Physical activity and type 2 diabetes

Question 1

physical activity improves….

Answer 1

control of blood glucose in type 2 diabetes mellitus due to improve insulin sensitivity thus reducing progression

Question 2

What is the best physical activity for type 2 diabetes

Answer 2

• aerobic and resistance training

Question 3

How much do exercise programmes reduce HBA1c levels by

Answer 3

• they can reduce HbA1c levels by about 0.6% as well as reducing adipose tissue and triglyceride levels

Question 4

what type of exercise is recommended for patients with diabetes

Answer 4

• For most patients with diabetes, including those at high risk of coronary heart disease, recommending light to moderate activity such as brisk walking is safe

Question 5

when should doctors consider a formal exercise tolerance test

Answer 5

• The patient has additional risk factors for cardiovascular disease or
• There are microvascular complications of diabetes or
• There is evidence of peripheral vascular disease.

Question 6

What is a risk of exercising with diabetes

Answer 6

The risk of hypoglycaemia when exercising is greatest in patients with type 1 diabetes, but it can also occur in patients with type 2 diabetes who take sulphonylurea drugs (such as gliclazide and glimepiride) or insulin

Question 7

How should patients avoid hypoglycaemia when exercising

Answer 7

• learn how there body responds to different types of exercise by checking their glucose before, every 30 minutes during and after exercise
• eat a carbohydrate snack before exercise if the patients blood glucose is less than 5.5 mmol/l
• Patients should eat 5 to 30 g of carbohydrate during and within 30 minutes after prolonged or intense exercise in order to lower their risk of later-onset hypoglycaemia
• always carry fast acting carbohydrate food such as glucose tablets
• ensure hydrated
• avoid going alone to remote areas to exercise
• wear diabetes identification bracelet
• take blood testing kit with them
• avoid injecting insulin into exercising limb as this can increase the risk of hypoglycaemia - abdomen or an alternative injection site is advised

Question 8

What level of glucose is it safe to exercise in

Answer 8

• safe to exercise if blood glucose is between 7-12mmol/l

Question 9

Name the risks of exercising with diabetes

Answer 9

• hypoglycaemia
• hyperglycaemia
• retinopathy
• peripheral neuropathy

Question 10

describe how hyperglycaemia can develop with diabetes

Answer 10

• very strenuous physical activity can cause hyperglycaemia is patients with type 2 diabetes but this is more likely in patients who are insulin deficient and have poorly controlled diabetes

Question 11

when should strenuous activity be delayed in hyperglycaemia

Answer 11

• Above 16.7 mmol/l without ketones or

- Above 13.3 mmol/l with ketones detected in the urine.

Question 12

in terms of retinopathy when should patients avoid vigorous exercise

Answer 12

• They have moderate to severe non-proliferative diabetic retinopathy
• They have proliferative diabetic retinopathy
• They are undergoing laser treatment for proliferative diabetic retinopathy.

Question 13

What are the contraindications to exercise in patients with diabetes

Answer 13

• presence of active retinal haemorrhage
• current illness or infection
• blood glucose less than 4 mmol/l
• patients with peripheral neuropathy with Charcot arthropathy or foot ulcers
• autonomic neuropathy

Question 14

How much exercise should you be doing

Answer 14

150 minutes a week