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Exercise as medicine exam > Type 1 Diabetes > Flashcards

Type 1 Diabetes Flashcards

1
Q

When is the onset of T1D?

A

any age, usually <18years old

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2
Q

What is the prevalence of T1D?

A

8%

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3
Q

Is there any effect to lifestyle?

A

No

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4
Q

What are the signs and symptoms of T1D?

A

Weight loss
frequent urination
irritability
blurry vision
fruity breath

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5
Q

How many people with diabetes have type 1?

A

10%

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6
Q

What does the body do in an individual to cause T1D?

A

body attacks insulin producing cells so that you can’t produce insulin
(not to do with an individuals lifestyle)

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7
Q

What does insulin allow for?

A

Glucose to enter our cells

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8
Q

What happens to glucose in T1D?

A

It builds up in the bloodstream as it can’t enter the cells

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9
Q

How does the body try to get rid of the build up in glucose?

A

Gets rid of glucose through the kidneys
-increased urination
-leading to extreme thirst
-fatigue
-weight loss( as fat is broken down to be used as fuel)

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10
Q

When do symptoms appear with T1D?

A

Within a few days/week

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11
Q

What are used to supply the individual with insulin?

A

injections and pumps

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12
Q

What does a high glucose level in the bloodstream cause?

A

damage to heart, eyes, feet, kidneys

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13
Q

What are the normal physiological defences against hypoglycaemia?

A

-hormonal counter regulation
-symptomatic and brain responses
-mechanisms-metabolic and behavioural

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14
Q

How does hormonal counter regulation provide a defence against hypoglycaemia?

A

-decrease in insulin secretion
-increase glucagon secretion
-increase catecholamine secretion, sympathetic activation, later cortisol and growth hormone secretion

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15
Q

What symptomatic and brain responses provide defences against hypoglycaemia?

A

-warning symptoms
-cognitive dysfunction
-coma

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16
Q

What metabolic and behavioural mechanisms act as a defence against hypoglycaemia?

A

-prevent further glucose decline
-increase endogenous glucose production
-glycogenolysis (liver)
-gluconeogenesis
-decrease peripheral glucose uptake
-increase exogenous carbohydrate supply (eating)

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17
Q

What are the defences against hypoglycaemia in T1D?

A

with impaired hypoglycaemia awareness
-cognitive dysfunction
-coma
-increased catecholamine secretion, sympathetic activation and later cortisol and growth hormone secretion

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18
Q

Why is prescribing exercise to someone with T1D is difficult?

A

-muscle energy source uses ATP from CP initially
-glucose from muscle glycogen –> then glucose from liver glycogen
-glucose from gluconeogenesis
-with prolonged aerobic metabolism, FFA and ketones are the main fuel
-with increased intensity and duration = increase glucose use

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19
Q

How are the problems with individuals with T1D exercising mediated?

A

-decrease insulin, increase glucagon and for intense exercise catecholamines and GH
-this has significant implications for people with T1D

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20
Q

What are the barriers for exercise with T1D?

A

-Time and environment
-Social and personal
-Psychological
-Medical

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21
Q

What are the barriers for exercise for individuals with a new onset of T1D?

A

-Hypoglycaemia (fear and actual)
-Lack of knowledge
-Advice from healthcare professionals to stop exercising
-Planning (e.g. checking blood glucose)
-Overwhelmed by diagnosis

22
Q

What are the barriers for exercise for individuals with established T1D?

A

-Loss of control of diabetes
-Lack of knowledge an management of T1D for exercise

23
Q

What is exercising beneficial in reducing in T1D?

A

HbA1c

24
Q

What should individuals do/know to improve glycemia for exercise in T1D?

A

-to know type, intensity and duration
-check glucose and trend arrows
-consider timing of exercise
-know how much insulin on board
-take in carbs if needed

25
Q

What is resistance exercise associated with in people with T1D?

A

-stable postexercise glucose level
-much smaller decrease in blood glucose during exercise than aerobic exercise or no exercise
-

26
Q

What is aerobic exercise associated with in people with T1D?

A

-Greater increase in glucose levels during early recovery, which resulted in a trend towards higher glucose concentrations in late recovery
(reference- Yardley et al, 2012)

27
Q

What effect does the volume of resistance training have on an individual with T1D?

A

-Large volume of resistance training can induce hyperglycaemia and reduced effects of blood glucose levels
(1/2 sets of RE improved BG, 3rd set induced hyperglycaemia)

28
Q

When should you perform resistance training? before or after aerobic training? and why?

A

-Before aerobic training
-to lead to a lower reliance on glucose supplementation during exercise and might decrease the severity of potential nocturnal hypoglycaemia

29
Q

When exercising when do significantly fewer hypoglycaemic events occur?

A

In the morning

30
Q

When do most episode of post-exercise hypoglycaemia occur?

A

between 15-24hrs after exercise
(Reference- Gomez et al, 2015)

31
Q

What does exercising in the morning improve?

A

metabolic control on the subsequent day and maintains patients in the euglycemic range for a long time

32
Q

What intensity of exercise is the decline in blood glucose levels less?

A

High intensity exercise compared to moderate

33
Q

What intensity of exercise induces a higher risk of hyperglycaemia?

A

moderate intensity exercise compared to high intensity

34
Q

What effect does low-moderate exercise have on glucose response to insulin?

A

decrease

35
Q

Pre-mild aerobic exercise, how much should you decrease insulin intake by?

A

25%

36
Q

Pre-moderate aerobic exercise, how much should you decrease insulin intake by?

A

50%

37
Q

Pre-intense aerobic exercise, how much should you decrease insulin intake by?

A

75%

38
Q

What effect does moderate-intensity exercise have on glucose response to insulin?

A

increase and decrease

39
Q

If stable glucose is expected what action should be taken?

A

No reduction in insulin

40
Q

If a slight glucose drop is to be expected, what action should be taken?

A

25% mealtime insulin increase

41
Q

If a moderate glucose drop is to be expected, what action should be taken?

A

50% mealtime insulin increase

42
Q

What effect does intense (an)aerobic exercise have on glucose response to insulin?

A

increase

43
Q

What pre-exercise adaptations to mealtime insulin consumption should an individual take?

A

No mealtime insulin reduction required

44
Q

What should T1D individuals consider when exercising at a high intensity?

A

micro-bolus insulin correction

45
Q

When blood glucose level is <3.5 what should an individual do?

A

20g carb and wait 45min

46
Q

When blood glucose level is 3.5-5.6 what should an individual do?

A

20g carb and wait 15min

47
Q

When blood glucose level is 5.7-6.9 what should an individual do?

A

15g carb and exercise

48
Q

When blood glucose level is 7-15 what should an individual do?

A

exercise

49
Q

What should an individual do when blood glucose is >15

A

Ketone <mmol/L, 30% of correction dose

50
Q

When exercising how many carbohydrates should an individual be consuming?

A

30g per hour
-take every 20mins

51
Q

When should an individual with T1D not exercise?

A

Severe hypo in the last 24 hours

Exercise as medicine exam (15 decks)

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