Type 1 Diabetes Flashcards by Izzy Boyden

When is the onset of T1D?

any age, usually <18years old

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What is the prevalence of T1D?

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Is there any effect to lifestyle?

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What are the signs and symptoms of T1D?

Weight loss
frequent urination
irritability
blurry vision
fruity breath

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How many people with diabetes have type 1?

10%

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

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

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What does insulin allow for?

Glucose to enter our cells

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What happens to glucose in T1D?

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

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

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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When do symptoms appear with T1D?

Within a few days/week

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What are used to supply the individual with insulin?

injections and pumps

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What does a high glucose level in the bloodstream cause?

damage to heart, eyes, feet, kidneys

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What are the normal physiological defences against hypoglycaemia?

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

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How does hormonal counter regulation provide a defence against hypoglycaemia?

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

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What symptomatic and brain responses provide defences against hypoglycaemia?

-warning symptoms
-cognitive dysfunction
-coma

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

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

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What are the defences against hypoglycaemia in T1D?

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

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Why is prescribing exercise to someone with T1D is difficult?

-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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How are the problems with individuals with T1D exercising mediated?

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

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What are the barriers for exercise with T1D?

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

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

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

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

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

What is exercising beneficial in reducing in T1D?

HbA1c

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

-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

What is resistance exercise associated with in people with T1D?

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

What is aerobic exercise associated with in people with T1D?

-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)

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

-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)

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

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

When exercising when do significantly fewer hypoglycaemic events occur?

In the morning

When do most episode of post-exercise hypoglycaemia occur?

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

What does exercising in the morning improve?

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

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

High intensity exercise compared to moderate

What intensity of exercise induces a higher risk of hyperglycaemia?

moderate intensity exercise compared to high intensity

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

decrease

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

25%

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

50%

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

75%

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

increase and decrease

If stable glucose is expected what action should be taken?

No reduction in insulin

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

25% mealtime insulin increase

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

50% mealtime insulin increase

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

increase

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

No mealtime insulin reduction required

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

micro-bolus insulin correction

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

20g carb and wait 45min

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

20g carb and wait 15min

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

15g carb and exercise

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

exercise

What should an individual do when blood glucose is >15

Ketone

When exercising how many carbohydrates should an individual be consuming?

30g per hour -take every 20mins

When should an individual with T1D not exercise?

Severe hypo in the last 24 hours