Metabolic Conditions and Related Clinical Assessments

Question 1

What is diabetes mellitus?

Answer 1

Chronic conditions of elevated blood glucose (hyperglycemia).
Monitor with glucose readings with daily glucose readings and HbA1C levels through lab blood work every 3-6 months.

Question 2

Type 1 Diabetes

Answer 2

Autoimmune destruction of beta cells in pancreas that produce insulin.

Question 3

Diagnosis of Type 1

Answer 3

> 6.5% HbA1C
11.1 mmol/L random blood glucose or OGTT
7 mmol/L fasting blood glucose
Often diagnosed in those <35 years old and lower BMI (<25kg/m2) due to lifestyle not being a factor in the condition.
Most likely childhood.
At the higher end of numbers.

Question 4

Type 2 Diabetes

Answer 4

Lifestyle disease from elevated glucose levels from insulin resistance (from visceral fat accumulation).
Genetic factor as well = individuals with family who have type 2 diabetes are more likely to get it themselves.
Pre-diabetes can be managed with lifestyle changes.
-progresses to needing medication and insulin shots.

Question 5

Diagnosis of Type 2 Diabetes

Answer 5

> 6.5% HbA1C
11.1 mmol/L random blood glucose or OGTT
7 mmol/L fasting blood glucose
Normally different from T1 due to lifestyle factors influencing the conditions (ie. BMI>25kg/m2).
No weight loss
No ketoacidosis, less marked hyperglycemia to start with compared to T1

Question 6

Daily Glucose Readings

Answer 6

Blood glucose meters
-important to monitor blood glucose levels and ensure that patients are aware of what is going on.
Continuous glucose monitoring
-measuring glucose through interstitial fluid every few minutes by externally-worn glucose sensory on the upper arm
-give reading with a scanner

Question 7

Management of Diabetes

Answer 7

Medications
Insulin Shots
Lifestyle

Question 8

Medication Management of Diabetes

Answer 8

Insulin sensitizers (metformin)
Insulin secretors
Obesity medications (ozempic)

Question 9

Insulin Shots in the Management of Diabetes

Answer 9

Needed when other medicators do not meet demand to manage hyperglycemia.
Brings glucose into tissues and out of the blood.
Required for type 1 diabetes (last progression for type 2 diabetes).

Question 10

Lifestyle for the Management of Diabetes

Answer 10

Nutrition, stress management, weight management
Exercise = increases insulin sensitivity by increasing upregulation of insulin and responsiveness of receptors into tissues.
-single bout of exercise can increase insulin sensitivty for 24-72 hours.
-caution with hypoglycemia = monitor blood glucose before and after exercise.
-blood glucose level more than 11 or 12 mmol/L on test prior to exercise = contraindication to exercise.

Question 11

Clinical Assessment of Diabetes

Answer 11

Fasting and Random blood glucose tests

Question 12

What is dyslipidemia?

Answer 12

Defined as abnormal lipid levels in blood.
-High levels of low-density lipoprotein (LDL) cholesterol.
-Low levels of high-density lipoprotein (HDL) cholesterol.
-High total cholesterol.
-Elevated triglyceride levels.
Can be genetic or lifestyle.
Will most likely see this condition with another one as well.

Question 13

Primary Dyslipidemia

Answer 13

inherited and caused by genetic mutations.

Question 14

Secondary Dyslipidemia

Answer 14

Caused by lifestyle factors or other medical conditions.

Question 15

Management of Dyslipidemia

Answer 15

Medications
Lifestyle

Question 16

Medications for the Management of Dyslipidemia

Answer 16

Statins
Ezetimibe
PCSK inhibitors

Question 17

Lifestyle for the Management fo Dyslipidemia

Answer 17

Healthy diet = reducing processed foods and unhealthy saturated or trans fats.
Maintaining healthy weight = reducing visceral fat.
Quit smoking and limit alcohol consumption.
Exercise regularly = can lower LDLs and triglycerides and increase HDLs

Question 18

Clinical Assessment of Dyslipidemia

Answer 18

Lipid panel procedure
Lab blood work
Finger prick tests
-not very common in clinic, usually done in lab
-can be completed in clinic or at home
-can take cholesterol and triglycerides in single sample
-may need multiple if trying ti distinguish between LDL and HDL levels, depending on the brand of test

Question 19

What is metabolic syndrome?

Answer 19

Cluster of risk factors that increase risk and onset of T2D, CVD, stroke, cancer, etc.
Defined as poor glycemic control (pre-diabetes), central obesity (increased waist circumference), dyslipidemia (specifically high cholesterol, but also high triglycerides), AND hypertension.

Question 20

Management of Metabolic Syndrome

Answer 20

Medications
Lifestyle

Question 21

Medications of the Management of Metabolic Syndrome

Answer 21

Diabetes medications (metformin, insulin, etc.)
Obesity medications
Cholesterol controlling medications (statin, etc.)

Question 22

Lifestyle in the Management of Metabolic Syndrome

Answer 22

Healthier diets
No smoking and reduced alcohol consumption.
Regular exercise (ie. PA guidelines).
-lots of goal setting and behaviour change work with these types of clients.

Question 23

Clinical Assessments for Metabolic Syndrome

Answer 23

Blood pressure
Waist circumference
-possible weight and BMI
Random or fasted blood glucose levels
Cholesterol and triglyceride blood levels.
Questionnaires for QOL, goal settings, quitting smoking, etc.

Question 24

What is cancer?

Answer 24

Multiple forms from multiple causes/risk factors.
-Nutrition, exercise, radiation exposure, chemicals, hormones, immune system, genetic, aging, etc.
-caused by uncontrolled division of abnormal cells in certain tissues.
-can lead to malignancy (spreading to other tissues)
Breast cancer, prostate cancer, lung cancer, skin cancer, colorectal cancer are the most common.

Question 25

Diagnosis of Cancer

Answer 25

Each type of cancer has its own diagnosis Self examination -early detection is possible and important -breast and prostate/testicular cancer can be easiest to self detect Imaging Blood tests Biopsies

Question 26

Treatment for Cancer

Answer 26

Each type of cancer has its own treatment process depending on the stage of cancer, and patient factors/wishes -surgery, radiotherapy, chemotherapy, hormone therapy, immunotherapy. Combination of treatments are often used. Symptoms of treatment includes nausea, fatigue, muscle atrophy, cardiovascular fitness decline, loss of appetite, anemic, skin sensitivity, decreased bone density, etc.

Question 27

Exercise and Cancer

Answer 27

Exercise is beneficial before, during, and after cancer treatment. Before = increase strength, muscle mass, and CV fitness prior to treatment. During = offsets side effects of treatment, retains strength and CV fitness, lower fatigue and nausea, increases self-efficacy and coping mechanisms, increases bone density, improved immune function, circulated chemotherapy, improve overall physical and mental well being, improve QOL. After = regain strength and fitness, improved QOL and body image, decreases likelihood of secondary cancer.

Question 28

Clinical Assessments for Cancer

Answer 28

Subjective measures = pain VAS, fatigue scales, SOB, RPE scales, QOL questionnaires, cancer specific questionnaires. Anthropometric measures = weight, BMI, BIA, waist circumference, bone imaging (DEXAs). Vitals = should be monitored during exercise as well (blood pressure, SpO2, heart rate, ECGs). Cardiovascular fitness = submaximal VO2 or GXTs. Muscular and bone strengthening/endurance = 5-10 RM, functional strength tests, grip strength. Balance and functional mobility tests.