulation

Question 14

Consideration

Obese individuals (2)

Answer 14

1. Higher risk for orthopedic problems and injuries

2. Higher risk for hyperthermia (b/c adipose tissue insulates)