Week 7 & 8: T2D

Question 1

What is T1D?

Answer 1

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

Question 2

What is T2D?

Answer 2

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

Question 3

How is T2D diagnosed?

Answer 3

• 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

Question 4

How are asymptomatic patients assesed to be at high risk of diabetes?

Answer 4

• 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

Question 5

What is OGTT?

Answer 5

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

Question 6

What are the blood sugar levels that indicate normal, impaired fasting glucose, and type 2 diabetes according to the OGTT?

Answer 6

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

Question 7

What is the prevalence of T2D in men and women?

Answer 7

• greater prevalence in men and women 75+ years
• Men have increased prevalence compared to women 55-75+

week 7 lecture slide 76

Question 8

What is the burden of hospitalisation for T1D and T2D?

Answer 8

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

Question 9

What are the hospitalization Rates for Type 2 Diabetes by Age?

Answer 9

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

Question 10

What are the hospitalization Rates by Region and Socioeconomic Status (SES)?

Answer 10

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

Question 11

What happens in blood glucose homeostasis?

Answer 11

• 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.

Question 12

Factors Affecting Insulin Secretion and Action

Answer 12

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

Question 13

summary of effects of T2D on body systems and organs

Answer 13

slide 83 lecture week 7

COME BACK TO THIS SLIDE .. do i even need it vcayse slide 85 talks about exact same thing

Question 14

Effects of Insulin Resistance

Answer 14

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

Question 15

How does insulin reduce blood glucose?

Answer 15

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

Question 16

Individualizing HbA1c Targets

Answer 16

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

Question 17

Make an exhaustive list of the parmacological treatment of type 2 diabetes (based on the lectures)

Answer 17

• 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

Question 18

What are biguanides

Answer 18

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

Question 19

What are alpha glucosidase inhibitors

Answer 19

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

Question 20

What are DPP -4 inhibotrs

Answer 20

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

Question 21

What are sulphonylureas

Answer 21

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

Question 22

What are meglitinides

Answer 22

– Meglitinides (Mitiglinde, Nateglinide, Glufast, Starlix)
– Insulin secretagogue; Increases insulin secretion from the pancreas
– Can cause hypoglycaemia

week 7 lecture slide 90

Question 23

what are thiazolidinediones

Answer 23

– 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

Question 24

what are glucagon like peptide 1 receptor agonists

Answer 24

– 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

Question 25

What are incretin mimetics

Answer 25

– 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

Question 26

Australian Type 2 Diabetes Glycemic Management Algorithm

Answer 26

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

Question 27

Goals for T2D optimum management

Answer 27

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

Question 28

Intensive blood glucose control and vascular outcomes in patients
with type 2 diabetes

Answer 28

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

Question 29

Lifestyle treatment of T2D

Answer 29

– 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

Question 30

serious complicaitons associated with diabetes

Answer 30

• 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

Question 31

Different Treatment Regimes for Newly Diagnosed vs. Long-Term Type 2 Diabetes

Answer 31

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)

Question 32

AHA Scientific Statement for Exercise Testing

Answer 32

(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

Question 33

Obesity, Osteoarthritis (OA) and Diabetes

Answer 33

• 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

Question 34

Symptoms of Hypoglycaemia

Answer 34

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

Question 35

Pre exercise and hypoglycaemia related risks with medication

Answer 35

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

Question 36

hypoglycaemia protocol

copy of osce notes

Answer 36

(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

Question 37

prevention protocol for hypoglycaemia for those who take meds that predispose them to hypoglycaemia

Answer 37

1. have them discuss with their doctor if medication should be adjusted on exercise days, particularly if they have had hypoglycaemic effects in the past
2. have them exercise 60-90min post meal
3. 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

Question 38

Exercise and Blood Sugar Levels in T2D

Answer 38

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

Question 39

pre exercise cardiac screening

Answer 39

• 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

Question 40

indications for preparticipation exercise stress testing in adults

Answer 40

• 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

Question 41

pre exercise HTN and PVD

Answer 41

• 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

Question 42

come back i dunno what this slide is talking about

Answer 42

refer to slide 82 of week 8 lecture

Question 43

main considerations for autonomic/diabetic neuropathy (in general)

Answer 43

• 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

Question 44

symptoms of peripheral neuropathy

Answer 44

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

Question 45

pre-exercise neuropathy foot considerations

Answer 45

• 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

Question 46

pre exercise considerations for peripheral neuropathy

Answer 46

• 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

Question 47

pre exercise considerations for obesity and OA

Answer 47

• 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

Question 48

pre exercise medicaotin concerns for T2D

Answer 48

• 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

Question 49

co-morbidities - careful considerations

Answer 49

• 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

Question 50

Exercise Restrictions for Diabetic Retinopathy

Answer 50

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

Question 51

Managing Hypertension and Peripheral Arterial Disease (PAD) with Exercise

Answer 51

• 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

Question 52

Exercise Concerns, Precautions
& Contraindicatoins related to
Diabetes & Metabolic Diseases

Answer 52

• 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

Question 53

considerations in older adults

Answer 53

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