Type 2 Diabetes Flashcards
How many adults have Impaired Glucose Tolerance (IGT), therefore increasing there risk of Type 2 Diabetes?
International Diabetes Federation Atlas 10th Edition (2021)
541 Million
What onsets type 2 diabetes?
Gradual Development
Most common in adults over the age of 40
What is the prevalence of type 2 diabetes in diabetes diagnosis?
90%
Is type 2 diabetes influenced by lifestyle?
Yes
What causes type 2 diabetes?
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
What are the symptoms of type 2 diabetes prior to diagnosis?
Weight loss
Excessive thirst
Unceasing hunger
Headaches
Dry mouth
What are the 2 main screenings to diagnose type 2 diabetes?
Foot screening
Eye screening
What is a diagnostic measure for type 2 diabetes?
HbAIc test
Oral Glucose Tolerance Test
How does HbAIc determine type 2 diabetes through scores?
Less than 42= metabolically healthy people
42-48= pre diabetes
Greater than 48= type 2 diabetes
Greater than 75= risk of DKA
How does the C-Peptide test determine type 2 diabetes?
High C-Peptide (>2.72 ng/ml) and High blood glucose
What does high glucose levels cause?
Damages to the:
- Heart
- Eyes
- Feet
- Kidneys
What is the criteria for a diagnosis of type 2 diabetes
HbA1c= >48 mmol/mol
Fasting plasma glucose level= >7 mmol/L
2hr Plasma Glucose level >11mmol/L
Random plasma glucose levels >11mmol/L
What is the classification of pre-diabetes?
HbA1c= >42mmol/mol
Fasting plasma glucose level= 5.6-6.9mmol/L
2hr Plasma Glucose level 7.8- 11mmol/L
What is the definition of type 2 diabetes?
(Alberti and Zimmet, 1998)
A metabolic disorder characterised by hyperglycaemic due to disorder of insulin secretion/action
What percentage of patients with type 2 diabetes are currently reaching the activity guidelines?
(Morrato et al 2007)
(Cassidy et al 2016)
Less than 40% of adults with diabetes reported being regularly engaged in moderate or vigorous PA
What are the internal barriers to exercise for people with type 2 diabetes?
(Korkiakageas et al. 2009)
Exercise is not motivating
- Lack of time
- Exercise is not interesting
- Exercise is uncomfortable
Health problems
- Physical
- Mental
Emotions
- Shame
- Laziness
- Fear
- Stress
What are the external barriers to exercise for people with type 2 diabetes?
(Korkiakageas et al. 2009)
Lack of social support
Lack of facilities to exercise
Cultural barriers
Weather
What are the acute responses to a bout of exercise?
- Pancreas
Pancreas
- Decreases insulin secretion as wants to use glucose as a fuel source
- Increases glucagon secretion to produce and utilise more glucose
What are the acute responses to a bout of exercise?
- Liver
Liver
- Increases glucose release
What are the acute effect to exercise= Phase 1? (minutes to hours)
Increased glucose uptake via AMPK, ROS, TBC1D1
Increased glycolysis
Increased fatty acid oxidation
What are the acute effect to exercise= Phase 2? (up to 2 days )
Increased insulin-stimulated glucose uptake
Increased glycogen synthesis
Increased fatty acid oxidation
Increased transcription of GLUT4
What are the chronic effect to exercise= Phase 3?
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
What is the recommended frequency of exercise for individuals with type 2 diabetes?
3x a week
Moderate, Continuous Exercise
What type of exercise intensity is recommended for individuals with type 2 diabetes?
Moderate, Continuous Exercise
Strength Exercise
Vigorous Exercise
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
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)
What is the frequency prescription of exercise for type 2 diabetes?
Umpierre et al. 2013
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
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
170 minutes of exercise
What intensity is genuinely recommended for those with type 2 diabetes?
Liubaoerjijin et al. 2016
Higher intensity elicit greater reductions in HbAIc
Improvements still seen at lower intensity
How does HIIT affect type 2 diabetes?
De Mello et al. 2022
More enjoyable= greater adherence
Very quick changes and allows progression
What types of exercise are beneficial in reducing HbAIc?
Umpierre et al. 2011
All are beneficial
Aerobic= -0.73%
Resistance= -0.57%
Combined=0.67%
What types of exercise intensities are beneficial in reducing HbAIc?
The more you do, the better
> 150mins= -0.89%
<150mins= 0.36%
For every weekly weight session, HbAIc fell by 0.4%
What is metformin?
Leading drug for lowering blood glucose for type 2 diabetes
500g diagnosis
1 pill= aerobic exercise, strength session
2 pills= combined exercise
How does type 2 diabetes effect circadian rhythm?
Savikj et al. 2019
People with diabetes have a dysregulated muscle clock
Partly mediated by the inner-mitochondrial membrane
Exercise can re-set the core-clock
How does morning vs afternoon exercise influence type 2 diabetes?
Savikj et al. 2019
Afternoon HIIT= decreases blood glucose
Morning HIIT= increases blood glucose
Mechanisms unknown
What are the exercise guidelines for type 2 diabetes?
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)
What are the risk factors in contributing to insulin resistance?
Obesity
Lack of exercise
Hypertension
Genetics
What is insulin resistance?
Kumar et al. 2010
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
