Week 6 --> Metabolic diseases 2: diabetes and insulin resistance Flashcards
Metabolic syndrome X
Abdominal circumference greater than 102cm (men) or 90cm (women)
Hypertension
Hyperglycaemia
Elevated triglycerides
Low levels of HDL-C
- McArdle’s disease
Absence of phosphorylase
Diabetes
Metabolic disorders characterised by hypo/hyperglycaemia resulting from defects in insulin secretion, insulin action or both
Health costs of diabetes
In Australia, approx. 14 billion direct health care costs
Type 1
Autoimmune destruction of beta cells in the pancreas
Damaged cells can further destroy beta cells
Mediated by the immune system
Health complications from type 1
Retinopathy
Neuropathy
Peripheral vascular disease
Common symptoms
Glycosuria (elevated glucose concentration in the urine)
Polyuria (more frequent urination)
Polydipsia (increased thirst)
Type 2
Cellular insulin resistance with relative insulin insufficiency
Insulin resistance related to impaired insulin receptor function hyperinsulinemia
Elevated triglycerides and BP, reduced HDL-C
Obesity is a classic risk factor (80% of cases)
o Genetic component
o Strong relationship to age
o Strong relationship to abdominal adipose tissue
What is insulin resistance/metabolic disease
Impaired glucose tolerance, but no reliance on extra insulin
Management of the conditions of insulin resistance
Physicians, endocrinologists, dietitians, nurses, mental health professionals
Education about the condition is important
Pre-screening is imperative
· Common insulin injection
patterns
· Identify knowledge of condition
Medication, Diet, Exercise
Management of type 1
Consistent blood glucose monitoring
Insulin injections
o Different types
Fast acting
Intermediate acting
Long acting
o Must be injected prior to eating
Training is associated with reduced insulin dosage and better glucose control
Management of type 2
Exercise is a valid form of prevention and management
Primary goal is to reduce body mass and % fat
Metformin medication to control high BP
Eventually patients will need to inject insulin
Research reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
Results both lifestyle interventions and metformin reduce the incidence of diabetes in people at high risk
Lifestyle intervention was more effective
- Physical assessment
Blood glucose assessment
§Fasting glucose
· Glucose readings of >6.9mmol/L
§ Oral glucose challenge
· High GI drink
· Glucose 11 mmol/L after
consumption
· Elevated glucose (7-11 mmol/L) 2
hours after
New detection methods
Soft contact lens encapsulates electronics
Sensor detects glucose in tears
Chip and antenna received power and sends info
Physical assessment
Graded exercise test
Must consider blood glucose issues
Treat the patient as if they have CV implications include ECG
Test for:
§ Claudication pain (PVD)
§ Eye problems
§ Nephropathy
§ Neuropathy
Exercise prescription and guidelines
(type 1)
Careful with blood glucose levels
Beware of hypoglycaemia during and after exercise
Can follow normal physical activity prescription guidelines
Low intensity aerobic focus
The higher the intensity, greater requirement for supplemental carbs
Avoid heavy resistance training especially when there is a microvascular disease
Exercise prescription and guidelines
(insulin resistance)
Similar to type 2 guidelines
Ensure aerobic focus, HIT is plausible
Growing body of evidence for resistance training
Priority reduce body mass, reduce systematic inflammation
Exercise prescription and guidelines
(type 2)
Promote aerobic exercise
§ Frequency 3-4 times per week
§ Intensity 50-80% of VO2max
§ Duration 30-60 minutes per session
§ Mode weight bearing/non-weight bearing careful w patients with neuropathy
HIT training is emerging as effective where tolerable and safe
Resistance training is an effective aid
Moderate loads time under tension matters
