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*CLINICAL EXERCISE PHYSIOLOGY > FINAL/CH8- Diabetes > Flashcards

FINAL/CH8- Diabetes Flashcards

1
Q

clinical name for diabetes

A

diabetes mellitus

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2
Q

diabetes mellitus

A

group of metabolic diseases characterized by inability to produce sufficient amounts of insulin OR inability to use it properly

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3
Q

result of diabetes

A

hyperglycemia (elevated blood glucose)

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4
Q

hyperglycemia

A

elevated blood glucose

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5
Q

scope of diabetes

A

-34 million in the US have diabetes
-88 million have prediabetes
-CDC considers diabetes epidemic in US
-7th leading cause of death in US

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6
Q

3 reasons for diabetes epidemic

A

-increasing overweight and obesity
-increasing sedentary lifestyle
-poor eating practices

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7
Q

where is insulin secreted from

A

cells in Islets of Langerhans (pancreas)

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8
Q

insulin does what

A

promotes tissue storage of glucose, amino acids, + fats
-helps us utilize carbohydrates as a substrate

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9
Q

type 1 diabetes

A

lack of insulin production
-NOT PREVENTABLE

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10
Q

type 2 diabetes

A

ineffective insulin (sometimes coupled with low insulin production)
-PREVENTABLE

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11
Q

which diabetes is preventable

A

type 2

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12
Q

which diabetes is not preventable

A

type 1

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13
Q

2 subcategories of type 1 diabetes

A

-immune-mediated (aka juvenile onset)
-idiopathic

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14
Q

immune-mediated type 1 diabetes (aka juvenile onset)

A

-cause: beta-cell destruction leading to insulin deficiency
-considered an autoimmune disease
-onset typically in childhood or adolescence
-requires exogenous insulin (injection or pump)

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15
Q

idiopathic type 1 diabetes

A

-cause: unknown
-can occur at any time during the lifespan
-much less common

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16
Q
A
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17
Q

idiopathic

A

what we call a condition that doesn’t fit the normal description of how it normally presents
-occurs within many different diagnosis
-example: someone gets diagnosed at later age in life with no explanation as to why

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18
Q

type 2 diabetes pathophysiology

A

-multifactoral cause, typically a combination of genetics + lifestyle
-insulin resistance + progressive loss in insulin secretion
-peripheral tissues become less sensitive to insulin
-declining beta cell function

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19
Q

type 2 diabetes was formally called what

A

adult-onset diabetes
-typical onset was 40+ years old but now seeing children with type 2

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20
Q

what is the most common form of diabetes

A

type 2
-90-95% of diabetes cases

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21
Q

gestational diabetes mellitus

A

diagnosed in 2nd or 3rd trimester of pregnancy via oral glucose challenge
-typically resolves following childbirth
-greater likelihood of developing type 2 later in life

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22
Q

what is used to diagnose gestational diabetes mellitus

A

oral glucose challenge

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23
Q

oral glucose challenge

A

-pt drinks a bottle of glucose drink + chugs as fast as possible
-after an hour from drinking, take a blood draw
-another hour after, take another blood draw
-we are looking for how well the body clears excess glucose over time after consuming very high sugar bolus

-also used to diagnose pts without signs/symptoms

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24
Q

what will a mother with gestational diabetes mellitus have to do throughout pregnancy after diagnosis

A

limit excess carbs, focus on complex carbs that won’t skyrocket blood glucose, etc.
-very uncommon to prescribe insulin to a pregnant woman, because this diagnosis can be monitored via change in behaviors alone
-also this diabetes goes away after childbirth

25
Q

dangers of gestational diabetes mellitus

A

-baby is more likely to be preterm (one of the very last things to develop is lungs, so this is very dangerous to give birth preterm since lungs may not be developed yet)
-baby is likely to be chubby/excess weight (bigger baby is harder to push and more likely to have a c-section)
-if mom had this diabetes, she + THE BABY is at increased risk for type 2 diabetes later in life

26
Q

other types of diabetes

A

-account for very small proportion of all diagnosed cases
-caused by reasons other than those for type 1/2 (ex: certain diseases, injuries, genetic syndromes)
-ex: someone is in a car accident with organ damage to pancreas where beta cells are ineffective + not secreting insulin)

27
Q

primary issue of diabetes

A

hyperglycemia

28
Q

signs/symptoms of uncontrolled diabetes (above pt’s glycemic goal)

A

-dehydration
-increased urine production
-headache
-weakness
-fatigue

29
Q

how to controll uncontrolled diabetes

A

-hydrate with non-carb beverages (sugar free)
-regular monitoring of blood glucose
-medication

30
Q

what 2 things can uncontrolled diabetes (above glycemic goal) lead to

A

-diabetic ketoacidosis
WHICH CAN LEAD TO…
-hyperosmolar nonketotic syndrome
WHICH CAN LEAD TO DEATH

31
Q

why do we see dehydration/increased urine in uncontrolled diabetes

A

when you have chronically elevated glucose, kidneys try to filter as much as possible
-urine would have high levels of sugar

32
Q

diabetic ketoacidosis

A

-poorly controlled diabetes with low/no effective insulin
-formation of ketones from ineffective fat metabolism
-fat metabolism is considered to be incomplete- body still can’t even use the fat as a proper source of energy + all together our body becomes more acidic
-pH goes down, enzymes can’t function properly, etc.

33
Q

hyperosmolar nonketotic syndrome

A

-profound + prolonged hyperglycemia typically leads to illness, stress, or undiagnosed diabetes
-severe dehydration, decreased mentation, possible coma
-diabetic shock or diabetic coma
-start to see brain effects, due to brains use of carbs

34
Q

other complications of diabetes

A

hypoglycemia
-too much insulin or selected antidiabetic oral agent
-too little carbohydrate intake
-missed meals
-excessive/poorly planned exercise

35
Q

3 chronic complications of diabetes

A

-macrovascular
-microvascular
-neuropathy

36
Q

chronic complications of diabetes- macrovascular

A

large-vessel disease of coronary arteries, cerebrum, + peripheries
-can result in PAD, intermittent claudication, exercise intolerance

37
Q

chronic complications of diabetes- microvascular

A

small-vessel disease of eyes + kidneys
-can result in blindness + end-stage renal failure

38
Q

chronic complications of diabetes- neuropathy

A

affecting both the peripheral + autonomic systems

39
Q

peripheral neuropathy

A

burning, tingling, or loss of sensation in hands/feet
-“diabetic foot”- because diabetics have vascular issues, periphery is not getting adequate circulation, so when they scrape/cut their foot it won’t get adequate circulation, can get infected, + become gangrene
-common for diabetics to have amputations due to chronic vascular complications

40
Q

autonomic neuropathy

A

nerve damage resulting in system dysfunction
-presents as abnormal HR, BP, etc.

41
Q

signs + symptoms of diabetes

A

-polydispia
-polyuria
-unexplained weight loss
-infections/cuts that are slow to heal
-blurry vision
-fatigue

42
Q

polydispia

A

excessive thirst

43
Q

polyuria

A

frequent urination

44
Q

does everyone with diabetes experience signs/symptoms

A

no
-25% with diabetes don’t even know it

45
Q

diabetes- medical history review

A

-exercise participation + training status
-BW + BMI
-laboratory values for A1C, plasma glucose, lipids, + proteinuria
-other non-diabetes-related health issues

46
Q

diabetes- physical exam

A

presence of chronic complications
-poor eyesight, neuropathy, etc.

47
Q

A1c

A

the % of hemoglobin that has sugar attached to it
-ex: 5.7% would mean that 5.7% of hemoglobin has sugar attached to it

48
Q

stepwise progression of diagnosing diabetes

A

fasting plasma glucose -> glucose bolus -> subsequent tests from there like A1c

-know there can be prediabetes before full blown diabetes

49
Q

diabetes treatment

A

-exercise
-medical nutrition therapy (MNT)
-self-monitoring of blood glucose
-diabetes self-management education
-medication

50
Q

medical nutrition therapy (MNT)

A

may ultimately focus on large weight loss from a complete meal replacement diet or bariatric surgery

51
Q

diabetes self-management education

A

delivered by a certified diabetes educator (can also be a CEP who is certified)

52
Q

is exercise testing necessary for diabetes?

A

-according to ACSM, yes BUT it may not be necessary for those with well-controlled diabetes who have no other major risk factors
-may be beneficial if exercise training intensity is planned to be vigorous (>60% of peak VO2)
-may be necessary to develop baseline measures used to inform ExRx

53
Q

exercise testing for diabetes

A

-similar to standardized testing
-treadmill or ergometer recommended for mode
-adjust workload/intensity appropriately
-modify for physical limiations (amputations, neuropathy, etc.)

54
Q

special considerations for GXT + ExRx- influence of chronic complications

A

-macrovascular disease (heart + peripheral vasculature)
-peripheral neuropathy
-autonomic neuropathy (reduced HR, BP, + blood flow redistribution control)

55
Q

PRIOR to each exercise testing/training session the CEP may inquire about

A

-starting blood glucose level (self-monitored)
-timing, amount, + type of recent food intake
-medication use + timing

56
Q

ExRx for diabetic pts

A

-start with a program that is doable for pt then progress
-at the absolute minimum program should include:
-CR
* 10 min per bout of exercise
* 2-3 days per week

-resistance training
* 2-3 days per week

-flexibility/balance
* as often as possible

57
Q

physioloigcal adaptations + benefits of ACUTE exercise for diabetics

A

-improves blood glucose values
-sustains post-exercise blood glucose control
-increases skeletal muscle glucose utilization

58
Q

physiological adaptations + benefits of CHRONIC exercise for diabetics

A

-improved overall metabolic control (blood glucose, insulin resistance)
-BP control + reduced hypertension risk
-blood lipid improvements
-reduced body fat + increased lean body mass
-weight loss + improved weight maintenance
-delay/prevention of type 2 diabetes in those at risk
-psycholoigcal benefits (reduced stress + depression, improved self-esteem)

59
Q

effects of training

A

-improved glucose tolerance was seen in as little as 7 consecutive days of training in subjects with early type 2 diabetes
-BUT the effect of exercise on insulin action is lost within a few days, indicating consistent exericise participation is important
-epidemiological evidence supports the role of exercise in preventing type 2 diabetes

*CLINICAL EXERCISE PHYSIOLOGY (18 decks)

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