Diabetes, Oxidative, Stress, exercise Flashcards
what is insulin resistance
- systemic, asymptomatic
- related to development in Type 2 DM
- involved in hypertension, non-alcoholic steatohepatitis, erectile dysfunction, alzheimers disease, parkinson’s disease
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how does a cell become insulin resistance
- appears to relate to endoplasmic reticulum stress
- ER stress important for normal functional but chronic stress = reduced function
- endoplasmic reticulum is important for balance of intracellular Ca
- Ca important for contraction, secretion, ATP synthesis, membrane excitability, gene transcript
- pump in ER helps to maintain balance, active in times of ER stress
oxidative stress
- occurs during inflammatory states
- associated with release of NO and O- in systems free radicals
- occurs in all cells - including endothelial cells - and increase ER stress
- endothelial cells sensitive to high levels of nutrients; ceates ER stress and eventually results in decrease function of SERCA pump and Ca leak channels
What is the sequelae of prolonged ER stress
- insulin resistance
- atherosclerosis
- micrioangiopathy: neuropathy, retinopathy, nephropathy
- in animals (mice): reduction of ER stress asoicated with reduction of sequelae
How do we reduce stress
- exercise: high-intensity/moderate intensity, aerobic, balance
- improves ER stress, SERCA pump function
- improves HbA1c
how does exercise help with stress, and diabetes
- improve mircoangiopathy
- decreases insulin resistance/blood sugar
- can decrease leptin/increase adiponectin
- can improve BMI
- can improve HTN
- can decrease hypercholestermia
What is leptin
- adipokine protein that acts as a hormone (associated with fat tissue)
- at a health weight: increase in leptin is assoicated with decrease in hunger
what does leptin do in obesity
- chronic increase in leptin levels promotes inflammation
- activates inflammatory pathway and macrophages
- assoicated with diabetes, RA
Adiponectin
- protein hormone
- anti-inflammatory properties
- levels increase with long term physical exercise
- improves insulin sensitivity (cells use glucose more effectively)
- more prevalent in subcutaneous fat (less in visceral fat)
Monitoring diaetes
- fasting glucose
- glucose tolerance test: within insulin sensitivity = shouldnt spike
- hemoglobin AB1C < 5.5 for general population
Symptoms of low glucose
- confusion
- irritability
- dizziness/shakiness
- headache
- hard, fast heartbeat
- tingling feeling
- sweating or cold clammy skin
Symptoms of hyperglycemia
- extreme thirst
- hungry
- dry skin
- need to urinate often
- blurrry vision
- drowsy
- slow healing wounds (long term)
- check blood glucose
- call your healthcare provider
Symptoms of diabetic ketoacidosis
- high blood sugar levels and ketones in urine
- vomiting
- excessive thirst
- signs of dehydration: dry mouth and tongue, sore throat, dark circles under eyes
- deep, heavy breathing
- urinating much more often and in larger amounts
- sudden loss of weight
- fruity-smelling breath (smells like they have been drinking)
- complaints of stomach pain or nausea
- drowsiness leading in time to unconsciousness
treatments of DKA
- fluid administration
- insulin adminstration
- correction of electrolyte imbalance; hypokalemia (cardiac arrythmia)
- intervention for underlying patholgy: infection (causing hyperglycemia)
Hyperosmolar hyperglycemic syndrome
- similar to DKA but little or no ketones, lack of acidosis
- blood glucose >600 mg/dl
- polyuria, polydipsia, dehydration
- lethargy, confusion
- can progress to seizures, coma
- treatment: short-acting insulin, electrolyte replacement (Careful fluid replacement)
Diabetes and exercise when can you exercise and what is beneficial for people with diabetes
- DO NOT exercise if blood glucose is < 70 or over 300 (use caution over 250 check ketones)
- high intensity aerobic exercise can cause hyperglycemia
- other exercise can cause hypoglycemia
- eat before exercise, after exerrcise (esp. type 1 but also true for type 2)
- do not inject insulin in working Muscles before
insulin will metabolize quickly
exercise contraindications
- blood glucose < 70
- blood glucose >300
- dehydration
- extreme temperatures
- poorly controlled HTN
- retinopathy
- neuropathy
- nephropathy
Musculoskeletal system and DM complications
- stiff hand syndrome
- dupuytren contracture
- flexor tenosynovitis/trigger finger
- carpal tunnel syndrome
- adhesive capsulitis
- disseminated idiopathic spinal hyperstosis (DISH)
- arthritis
- osteoporosis
