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Exercise as Medicine > Type 2 Diabetes > Flashcards

Type 2 Diabetes Flashcards

1
Q

How many adults have Impaired Glucose Tolerance (IGT), therefore increasing there risk of Type 2 Diabetes?

International Diabetes Federation Atlas 10th Edition (2021)

A

541 Million

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2
Q

What onsets type 2 diabetes?

A

Gradual Development

Most common in adults over the age of 40

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3
Q

What is the prevalence of type 2 diabetes in diabetes diagnosis?

A

90%

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4
Q

Is type 2 diabetes influenced by lifestyle?

A

Yes

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5
Q

What causes type 2 diabetes?

A

Insulin resistance

The body is releasing insulin but your cells are not utilising the insulin effectively

Insulin is getting a response but does not allow glucose into the cell and therefore there is no response to the signal

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6
Q

What are the symptoms of type 2 diabetes prior to diagnosis?

A

Weight loss

Excessive thirst

Unceasing hunger

Headaches

Dry mouth

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7
Q

What are the 2 main screenings to diagnose type 2 diabetes?

A

Foot screening

Eye screening

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8
Q

What is a diagnostic measure for type 2 diabetes?

A

HbAIc test

Oral Glucose Tolerance Test

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9
Q

How does HbAIc determine type 2 diabetes through scores?

A

Less than 42= metabolically healthy people

42-48= pre diabetes

Greater than 48= type 2 diabetes

Greater than 75= risk of DKA

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10
Q

How does the C-Peptide test determine type 2 diabetes?

A

High C-Peptide (>2.72 ng/ml) and High blood glucose

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11
Q

What does high glucose levels cause?

A

Damages to the:

  • Heart
  • Eyes
  • Feet
  • Kidneys
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12
Q

What is the criteria for a diagnosis of type 2 diabetes

A

HbA1c= >48 mmol/mol

Fasting plasma glucose level= >7 mmol/L

2hr Plasma Glucose level >11mmol/L

Random plasma glucose levels >11mmol/L

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13
Q

What is the classification of pre-diabetes?

A

HbA1c= >42mmol/mol

Fasting plasma glucose level= 5.6-6.9mmol/L

2hr Plasma Glucose level 7.8- 11mmol/L

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14
Q

What is the definition of type 2 diabetes?

(Alberti and Zimmet, 1998)

A

A metabolic disorder characterised by hyperglycaemic due to disorder of insulin secretion/action

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15
Q

What percentage of patients with type 2 diabetes are currently reaching the activity guidelines?

(Morrato et al 2007)
(Cassidy et al 2016)

A

Less than 40% of adults with diabetes reported being regularly engaged in moderate or vigorous PA

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16
Q

What are the internal barriers to exercise for people with type 2 diabetes?

(Korkiakageas et al. 2009)

A

Exercise is not motivating
- Lack of time
- Exercise is not interesting
- Exercise is uncomfortable

Health problems
- Physical
- Mental

Emotions
- Shame
- Laziness
- Fear
- Stress

17
Q

What are the external barriers to exercise for people with type 2 diabetes?

(Korkiakageas et al. 2009)

A

Lack of social support

Lack of facilities to exercise

Cultural barriers

Weather

18
Q

What are the acute responses to a bout of exercise?
- Pancreas

A

Pancreas
- Decreases insulin secretion as wants to use glucose as a fuel source
- Increases glucagon secretion to produce and utilise more glucose

19
Q

What are the acute responses to a bout of exercise?
- Liver

A

Liver
- Increases glucose release

20
Q

What are the acute effect to exercise= Phase 1? (minutes to hours)

A

Increased glucose uptake via AMPK, ROS, TBC1D1

Increased glycolysis

Increased fatty acid oxidation

21
Q

What are the acute effect to exercise= Phase 2? (up to 2 days )

A

Increased insulin-stimulated glucose uptake

Increased glycogen synthesis

Increased fatty acid oxidation

Increased transcription of GLUT4

22
Q

What are the chronic effect to exercise= Phase 3?

A

Increased capillarisation

Increased basal insulin sensitivity

Increased protein expression (GLUT4)

Increased substrate utilisation capacity

Repeated effects of the last exercise bouts phase 1 and 2

23
Q

What is the recommended frequency of exercise for individuals with type 2 diabetes?

A

3x a week
Moderate, Continuous Exercise

24
Q

What type of exercise intensity is recommended for individuals with type 2 diabetes?

A

Moderate, Continuous Exercise
Strength Exercise
Vigorous Exercise

25
Q

What is the relationship between exercise and type 2 diabetes?

(1) Smith et al. 2016
(2) Carbone et al. 2019
(3) Schellenberg et al. 2013
(4) Blomster et al. 2013

A

Linear association between MET h/week and reduced risk for T2D (1)

Linear association between improvements in CRF and reduced risk for T2D (2)

People who are moderately physically active for 150 minutes a week have 26% lower risk of developing type 2 diabetes than those who are inactive (3)
- Shows reduced lifestyle intervention versus usual care

Achieving twice this level (300min/wk) was associated with a 36% reduction in Type 2 diabetes (4)

26
Q

What is the frequency prescription of exercise for type 2 diabetes?

Umpierre et al. 2013

A

3 times a week

Every 20% absolute increase increase in adherence to exercise training prescribed thrice weekly, there was a 2mmol mol-1 reduction in HbAIc over 6 months

27
Q

What is the duration of exercise per week prescribed in order to enhance insulin sensitivity regardless of intensity in those with type 2 diabetes?

Houmard et al. 2004

A

170 minutes of exercise

28
Q

What intensity is genuinely recommended for those with type 2 diabetes?

Liubaoerjijin et al. 2016

A

Higher intensity elicit greater reductions in HbAIc

Improvements still seen at lower intensity

29
Q

How does HIIT affect type 2 diabetes?

De Mello et al. 2022

A

More enjoyable= greater adherence

Very quick changes and allows progression

30
Q

What types of exercise are beneficial in reducing HbAIc?

Umpierre et al. 2011

A

All are beneficial

Aerobic= -0.73%
Resistance= -0.57%
Combined=0.67%

31
Q

What types of exercise intensities are beneficial in reducing HbAIc?

A

The more you do, the better

> 150mins= -0.89%
<150mins= 0.36%
For every weekly weight session, HbAIc fell by 0.4%

32
Q

What is metformin?

A

Leading drug for lowering blood glucose for type 2 diabetes

500g diagnosis

1 pill= aerobic exercise, strength session
2 pills= combined exercise

33
Q

How does type 2 diabetes effect circadian rhythm?

Savikj et al. 2019

A

People with diabetes have a dysregulated muscle clock

Partly mediated by the inner-mitochondrial membrane

Exercise can re-set the core-clock

34
Q

How does morning vs afternoon exercise influence type 2 diabetes?

Savikj et al. 2019

A

Afternoon HIIT= decreases blood glucose

Morning HIIT= increases blood glucose

Mechanisms unknown

35
Q

What are the exercise guidelines for type 2 diabetes?

A

75 minutes vigorous activity across the week

Muscle strengthening activity at least 2 days a week

Adults should aim for at least 150 minutes of moderate intensity activity of 10 minutes or more (can be less by sitting less and moving more= exercise snacks)

36
Q

What are the risk factors in contributing to insulin resistance?

A

Obesity
Lack of exercise
Hypertension
Genetics

37
Q

What is insulin resistance?

Kumar et al. 2010

A

Insulin resistance impairs the ability of muscle cells to take up and store glucose and triglycerides, which results in high levels of glucose and triglycerides circulating in the blood

38
Q
A

Exercise as Medicine (7 decks)

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