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Exercise Prescription, Referral & Rehabilitation > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is insulin?

A

Insulin is produced by the beta cells in the pancreas and is released in response to elevated blood glucose.

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2
Q

What role does insulin play?

A
  1. Insulin stimulates liver, muscles and fat cells to remove blood glucose from the blood.
  2. Stimulates absorption of glucose into muscle and adipose tissue by changing cell permeability.
  3. Stimulates conversion of glucose into glycogen in liver & muscle.
  4. Promotes conversion of glucose into fats (lipogenesis).

5 Promotes glycolysis in cells.

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3
Q

What is the four different types of Diabetes?

A 
Type 1 (During this asymptomatic period the insulin-producing beta cells of the pancreas become destroyed in an autoimmune response results in hyposecretion and or hypoactivity). 
Type 2 (The body is insulin resistance, but the body still produces insulin and as a result the glucose will accumulate in the bloodstream). 
Gestational Diabetes (Impaired ability to metabolise CHO due to temporary insulin deficiency) 
Other types of diabetes
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4
Q

What are the risk factors of Diabetes?

A

Being overweight or obese, having a close family member with Type 2 diabetes, having high blood pressure, having high blood cholesterol, older (>40) and ethnicity (South Asian, Middle East, Afro Caribbean).

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5
Q

What are the signs and symptoms of Diabetes?

A

Chronic hyperglycaemia (normal BG= 4-6mmol.l), feeling tired and lethargic (fatigue), feeling thirsty (polydipsia), increased urination (polyuria), having an increased hunger (polyphagia), developing patches of darker skin (under arms & around neck), itchy privates, thrush, blurred vision, cuts or sores taking a long time to heal and increased susceptibility to infections.

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6
Q

What are the safe levels of blood glucose prior to the start of activity for a diabetic client?

A

The safe levels of blood glucose is 5.5mmol/L to 13mmol/L.

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7
Q

What is the normal fasting plasma glucose level?

A

> 5.5mmol.L-1

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8
Q

What is diagnostic criteria for prediabetes?

A

IFG = Fasting plasma glucose 5.55 mmol.L-1 – 6.94 mmol.L-1
IGT = 2-h plasma glucose
7.77 mmol.L-1 - 11.04 mmol.L-1 during an OGTT

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9
Q

What is diagnostic criteria Diabetes Mellitus?

A

Symptomatic with casual glucose > 11.10 mmol.L-1
Fasting plasma glucose > 6.99 mmol.L-1
2-h plasma glucose > 11.10 mmol.L-1 during an OGTT

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10
Q

What is Glycosylated Haemoglobin (HbA1c)?

A

This is a specific blood test and reflects mean blood glucose control over the past 2 – 3 months (60 – 90 days), with the patient goal being < 6.5% HbA1c (48 mmol.mol-1) .

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11
Q

What are the problems associated with Diabetes?

A

Macrovascular: Stroke, Heart Disease and Hypertension, Peripheral vascular disease and foot problems.

Microvascular: Diabetic eye disease (retinopathy and cataracts), renal disease, neuropathy and foot .

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12
Q

What is the normal response to insulin and insulin resistance in the liver?

A

Normal response include: Glucose uptake
Glycogen synthesis
Suppressed glycogenolysis & gluconeogenesis

Insulin Resistance: Glucose release due to lack of suppression of glycogenolysis & gluconeogenesis

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13
Q

What is the normal response to insulin and insulin resistance in the muscle?

A

Normal response to insulin include: Glucose uptake
Glucose oxidation
Glycogen synthesis

Insulin response include:
Impaired glucose uptake, oxidation & storage

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14
Q

What is the normal response to insulin and insulin resistance in adipocytes?

A

Normal response to insulin include: Glucose uptake & utilisation
Triglyceride synthesis

Insulin response include: Impaired glucose uptake & utilisation
Inappropriate triglyceride catabolism

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15
Q

What is the normal response to insulin and insulin resistance in the brain?

A

Normal response to insulin include: Appetite suppression
Possible suppression of hepatic glucose output

Insulin response include: Increased appetite
Possible increase in hepatic glucose output

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16
Q

What are the short and long term risks of Diabetes Mellitus?

A

Short term: Risk of diabetic coma associated with hypoglycaemia.

Long term: Stroke, kidney disease (nephropathy).

17
Q

What are the risk factors and implications of Autonomic Neuropathy?

A

Depresses HRmax
Increases HRrest
Increased risk of exercise-induced hypotension
Abnormal HR & SBP response to exercise
Silent Ischaemia (no angina pain)

Implications include: Low level activity and using RPE to supplement objective exercise intensity response (i.e. HR, BP) and monitor for signs/symptoms of hypoglycaemia.

18
Q

What are the risk factors and implications of Peripheral Neuropathy?

A

Affects extremities (esp. lower legs & feet).
Loss of distal sensation & weakness that could lead to musculoskeletal injury or infection.
Balance problems.

Implications: Use non-weight bearing forms of activity; avoid skin irritation/trauma to lower legs and feet; appropriate footwear; regular foot inspections.

19
Q

What are the risk factors and implications of Nephropathy?

A

Increase BP is a common precursor for kidney disease.

Implications: Avoid activities that cause SBP rises to 180-200mmHg (e.g. performing Valsalva Manoeuvre, high intensity aerobic/resistance work); stick to low-moderate intensity activities.

20
Q

What are the implications and what to avoid if suffering from Retinopathy?

A

Implications: Avoid activities that cause increase in SBP to 180-200 mmHg (performing Valsalva Manoeuvre, high intensity aerobic / resistance work).

Avoid: Dramatic increases in BP, head down or jarring activities with arms overhead. Possible problems associated with vigorous intensity aerobic exercise.

21
Q

Metformin is a common medication used by diabetics. What effect does it have when taken?

A

Metformin decrease hepatic glucose production which as a result lowers blood glucose. However the problem that comes with this is that stimulates insulin secretion (short term- palpitations, perspiration, sensation of anxiety and hunger, long term-mental confusion, seizures).

22
Q

What effect does the ATP-CP system have on blood sugar levels?

A

Generally does not reduce blood sugar levels as glucose is not involved in energy production but can raise blood sugar levels when accompanied by heightened release of hormones.

23
Q

What effect does the Lactic Acid System have on blood sugar levels?

A

An acute response would be an hormonal response of raised blood glucose due to response to the workload but in the long term could lead to hypoglycaemia

24
Q

What is the training effects on fuel use on blood sugar levels?

A 
Increased capacity to mobilise fat.
Reduced use of blood glucose.
Reduced need for additional CHO.
Less dramatic endocrine response (training effect).
More stable blood sugar level.
25
Q

What are the exercise testing considerations for diabetics?

A

Age, Duration of diabetes, presence of diabetic complications (e.g. autonomic or peripheral neuropathy. With the objectives being to identify presence and extent of CAD (ECG required) and determine quantity of training stimulus (FITT).

26
Q

Guidelines for aerobic exercise testing?

A 
Cycle or Treadmill with protocols 25- 50 W (3 min. stages), 1-2 METS/stage, ECG/HR/BP/RPE with the endpoints: Dysrhythmias
>2mm ST dep / elev. 
Isch. threshold
SBP > 250 mmHg
DBP > 115 mmHg
Onset of peripheral pain
27
Q

Guidelines for strength testing?

A

Isokinetic/Isotonic with protocols being Rep Max, Peak Torque and endpoints being BP increasing.

28
Q

Guidelines for flexibility exercise testing?

A

Goniometry

Sit & reach

29
Q

Guidelines for Gait Analysis?

A

Check balance and peripheral neuropathy

30
Q

Aerobic exercise programme prescription and goals?

A

Prescription: 50-80% peak HR/VO2, Monitor RPE, 4-7 Sessions/week and 20-60 Minute sessions

Goals include: Increase in aerobic capacity (VO2 max),increase in endurance, increase in work capacity, improve BP response, reduce CV risk factors and achieve required kcal expenditure.

31
Q

Strength exercise programme prescription and goals?

A

Prescription: Low resistance/high reps/High resistance OK for well controlled diabetics

32
Q

Flexibility exercise programme prescription and goals?

A

Prescription: 2-3 sessions/week
Goals: Maintain/increase ROM and improve gait.

33
Q

Fitness components for diabetics?

A

Frequency: Acute effect of activity on blood glucose approx. 72 hours (max) post-exercise (daily recommended).

Intensity: Low-moderate (40-70 VO2max) over >50% VO2max may be needed to increase V02 max but can increase injury risk.

Duration: 10-15 minutes (initially), ideally 30 mins ( can be 3 x 10 mins). May need to be more active
loss (>60 mins)

Mode: Weight bearing exercises (Resistance training, low resistance/high reps but not to exhaustion, or isometric contractions) and non-weight bearing like stationary cycling or swimming better alternative minimising effects of peripheral neuropathy).

Progression: Emphasis on frequency and duration to prevent adverse BP and blood sugar responses. i.e. 10-15 mins at low intensity (10-12 RPE), 3-5 a week.

34
Q

What are the benefits of exercise for diabetics?

A

Reduced blood glucose levels.

Improved glucose tolerance.

Improved insulin response to oral glucose stimulus.

Improved peripheral & hepatic insulin sensitivity.

Improved blood lipid & lipoprotein levels.

Decreased blood pressure.

Decreased risk for cardiovascular disease.

Improved physical fitness.

Increased caloric expenditure & reduction in body fat.

Improved flexibility & strength.

Improved psychological well-being.

Enhances insulin sensitivity and may reduce the insulin dose needed to control blood glucose levels.

35
Q

Variables affecting blood sugar response to exercise?

A

Time of day exercise takes place

Timing & type of insulin used

Insulin injection site

Timing & type of food consumed

Blood sugar levels at commencement of exercise

Type, duration & intensity of exercise

Accustomed to exercise (training effect)

Environmental temperature & conditions

Illness

Timing of menstrual cycle / pregnancy

Level of hydration

36
Q

What are the special considerations of exercise on diabetics?

A

A snack and/or insulin dosage change may be needed before exercise

Possible non-impact/non-weight bearing exercise mode due to the increased risk of peripheral nerve damage and retinopathies

Monitor blood glucose before, during and after exercise

Late exercise sessions increase risk of nocturnal hypoglycaemia

Peripheral neuropathy effects feet so take care of feet, checking before and after session/can effect fingers so don’t take pulse take a breathless or fatigue scale (RPE)

Autonomic neuropathy may be present so change of posture abruptly should be avoided

Retionpathy should avoid activities excessive jarring and those with illicit a marked increase in BP, avoiding bending over

37
Q

General exercise precautions?

A

Low VO2 max compared to healthy age matched controls

Keep a source of rapidly acting CHO available during exercise

Exercise with partner (in case of hypoglycaemia)

Avoid injecting in active muscle sites as this increases the rate at which insulin is absorbed.

Regular foot inspections due to the increased risk of foot trauma (Peripheral neuropathy)

38
Q

Contraindications to exercise for diabetics?

A

Poor glycaemic control:
< 5.5 mmol.l-1 need CHO before exercise (20 – 30g) due to increase risk of hypoglycaemia
> 10 mmol.l-1 check after 10 mins. of exercise due to the risk of hyperglycaemia
> 13 mmol.l-1 do not exercise, as exercise triggers the release of glycogen stored in the liver and blood glucose rise

39
Q

Insulin Types include:

A

Rapid Acting: Insulin lispro, Insulin aspart, Insulin glulisine; Tradename: Humalog, Novolog, Apidra; Onset:<15 mins; Peak: 30-90 mins; Duration: 1-3 hours

Short Acting: Regular; Tradename: Humulin R, Novolin R; Onset: 30-60 mins; Peak: 2-3 hours; Duration: 3-6 hours

Intermediate Acting: NPH, Lente; Tradename: Humulin N, Novolin N, Humulin R; Onset: 2-4 hours; Peak: 4-10 hours; Duration: 10-16 hours

Long Acting: Insulin glargine, Ultralente;; Tradename: Lantus, Humulin U; Onset: 2-4 hours; Peak: Does not peak; Duration: 18-36 hours

Exercise Prescription, Referral & Rehabilitation (10 decks)

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