Type 1 and type 2 diabetes

Question 1

Why prescribing exercise to people with Type 1 diabetes is challenging…

Answer 1

Muscle energy source uses ATP from CP initially Then Glucose from muscle Glycogen Then glucose from liver glycogen The glucose from gluconeogenesis
* With prolonged aerobic metabolism, FFA and Ketones are the main fuel
* With increasing intensity and duration, glucose use increase
* These are mediated by falling insulin, increasing glucagon, and for intense exercise increase catecholamines and later Growth hormone This has significant implications for people with T1D

Question 2

Differences between t1 and t2 diabetes

Question 3

tests for diabetes, glucose cont and insulin sensitivity

Answer 3

Blood glucose levels
Hemoglobin Ac1 test
Oral glucose tolerance test
Glucose clamp
ELSA anti body test
Continuous glucose monitors

Question 4

Need to knows before a patient can be prescribed exercise with diabetes

Answer 4

Freq of activity
Intensity of activity
Duration of activity and time of day
Type of activity

Question 5

Blood glucose classifications for pre diabetes and diabetes (fasting and post prandial

Answer 5

Classification of pre diabetes –
HbA1c ≥42mmol/mol
Fasting plasma glucose level 5.6-6.9mmol/L
2hr plasma glucose level 7.8-11mmol/L
Criteria for a diagnosis of type 2 diabetes
HbA1c ≥48mmol/mol
Fasting plasma glucose level ≥7mmol/L
2hr plasma glucose level ≥11mmol/L

Question 6

Internal and external barriers for type 2 diabetics

Answer 6

Internal barriers for people with t2 diabetes
- Exercise is not motivating
- Health problems
- Emotions
External barriers for people with t2 diabetes
- Lack of social support
- Lack of facilities to exercise
- Cultural barriers
- Weather

Question 7

frequency prescription for diabetics and what may it include?

Answer 7

Frequency prescription is 3 times a week  (Umpieiie at al 2013 )
Exercise prescription that incorporates ≈170min of exercise per week improved insulin sensitivity regardless of intensity - Houmard et al 2004 Journal of Applied Physiology
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Question 8

Intensity of exercise T2

Answer 8

Exercise intensity = higher intensity elicit greater reductions in HbA1c but improvements also seen at lower intensities Liubaoerjijin et al 2016 Acta Diabetol

Question 9

Type (modality) of exercise T2

Answer 9

Type = all beneficial at reducing HbA1c in a supervised environment
Umpierre et al. 2011 JAMA

Question 10

Timing of exercise t2

Answer 10

• People with diabetes have a dysregulated muscle clock
• Partly mediated by the inner-mitochondrial membrane
• Exercise can re-set the core-clock
• So can correctly timed exercise be a tool to treat metabolic disease?
  Study found that
  ▪ Afternoon HIIT ↘ blood glucose
  ▪ Morning HIIT ↗ blood glucose
  ▪ Mechanism – requires further investigation
  Savikj et al (2019) Diabetologia

Question 11

Why prescribing exercise to people with Type 1 diabetes is challenging…

Answer 11

Muscle energy source uses ATP from CP initially
Then Glucose from muscle Glycogen
Then glucose from liver glycogen
The glucose from gluconeogenesis
* With prolonged aerobic metabolism, FFA and Ketones are the main fuel
* With increasing intensity and duration, glucose use increase
* These are mediated by falling insulin, increasing glucagon, and for intense exercise increase catecholamines and later Growth hormone
This has significant implications for people with T1D

Question 12

Barriers for people with t1

Answer 12

Time and environmental, Social and personal, Psychological
Kennedy et al 2018

Question 13

Summary of exercise and the impact on blood glucose

Answer 13

• Aerobic/sub maximal exercise causes blood glucose to fall rapidly
• Intense exercise causes blood glucose to rise
• Aerobic/sub maximal exercise increases risk of nocturnal hypoglycaemia
• Repeated resistance exercise causes blood glucose to fall
• Intermittent high intensity exercise protects against hypoglycaemia during exercise, but is more likely to cause nocturnal hypoglycaemia