Week 7 & 8: T2D Flashcards
What is T1D?
Type 1 D: often juvenile onset
- approximately 10% of diabetes cases
- onset occurs by age 20 usually
- idiopathic
- autoimmune destruction of beta cels
- treated with exogenous insulin
refer to week 7 lecture slide 71
What is T2D?
Type 2 D: usual onset greater than 40 years
- approx. 85-95% of diabetes cases
- increasing incidence of adoloscent cases
- characterised by insulin resistance
- treated by hypoglycaemic medication
- people with T2D for a long time often require exogenous insulin later in life
refer to week 7 lecture slide 71
How is T2D diagnosed?
- FPG ≥7.0 mmol/L
- Fasting = no caloric intake for at least 8 hours
or - HbA1C ≥6.5% (in adults)
- Using a standardized, validated assay, in the absence of factors that affect the accuracy of the A1C and not for suspected type 1 diabetes
or - 2hPG in a 75-g OGTT ≥11.1 mmol/L
or - Random PG ≥11.1 mmol/L
random = any time of the day, without regard to the interval since the last meal
2hPG = 2-hour plasma glucose; FPG = fasting plasma glucose; OGTT = oral glucose tolerance test; PG = plasma glucose
week 7 lecture slide 73
How are asymptomatic patients assesed to be at high risk of diabetes?
- Asymptomatic patients are those who are not diagnosed with diabetes but are assessed to be at high risk based on a risk score.
- There are two ways to test for diabetes:
- Fasting blood glucose (FBG)
- Hemoglobin A1c (HbA1c)
- The results of the tests are used to determine the likelihood of diabetes.
- If the initial test results are high, a confirmatory test with the other method (blood glucose or HbA1c) is needed.
- If the confirmatory test is negative, the patient should be retested in one year.
- If the confirmatory test is positive, the person is considered to have diabetes. HbA1c results less than 6.5% do not rule out diabetes.
week 7 lecture slide 74
What is OGTT?
Oral glucose tolerance test (OGTT) is used to diagnose diabetes.
Procedure:
Fasting blood sugar test
Drink a sugary solution
Blood sugar tests at intervals (e.g., 1, 2 hours)
Measures: Body’s ability to process sugar (glucose)
week 7 lecture slide 75
What are the blood sugar levels that indicate normal, impaired fasting glucose, and type 2 diabetes according to the OGTT?
Normal: ≤ 7.8 mmol/L at 2 hours
Impaired fasting glucose: > 7.8 mmol/L and < 11.1 mmol/L at 2 hours
Type 2 diabetes: ≥ 11.1 mmol/L at 2 hours
week 7 lecture slide 75
What is the prevalence of T2D in men and women?
- greater prevalence in men and women 75+ years
- Men have increased prevalence compared to women 55-75+
week 7 lecture slide 76
What is the burden of hospitalisation for T1D and T2D?
source: AIHW National Hospital Morbidity Base, Figure 1 showing hospitalisations by diabetes type, 2015-2016
- Type 2 Diabetes: Most frequent hospitalization cause among diabetes types (63%).
- Additional Diagnosis: Highest hospitalization rate (90%) for patients with both diagnosed type 1 or 2 diabetes and another condition.
- Type 1 Diabetes: Lower hospitalization rate (29%) compared to type 2.
- Gestational Diabetes & Other: Lowest hospitalization rate compared to other types.
week 7 slide 77
What are the hospitalization Rates for Type 2 Diabetes by Age?
source: AIHW National Hospital Morbidity Base, Figure 1 showing hospitalisations by age, 2015-2016
- The graph shows hospitalisation rates per 100,000 people for Type 2 Diabetes.
- Generally, hospitalization rates increase with age for both males and females
- males have increased hospitalised to a higher extent than females with age
week 7 slide 78
What are the hospitalization Rates by Region and Socioeconomic Status (SES)?
source: AIHW National Hospital Morbidity Base, Figure 1 showing hospitalisations by region and SES, 2015-2016
- females in remote/very remoteregions had highest hospitalisation rate
- male in major cities, inner and outer regional areas had higher hospitalisation rates than females
- across the lowest and highest SES groups, males had higher hopspitalisation rates than females
refer to week 7 lecture slide 79
What happens in blood glucose homeostasis?
- The body tightly regulates blood sugar (glucose) levels for energy.
- Process:
- Liver stores glucose as glycogen (when high)
- Liver releases glucose (when low)
- Pancreas releases insulin (low blood sugar) - promotes glucose uptake into cells
- Pancreas releases glucagon (high blood sugar) - promotes glycogen breakdown and glucose release from liver
- Importance: Maintains energy for cells, prevents blood sugar from getting too high or too low (dangerous).
slide 81 lecture week 7
The liver plays a central role in regulating blood sugar levels.
When blood sugar rises (hyperglycemia), the liver converts glucose into glycogen, a storage form of glucose, for later use.
The pancreas releases insulin, a hormone that signals cells to absorb glucose from the bloodstream, lowering blood sugar levels.
When blood sugar falls (hypoglycemia), the liver breaks down glycogen back into glucose to release it into the bloodstream, raising blood sugar levels.
Glucagon, another hormone produced by the pancreas, stimulates the liver to convert glycogen into glucose when blood sugar is low.
The body maintains a delicate balance between these processes to ensure blood sugar levels stay within a healthy range.
Factors Affecting Insulin Secretion and Action
Positive factors that increase insulin secretion and action:
- Increased physical activity
- Normal body weight
Negative factors that decrease insulin secretion and action:
- Heavy alcohol consumption
- Smoking
- Genetic predisposition (genes)
- Gestational diabetes
- Epigenetics (environmental influences on genes)
Consequences:
- Hyperglycemia (high blood sugar) –> Long-term damage to nerves, eyes, kidneys
- Insulin resistance (Cells become less responsive to insulin)
- B-cell dysfunction (impaired insulin secretion)
slide 82 lecture week 7
summary of effects of T2D on body systems and organs
slide 83 lecture week 7
COME BACK TO THIS SLIDE .. do i even need it vcayse slide 85 talks about exact same thing
Effects of Insulin Resistance
Increased:
- Glycogenolysis & Gluconeogenesis (↑ glucose output, ↓ storage)
Reduced:
- Muscle glucose transport (↓ uptake & storage)
- Glucose uptake (↓ uptake & storage)
- Lipolysis (↑ FFA release into blood)
Pancreas:
- Initially ↑ insulin output (to overcome resistance)
- Over time, ↓ insulin secretion (worsens blood sugar control)
refer to slide 85 of week 7 lecture
How does insulin reduce blood glucose?
Its effect on liver:
- Store glucose as glycogen
- Turn off gluconeogenesis
Its effect on muscle:
- Increase glucose transport to reduce blood glucose
- Increase storage as glycogen to reduce blood glucose
Its effect on fat cells:
- Increase glucose transport
- Turn off hormone sensitive lipase (the enzyme that breaks down stored fat)
refer to slide 85 of week 7 lecture
Individualizing HbA1c Targets
Most patients with type 1 or 2 diabetes should aim for HbA1c ≤7%
Consider higher targets (up to 8.5%) for:
* Limited life expectancy
* High functional dependency
* Extensive coronary artery disease
* Multiple co-morbidities
* History of recurrent severe hypoglycemia
* Longstanding diabetes with difficulty achieving HbA1c ≤7% despite treatment
Consider lower targets (down to 6.5%) for:
* Some patients with type 2 diabetes to lower risk of nephropathy and retinopathy
Balancing benefits and risks is important (e.g., tighter control may increase risk of hypoglycemia)
refer to slide 88 of week 7 lecture
Make an exhaustive list of the parmacological treatment of type 2 diabetes (based on the lectures)
- biguanides
- alpha glucosidase inhibitors
- DPP -4 inhibitors
- sulphonylureas
- meglitinides
- thiaszolidinediones
- glucagon like peptide 1 (GLP-!) receptor agonists)
use this when oral hypoglycaemics fail
* short acting insulin
* long acting insulin
* incretin mimetics
refer to slide 89 - 92 of week 7 lecture
What are biguanides
Biguanides (Glucophage, Metformin, diaformin, diabex)
- – First line treatment for diabetes
– Sometimes used to prevent diabetes (US DPP)
– Primary effect is to sensitize liver to insulin – reduces glycogenolysis and gluconeogenesis
– Does not cause weight gain, can cause some weight loss
– Minimal risk of hypoglycaemia
week 7 lecture slide 89
What are alpha glucosidase inhibitors
α-glucosidase inhibitors (Acarbose, glucobay)
- – Slow digestion and absorption of carbohydrates
– On it’s own, does not cause hypoglycaemia, but if it does occur due to other medication, treatment must be
with glucose
week 7 lecture slide 89
What are DPP -4 inhibotrs
DPP-4 inhibitors (Linagliptin, Sinagliptin, Januvia, Trajenta)
- – On their own do not cause hypoglycaemia, but risk is elevated if treated together with a sulphonylurea
– Stimulate incretin secretion which in turn stimulates insulin secretion from the pancreas
week 7 lecture slide 89
What are sulphonylureas
Sulphonylureas (Gliclazide, glimepride, diamicron)
– Insulin secretagogue; Lower blood glucose by stimulating insulin release from the pancreas
– Can cause weight gain
– Can cause hypoglycaemia
week 7 lecture slide 90
What are meglitinides
– Meglitinides (Mitiglinde, Nateglinide, Glufast, Starlix)
– Insulin secretagogue; Increases insulin secretion from the pancreas
– Can cause hypoglycaemia
week 7 lecture slide 90
what are thiazolidinediones
– Thiazolidinediones (Rosiglitazone, pioglitazone, Avandia, Actos)
– Increase sensitazation of peripheral tissues (fat, muscle)
– On their own do not cause hypoglycaemia, but risk is high if individuals are taking a sulphonylurea
– Can cause weight gain, however may re-distribute fat away from the waist
– Contraindicated in those with liver disease
week 7 lecture slide 90
what are glucagon like peptide 1 receptor agonists
– Glucagon-like peptide-1 (GLP-1) receptor agonists (exenatide, liraglutide,
semaglutide)
– Stimulates beta-cell insulin release and slows gastric emptying
– Benefits include weight loss
– BP lowering
– very low risk of hypoglycaemia unless used with SU or insulin
week 7 lecture slide 91
What are incretin mimetics
– Incretin mimetics (byetta, exenatide)
– Only prescribed when maximum dose of metformin or sulphonylurea (or combination) is
insufficient
– Stimulates secretion of insulin, downregulates glucagon, and reduces appetite
– Not suitable for those taking exogenous insulin
– Hypoglycaemia a risk when taking together with sulphonylurea
week 7 lecture slide 92
Australian Type 2 Diabetes Glycemic Management Algorithm
This algorithm should be used with the Living Evidence Guidelines in Diabetes.
All patients should receive education on healthy diet, physical activity, and weight management.
Individual HbA1c target should be determined.
Medications are reviewed if HbA1c target is not met or if cardiovascular/chronic kidney disease is present.
week 7 slide 96
Goals for T2D optimum management
clinical management goals:
* HbA1c below 7% or 53mmol/mol
individual goals
* diet: advise eating according to the ADG; dietary review for people with difficulty managing weight, maininting glucose levels in target range , CVD disk, or if otherwise concerned
* BMI: advise a goal of 5-10% weight loss for people who are overweight or obese with T2D; for people with BMI greater than 35kg/m2 and comoboridities, or BMI greater than 40kg/m2, consider facilttaing greater weight loss measures
* **PA: **at least 60min/day for kids & at least three days of muscle and one strengthening activity, at least 150 mins of aeorbic activity per week & 2-3 sesions of resistance exercise
* **cigarette: **0 cigarette consumption
* **alcohol consumption: **advise less than 2 standard drinks per day for men and women (20g of alcohol)
* blood glucose monitoring advise 4-7mmol/L fasting and 5-10mmol post prandial
refer to slide 97 of week 7 lecture
Intensive blood glucose control and vascular outcomes in patients
with type 2 diabetes
ADVANCE Collaborative Group. N Engl J Med 2008;358:24.
- median A1C for standard control is 7.3%
- median A1c for intensive control is 6.5%
refer to slide 98 of week 7 lecture
Lifestyle treatment of T2D
– Diet and physical activity are central to the management of Type 2 Diabetes
to improve glucose, lipids, BP, weight and associated co-morbidities
– When medications are used to control Type 2 diabetes, they should augment
the lifestyle prescription, not replace it
– The glycemic benefits of exercise are independent of the overall weight loss
achieved, but may depend on body composition shifts
refer to slide 99 of week 7 lecture
serious complicaitons associated with diabetes
- diabetic retinopathy; leading cause of blindness in adults
- diabetic nephorpathy; leading cause of endstage renal disease
- diabetic neuroapthy; leading cause of non-traumatic lower extremity amputation
- stroke: 2-4 fold icnrease in CV morality and stroke
- CVD: 8/10 individuals with diabetes die from CV events
slide 100 of week 7 lecture
Different Treatment Regimes for Newly Diagnosed vs. Long-Term Type 2 Diabetes
Lifestyle Management: Always a priority for both newly diagnosed and long-term Type 2 Diabetes (T2D).
Initial Treatment:
Newly Diagnosed: Focuses on medications with low hypoglycemia risk like Metformin (increases liver insulin sensitivity).
Treatment Adjustment:
Long-Term T2D: If initial medications (like Metformin) aren’t enough, doctors may add medications with a higher hypoglycemia risk like insulin. This is because the body’s ability to manage blood sugar naturally may decrease over time.
week 7 tutorial notes (met syndrome and T2D)
AHA Scientific Statement for Exercise Testing
(Fletcher et al 2013)
Individuals considering vigorous exercise (> walking) should undergo a medical evaluation, especially if they are at higher risk for exercise-related complications.
High-risk groups:
* Men over 45 years old
* Women over 55 years old
* People with diabetes mellitus
* People with 2 or more other cardiovascular risk factors
Recommended evaluation:
* Medical history
* Physical examination
* Risk factor profile
* Electrocardiographic stress test (ECG) in most cases
refer to slide 69 of week 8. lecture
Obesity, Osteoarthritis (OA) and Diabetes
- Obesity linked to: Higher rates of joint pain and discomfort in OA.
- Exercise: Can be a barrier due to pain, but low-impact options like cycling, swimming, and resistance training are safe and beneficial.
- **Weight loss: **Not necessary for initial blood sugar control (glycemic control) in obese individuals with OA.
- **Body composition: **Improved body composition (muscle gain) can help manage weight and improve long-term exercise adherence.
- **OA and exercise: **Loaded exercise (high impact) might be challenging, but low-impact exercise:
- Won’t worsen OA
- Improves joint mobility
- Helps decrease body mass
refer to slide 72 wee 8 lecture
Symptoms of Hypoglycaemia
Hypoglycemia (low blood sugar) can happen during, right after, or even up to 24 hours following exercise.
ensure you, your patient are aware of the risks, signs and symptoms of hypoglycaemia before initiating and ExRx
Symptoms to Watch For:
- Physical signs: Shaking, sweating, paleness, hunger.
- Feeling unwell: Lightheadedness, headache, dizziness, pins and needles around mouth.
- Behavioral changes: Mood swings, confusion, lack of concentration, slurred speech.
- Severe hypoglycemia: Difficulty drinking/swallowing, not following instructions, loss of consciousness, seizures
refer to slide 73 week 8 lecture
Pre exercise and hypoglycaemia related risks with medication
Hypoglycemia Risk: Certain medications can increase the risk of low blood sugar (hypoglycemia) during exercise.
High Risk:
* Insulin: Requires adjustments to dosage and/or carbohydrate intake before exercise due to high hypoglycemia risk.
* Insulin Secretagogues (e.g., Sulfonylureas, Meglitinides): Similar risk to insulin, consult your doctor.
Low Risk:
* Other Oral Medications: Generally do not require adjustments for exercise.
* Non-Insulin Injectables (e.g., GLP-1 agonists): Usually safe for exercise without medication changes.
refer to slide 74 of week 8 lecture
hypoglycaemia protocol
copy of osce notes
(1)Check BGL – If you cant check treat is as a hypo
If Below 4 mmol/L give 15 grams of fast acting carbs (e.g. 6-7 jelly beans or ½ can of regular soft drink)
(2)Wait 15 minutes, re-check BGL to see if risen above 4 mmol/L
BGL above 4 mmol/L → Go to step 3
Below 4 mmol/L → Repeat Step 1
(3)Eat a snack or meal with long acting carbohydrates
e.g. Slice of bread OR glass of milk OR 1 piece of fruit OR Pasta OR rice
slide 75 of week 8 lecture
prevention protocol for hypoglycaemia for those who take meds that predispose them to hypoglycaemia
- have them discuss with their doctor if medication should be adjusted on exercise days, particularly if they have had hypoglycaemic effects in the past
- have them exercise 60-90min post meal
- measure BGL before exercise
- if BGL between 5.5 and 8 mmol/L - ok to exercise, however ocnsider CHO snack if vigorous and/or for prolong duration
- if BGL is below 5 mmol/L - give CHO snack prior to exercise and wait for blood sugar to rise. Amount of CHO given depdends on intended volume and inteisty. Exercise session may need modification
refer to slide 76 of week 8 lecture
Exercise and Blood Sugar Levels in T2D
Key Point: Exercise is generally safe for people with T2D, even with high blood sugar, as long as they feel well.
- High Blood Sugar (Hyperglycemia):
- Skip Exercise IF: Blood sugar > 14 mmol/L with ketones OR > 16.6 mmol/L (with or without ketones).
- Consider Low-impact Exercise IF: Blood sugar is high but you feel well, hydrated, and have no ketones. Don’t skip exercise solely based on high blood sugar.
- Ketones: Rarely elevated in Type 2 Diabetes.
- Diabetic Ketoacidosis (DKA): Can occur with high or normal blood sugar in T2D taking SGLT2 medications (consult your doctor).
refer to slides 77-78 week 8 lecture
pre exercise cardiac screening
- cardiac screening with a stress test reccomended for previously sedentry patients with addiotnal CV risk factors
- especially for those attempting to udnergo more than brisk walking
- use clinical judgement
- stress testing screening, while providing valuable exercise prescription, is not necessary in all patients with T2DM or pre diabetes
refer to slide 80 of week 8 lecture
indications for preparticipation exercise stress testing in adults
- Generally, the test is recommended for adults who meet one or more of the following criteria:
- Age 40 or above, with or without risk factors for cardiovascular disease (CVD) other than diabetes.
- Age 30 or above with:
- Type 1 or type 2 diabetes for more than 10 years. - Other health conditions:
- Hypertension (high blood pressure)
- Cigarette smoking
- Dyslipidemia (abnormal cholesterol or fat levels in the blood)
- Proliferative or preproliferative retinopathy (eye disease caused by diabetes)
- Nephropathy (kidney disease) including microalbuminuria (small amounts of protein in the urine) - The test may also be recommended for anyone regardless of age with a known or suspected history of:
- Cardiovascular disease (CVD)
- Coronary artery disease (CAD) - Peripheral artery disease (PAD)
- Other conditions that may warrant the test include:
- Autonomic neuropathy ( nerve damage affecting involuntary functions like heart rate and digestion)
- Advanced nephropathy with renal failure (severe kidney problems)
slide 80 of week 8 lecture
pre exercise HTN and PVD
- Common comorbidity
- Poorly controlled? Avoid vigorous intensity resistance training
- Avoid Valsalva manouvre
- Treat hypertension as per other exercise guidelines
- PVD is a common, especially in those with HTN, obesty and
smoking history
– Presents as pain in calves or buttocks with exercise
– CAUTION: high impact or traumatic foot injuries during exercise
– Resistance training = viable alternative
slide 81 of week 8 lecture
come back i dunno what this slide is talking about
refer to slide 82 of week 8 lecture
main considerations for autonomic/diabetic neuropathy (in general)
- Silent ischaemia – patients may have angina or heart attacks that are not
felt due to impaired sensation - Orthostatic hypotension – autonomic dysfunction + anti-hypertensive
medication mean patients may be prone to dizziness and syncope when
changing posture or stopping exercise quickly - Hypoglycaemia – reduced sensitivity to low glucose, in addition to
hypoglycamic medication, may mean glucose lowering effects of
exercise may cause undetected hypoglycaemia, watch for symptoms - May have intolerance to heat, although not well studied
- Patients who are active (even with weight bearing exercise) do not seem
to increase their risk of ulcers - Regular inspection of feet recommended
- Type 2 diabetes is the leading cause of non-traumatic limb amputations
- Adults with type 2 diabetes also have
impaired healing - Consider safety in anyone with
neuropathy - lacerations/cuts are not felt, nor do they heal –> infection à image on the right –> amputation
slide 83 and 86 week 8 lecture
symptoms of peripheral neuropathy
sensory nerve damage
* unsual sensations
* pain from light touch
* burning
* numbness
* tingling
* balance problems
motor nerve damage
* muscle cramping
* twitching
* reflex abnormalities
autonomic nerve damage
* execess sweating
* heat intolerance
* getting full quickly
* impotence
* orthostatic hypotension (dizziness or fainting after standing up)
slide 84 of week 8 lecture
pre-exercise neuropathy foot considerations
- Reduces sensation in the hands and feet
– reduced awareness of painful sores that can result from impact-related
activities (walking or running). - Appropriate footwear?
- Regular foot inspection
- Low impact exercises
Essential for patients with peripheral neuropathy and highly
advised in all patients with T2D.
Active patients (even with weight bearing exercise) do not seem to
increase their risk of ulcers. 85
slide 85 of week 8 lecture
pre exercise considerations for peripheral neuropathy
- high impact exercise contraindicated; normal walking does not increase risk of ulcers
- higher intensities of aerobic trianing can be achieved with hills and stairs if needed
- good footwear and frequent exams required
- balance training helpful to compensate for sensory/motor loss from neuropathy
- if pain is sevre, use non-weight bearing resistance exercise to treat diabetes
slide 87 of lecture week 8
pre exercise considerations for obesity and OA
- higher rates of joint pain and discomfort
- barrier to exericse 🤷♂️
- weight loss not necessary to improve glycaemic control
- improve body composition improves long term adherence
- OA = loaded exercise challenging
- low impact exercise won’t accelerate condition, increases joint mobility and decreases mass
- cycling, swimming, resistance training
slide 88 of week 8 lecture
why is this in theb diabetes section of the lecture
pre exercise medicaotin concerns for T2D
- Over-the-counter (OTC) medications and diabetes:
* Avoid OTC drugs with alcohol or sugar: These can affect blood sugar control. - Pain relievers and diabetes:
* NSAIDs (ibuprofen, naproxen) are used cautiously: They may increase the risk of low blood sugar (hypoglycemia) in diabetics.
* Blood pressure monitoring: The effect of NSAIDs on blood pressure is unclear, so monitor patients with high blood pressure (HTN) taking NSAIDs closely. - Supplements and diabetes:
* Some supplements may improve blood sugar control: Mechanisms include increased insulin release, decreased insulin resistance, and reduced carbohydrate absorption.
* Effects on exercise unclear: Some claim slight improvements in oxygen consumption, while others report no change.
* Close blood sugar monitoring: Regardless of the effect on exercise, monitor blood glucose levels closely before, during, and after exercise when taking these supplements.
refer to slide 89 of week 8 lecture
co-morbidities - careful considerations
- Careful consideration to ensure client safety
– presence and severity of diabetes and associated
complications,
– medication regimens,
– schedule for these medications
- Clients with diabetes must always wear medical
identification
- Diabetes slows healing process- maintaining proper
foot care to reduce foot sores and blisters is vital.
– Longer healing times = foot sores and blisters
more likely to become infected à resulting in
more serious complications.
slide 92 of week 8 lecture
Exercise Restrictions for Diabetic Retinopathy
Conditions to Avoid Strenuous Exercise:
- Unstable proliferative retinopathy
- Severe retinopathy
Restricted Activities:
- Vigorous exercise (weightlifting, isometric exercises)
- Activities involving breath holding or straining
- Overhead lifting
- Activities lowering the head (yoga poses)
- Activities jarring the head (gymnastics)
Monitoring Intensity:
- No max heart rate test available - use RPE (Rating of Perceived Exertion) scale (10-12 on a 6-20 scale)
Absolute Contraindications:
- Unstable/untreated proliferative retinopathy
- Recent retinal photocoagulation or eye surgery
- Consult ophthalmologist for specific restrictions
- retinal hemorrhaege contraindication
- active haemorrahage or recent laser corrective surgery for retinophay is complex, exercise is contraidicated
- postponing exercise will limit risk of tiggering viterous haemmorage and retinal detachment
refer to slide 94 of week 8 lecture
Managing Hypertension and Peripheral Arterial Disease (PAD) with Exercise
- Common comorbidity
- Poorly controlled? Avoid vigorous intensity
resistance training - Avoid Valsalva manouvre
- Treat hypertension as per other exercise
guidelines - PVD is a common, especially in those with
HTN, obesty and smoking history
– Presents as pain in calves or buttocks
with exercise
– CAUTION: high impact or traumatic foot
injuries during exercise
– Resistance training = viable alternative
refer to slide 95 lecture of week 8
why is this info in this lecture for diabebtes bruh
Exercise Concerns, Precautions
& Contraindicatoins related to
Diabetes & Metabolic Diseases
- Exercising with a partner is often
recommended - Exercise in early evening should be completed
with caution because exercising at this time
could cause hypoglycemic conditions later in
the night, possibly during sleep.
– Dire consequences - If patient is ill or has fever, may need to
modify or suspend exercise due to
unpredictable metabolic control
slide 96 of week 8 lecture
considerations in older adults
weight loss diet
* very low compliance
* mucle and bone loss
* decreased metabolic rate
aerobic exercise
* difficulty aachieving volume/intesity require due to OA, CVD, and PVD
drugs
* polypharmacy/latrogensis
* weight gain
* no treatment of underlying cuases of visceral obesity/inactivity
slide 97 week 8 lecture
