W11: Diabetes Flashcards
What is diabetes mellitus? What types are there and what are their features?
diabetes mellitus is a state of chronic hyperglycaemia as a result of many environmental and genetic factors. There are 2 types of diabetes.
Type 1 diabetes is a state in which the beta cells are affected in the pancreas resulting in a deficiency of insulin. This type is mainly common in children around the age of 14 and patients are usually underweight. Symptoms are usually sever at the onset.
Type 2 diabetes is the more common type of diabetes where there is a deficiency in the beta cell and a insulin resistance therefore the secretion and uptake of insulin are impaired resulting in higher amounts of blood sugar levels. This disease is more common in older individuals around the age of 60. Many patients are overweight and symptoms are usually mild or absent.
What are the diagnostic criteria for diabetic patients
Whe random venous plasma glucose ≥ 11mmol/L OR resting plasma glucose level ≥7 mmol/L OR when plasma glucose ≥11mmol/L 2 hours after ingestion of 75g of oral glucose load
What is IGT and HbA1c
IGT is impaired glucose tolerance which is the category immediately between. normal glucose tolerance levels and overt diabetes. People with IGT have a higher risk of getting type 2 diabetes and the annual progression rate is 1-10% per year.
HbA1c is a lab test to measure blood glucose and is conducted every 3-6 months to track blood glucose. HbA1c is ususally measured in percentage where the normal ranges are 4-6% and abnormal ranges are ≥6.5%
What are some of the physiological complications due to high blood sugar.
Some microvascular problems such as
retinopathy - complications in the eye
neuropathy - complications in the nervous system
Nephropathy - complications in the kidney
and in macrovascular complications such as cardiovascular diseased could be expected.
What are some of the effects of improving blood sugar control and blood pressure on some of the vascular complications.
Improving control of blood glucose has little effect on macrovascular problems but can prevent microvascular complications. Lowering blood pressure can help both macrovascular and microvascular problems. In order to make these happen, patients must stop smoking, increase physical activity and manage their weights
What are the effects of lifestyle interventions on diabetes?
Lifestyle interventions over a long period of time have proven to decrease the risk of having type 2 diabetes compared to only standard care alone in people with IGT. individuals that underwent lifestyle interventions that include individualised detailed advice about physical activity and diet + standard care for 3 years had a 58% decrease in having type II diabetes compared to individuals that received standard care alone (Tuomileto et al., 2001). In a similar study conducted by the Diabetes Prevention Programme Research group (2002) saw similar results. Comparing a group with placebo, metformin treatment, and lifestyle advice group, the lifestyle advice group that included counceling by dietitians, behaviour counselor, and exercise specialist etc., suprevised exercise classes, and behavioural self-management session revealed higher prevention rates than the other two interventions over a span of 24 weeks.
How might physical activity improve people with diabetes? What do they improve?
Physical activity can induce many benefits for diabetic patients. First physical activity can improve glycaemic control in patients. This includes higher insulin sensitivity, and lower blood glucose levels. Secondly, improvements in cardiovascular risk factors could be observed. These include, improved muscular strength and cardiorespiratory fitness, body weight and blood pressure, and improvements in lipids. Finally, physical activity can impose benefits on the psychological wellbeing of patients.
There are many research conducted on the effects of physical activity on blood glucose control. In particular, a systematic review revealed that physical activity lowered HbA1c levels in diabetic patients (Macmillan et al., 2013). furthermore these benefits (HbA1c decrease) were observed in many studies with a span ranging from 4 weeks to 12 weeks (Thomas et al., 2006; Umpierre et al., 2011; Avery et al., 2012).
Talk about studies surrounding sitting behaviour in diabetic patients
Research comparing 3 groups of 8 hours conditions: 1 uninterupted sitting, sitting + 3minutes of light walking every 30 minutes, and +3 minutes of resistance training every 30 minutes. The outcome measures were blood glucose levels, insulin, C-peptide and triglyceride. Results revealed that breaking up sedentary time lowered blood glucose levels significantly. On the other hand, blood glucose levels were higher in the uninterrupted sitting group (Dempsey et al., 2016). Results indicate the importance of breaking up sedentary time in order to maintain healthier blood glucose levels.
Give some recommendations of PA for youth, and adult diabetic patients.
Younger population should (0-4 years) should engage in at least 150 minutes of physical activity every day. Infants must have 60 minutes of tummy time in the day. children must engage in moderate to vigorous intensity physical activity for at least 60 minutes a day. it is also crucial to include different types of physical activity to promote movement skills, bone and muscular strength. Breaking up sedentary behaviour is also highly recommended.
For adults, engaging in bone and muscular strength training at least 2 times a week is essential. These can be carried out in activities like gardening, carrying heavy items, or resistance exercise. As per aerobic exercise, engaging in 150 minutes of moderate exercise or 75 minutes of vigorous intensity exercise is recommended. Similar to children, sedentary behaviour should be broken down as much as possible.
Some other type 2 diabetic specific recommendations are to not allow more than 48 hours between exercise sessions to enhance insulin action, to engage in balance and flexibility training however not to replace resistance or aerobic training, engage in resistance and aerobic exercise for maximise health outcomes, break up sedentary behaviour every 30 minutes and include bouts of light exercise, and increasing physical activity for even 3-15 minutes can be effective in reducing post-prandial hyperglycaemia.
For type 1 diabetes specific recommendations, engaging in resistance training could minimise the risk of hypoglycaemia and therefore should be encouraged, response to exercise could be different everytime therefore, constant checks of blood glucose levels and intaking carbohydrate is crucial, short bouts of a 10s sprint before or after moderate intensity exercise could prevent hypoglycaemia, and intermittent high intensity bouts during moderate intensity exercise may bring similar effects as well.
Is pre-screening necessary for diabetic patients
There are no current evidence to suggest that other pre-participation screening beyond the usual diabetes care is necessary. For asymptomatic diabetes, pre-participation screening may be unnecessary.
What are some symptoms of hypoglycaemia and how do we prevent it from happening?
symptoms can highly be mistaken to normal responses to training. These include sweating, tingle in lips, shaking, racing heart, confusion, and paleness. These can occur up to 72 hours after exercise.
Usually they occur when unfamiliar abnormal, high intensity, longer duration exercise are performed.
These can be prevented by monitoring blood glucose levels, avoiding directly injection of insulin in working muscles, adjusting insulin injection, and making sure to intake high amounts of carbohydrates before exercise.
List some recommendation for prescription when the following conditions occur: retinopathy, peripheral neuropathy, autonomic neuropathy, nephropathy, and obesity
For obesity, retinopahy, and peripheral neuropathy, limiting activities that are weight bearing could be effective. For autonomic neuropathy engaging in lower exercise intensity with unwavering blood pressure and heart rate is recommended. finally for nephropathy, avoiding exercise that would substantially increase blood pressure is recommended.
What are sort of activities may you want to prescribe to diabetic patients? What might be some concerns and characteristics of current structured programme, and what kind of aspects would bring success?
There are concerns such as a long-term adherence level. These exercise programmes usually attract more healthy motivated individuals. Improvements are often seen in glycaemic control, and other health indicators, and there are many exercise referral schemes available (Macmillan et al., 2013).
We should encourage patients to walk more as there are many benefits in doing so. Acute responses could be the improvement in blood glucose levels, and the chronic responses being cardiorespiratory fitness, body composition, HbA1c, lipid profiles and insulin sensitivity. These improvements could also save loads of money in the long run as well.
Pedometers may be an effective method in promoting walking (Tudor Locke et al., 2004). These can be used to monitor physical activity intensity.
Finally, when trying to change a diabetic patients lifestyle, lifestyle behavioural interventions become very useful. Certain techniques of behavioural interventions were associated with successful reductions in HbA1c which included: goal-setting, using follow-up prompts/reviewing behavioural goals, providing information about when and where to perform physical activity, time management, planning social support, barriers identification and problem solving , providing information about patient specific consequences (Avery et al., 2012)
