T2D And Exercise

Question 1

Define obesity

Answer 1

Excessive adipose tissue with BMI >30kg/m^2

Question 2

What are some of the complications associated with obesity?

Answer 2

Stroke, depression, asthma, diabetes, heart disease, hypertension, cancers, kidney disease, infertility, arthritis, gout, NAFLD

Question 3

What is metabolic syndrome?

Answer 3

This is a syndrome made up of at least 3 of the following: -Central obesity -insulin resistance - glucose >5.6mmol/L -high TG >1.7mmol/L -low HDL chol <1-1.3 mol/L -hypertension >130/85 mmHg

Question 4

What is a metabolically unhealthy person?

Answer 4

Eg. A skinny person who eats lots of fatty foods - this fat is stored internally which is more dangerous to health. This includes visceral fat, liver fat and skeletal muscle fat (ectopic fat).

Question 5

What effect does fat within muscle tissue have?

Answer 5

It can negatively effect glucose uptake and lead to insulin resistance

Question 6

Outline post-prandial metabolism in skeletal muscles, liver and adipose tissue. How would this differ for post absorptive metabolism?

Answer 6

Post prandial, there are high insulin levels (in normal people).This promotes increased uptake of glucose in skeletal muscles and decreases FFA uptake. In the liver and adipose tissue, glucose uptake and TG synthesis is increased. In the liver, there is decreased glycogen breakdown. In adipose tissue there is also decreased FFA release. For post absorptive metabolism, there would be no secretion of insulin and therefore the responses would be opposite to the above.

Question 7

What is insulin sensitivity?

Answer 7

The responsiveness of insulin sensitive tissues when stimulated by insulin.

Question 8

Why do type 2 diabetics require more insulin to uptake glucose?

Answer 8

Because they have a lower sensitivity to insulin, which means insulin-sensitive tissues aren’t as responsive to insulin stimulation. Also, type 2 diabetic patients pancreas’ secrete less insulin.

Question 9

Why is it detrimental to have high blood glucose levels?

Answer 9

Microvascular complications such as vision impairment, nerve damage (eg. Sensory impairment and slow emptying of stomach) and kidney damage. Macro vascular complications include heart disease, stroke and peripheral vascular disease.

Question 10

What effect does insulin resistance have on post prandial metabolism?

Answer 10

Due to the low insulin receptor sensitivity and secretion of insulin, there is reduced glucose uptake in skeletal muscle. There is less suppression of FFA release in adipose tissue so there is an increase in lipolysis.This leads to denovolipogenesis, which is where excess glucose is diverted to the liver. There’s an increase in glycogen breakdown in the liver and so continued release of glucose into the blood. Collectively these processes result in hyperglycaemia and has a role in the pathogenesis of liver fat and hepatic insulin resistance.

Question 11

Give an overview of the mechanisms that lead to type 2 diabetes and cardiovascular disease

Answer 11

Question 12

What is metabolic inflexibility?

Question 13

What are the dietary and activity recommendations for obese individuals?

Question 14

Define type 2 diabetes

Question 15

Pathophysiology of type 2 diabetes?

Answer 15

Peripheral insulin resistance, impaired regulation of hepatic glucose production and declining B-cell function

Question 16

Name some of the complications of type 2 diabetes - micro and macro

Question 17

What is key in the treatment of T2D?

Question 18

What are the diet, PA and exercise recommendations for diabetics?

Answer 18

Exercise:

Aim for Aerobic >150 mins/wk spread over 3 days minimum.

Avoid 2 consecutive days without activity.

Mod-vig intensity (40-60%), if younger or fitter individuals, >75mins/wk of VIG (>60% VO2 max).

Resistance exercise 2-3 sessions/wk on non-consecutive days.

HIIT is effective, safe and time efficient also.

PA:

Aim to increase habitual activity.

Diet:

combine diet induced weight loss

Question 19

Why is exercise recommended to T2 diabetes patients?

Answer 19

Exercise has shown to improve HbA1c levels, decrease visceral adipose tissue, increase fat free mass, increase insulin sensitivity, decrease TGs.

improves management of blood glucose levels (A single bout of exercise decreases blood glucose for 48-72hrs), body weight, lipids, blood pressure, cardiovascular disease, mortality, and overall quality of life.

It can delay or prevent the onset of the disease.

Question 20

Why are long term benefits of exercise transient in T2 diabetes?

Answer 20

After 6-8 days, effects of exercise training are lost. Any long term benefits are cumulative effect of single bouts.

Question 21

What physiological adaptations occur from exercise to diabetics?

Answer 21

Acute exercise activates alternative molecular signals that can bypass defects in insulin signaling in skeletal muscle, resulting in an insulin-independent increase in glucose uptake.

Increased skeletal muscle glucose uptake by translocation of GLUT4.

Exercise Increases GLUT4 protein expression and therefore glucose transport.

Exercise (aerobic specifically) improves mitochondrial function (content, number, metabolic flex) which increases oxidative capacity.

Angiogenesis improving O2 and glucose supply.

These all result in improved glucose control, insulin sensitivity and whole body metabolic health.

Question 22

Discuss the use of HIIT training with T2D

Answer 22

Shows improvements in metabolic control (glycaemic control and IR).

CV benefits.

Superior improvements in CRF.

Increased GLUT4 expression and decreased blood glucose conc.

Peripheral benefits: increased mitochondria, GLUT4, capillary density, Ca2+ reputable in SR

Central benefits: decreased torsion and therefore myocardial damage, increased Ca2+ handling therefore increased SV and ejection fraction.

Has been considered safe to use in high risk patients.

Time efficient.

Question 23

What is ectopic fat? And why is it detrimental?

Answer 23

Storage of TGs in tissues other than adipose tissue, that normally only contain small amounts of fat eg. Liver, skeletal muscle, heart, pancreas.

This can interfere with cellular functions and is associated with insulin resistance.

Can lead to NAFLD.