WK3 - T1DM

Question 1

What is T1DM?

Answer 1

• lifelong autoimmune disease
• usually onset in childhood/early adolescence
• exact cause unknown
• requires daily insulin replacement to survive - except cases in pancreatic transplant
• AKA Juvenile Onset or Insulin-dependent diabetes

Question 2

What is the prevalence of T1DM?

Answer 2

• currently no national data that capture prevalence at all ages - estimates for children only

girls and boys prevalence very similar

• highest incidence <30y
• remoteness - all similar apart from “remote/very remote”
• socioeconomic group all relatively similar

Question 3

What is gestational diabetes?

Answer 3

• glucose intolerance of varying severity - develops/first recognied during pregnancy - 2nd/3rd trimester
• usually resolves post-natally
• can recur in later pregnancies
• significantly increases T2DM risk later in life, both mother and baby
• managed with diet and exercise - while some require Tx with meds

Question 4

What is the pathophysiology of T1D?

Answer 4

• genetic/environmental factors
• beta cell destruction –> absolute insulin deficiency
• Aus - T1D twice as common as it was 20y ago - because environment has changed
• understand environmental contributions to protect against T1D - modify factors to prevent future T1D

Question 5

What is gestational diabetes mellitus?

Answer 5

• overweight/obese
• physically inactive
• prediabetes
• GDM in previous pregnancy
• PCOS
• immediate family with diabetes
• previously delivered baby weighing >9lb (4.1kg)
• race/ethnicity (black, hispanic, american indian and asian american

Question 6

What is part of the continuous glucose monitoring and closed-loop insulin systems?

Answer 6

–>Insulin delivery (CSII)
–> glucose level
–> sensing (CGM)
–> modulation (control algorithm)

Question 7

What is the Ex prescription for T1D?

Answer 7

• generally no restrictions if BG controlled - lack of self-efficacy to Ex (risk of hypos)

Good control = Ex helps lower BG, require altered insulin dose

Poor control = Ex exacerbates increased/decreased BG

Consistency!! - Ex regularly at same time / consider intensity/duration/environmental conditions

• avoid Ex during peak insulin levels
• repeated day effects of Ex

Question 8

What to consider to maximise and facilitate post-Ex glycogen synthesis in endurance athletes with T1D?

Answer 8

• glucose checks
• insulin adjustments (include pre/post Ex)
• CHO intake
• protein intake (1.6-1.8g/kg)
• hydration
• caffeine (dose of 3mg/kg - 200-300mg) might reduce hypoglycaemia risk during/after Ex
• cool down (in last 10mins BGL >10mmol/L = longer low intensity cool down) (if 5-10mmol/L = reduce length of cool down)

Question 9

What did the study “CV Health Benefits of Ex Training in Persons Living with T1D: SR and MA” find?

Wu, et al 2019

Answer 9

Ex training (n=24)
* Increased maximal aerobic power
* reduced glycated hemoglobin
* reduced daily insulin dosage
* reduce total cholesterol

Question 10

What are some Ex considerations for T1D?

Answer 10

• large differences between individual in response of BG Ex
• avoid Ex when rapid/short/intermediate insulin is peaking - be aware of insulin action profile

Question 11

What are the absolute contraindications for gestational diabetes?

Answer 11

• restrictive lung disease
• ruptured membranes
• preeclampsia
• pregnancy-induced hypertension
• premature laboru during current pregnancy
• persistent bleeding (2nd/3rd trimester)
• incomplete cervix or cerclage
• placenta previa (placental implanting into lower uterus) after 26wk of gestation
• hemodynamically significant heart disease
• high order multiple gestation (triplets)

Question 12

What are the relative contraindications (in aerobic exercise)?

Answer 12

• heavy smoking
• Hx of sedentary lifestyle
• orthopaedic limitations
• poorly controlled hypertension
• extremely morbid obesity
• underweight (BMI <12)
• chronic bronchitis
• severe anaemia
• unevaluated materal cardiac arrhythmia
• intrauterine growth restriction in current pregnancy
• poorly controlled T1D, seizure disorder/hyperthyroidism
• previous spontaneous abortion
• Anaemia hb <100g/L
• twin pregnancy after 28wk
• malnutrition/eating disorder

Question 13

What are some considerations for gestational diabetes?

Answer 13

• use appropriate T2D action plan (i.e. dependent on meds) if hypo/hyper

Ex terminated if…
* vaginal bleeding, dizziness, headache, chest pain, muscle weakness, preterm labour, decreased foetal movement, amniotic fluid leakage, calf pain/swelling and dyspnoea without exertion

Important to regain stability of mother and foetus condition ASAP

Question 14

What did the study “The effects of VIPA in 3rd trimester: SR and MA” find?

Answer 14

• ten cohort studies (n=32,080) and 5 RCT (n=623)
• no sig’ difference in infant birthweight of mothers who performed VIPA and those who lacked this.
• no increase risk of: small gestational age, low birth weight (<2500g), materal weight gain
• women who engaged in VIPA had small but sig’ increase in length of gestational age before delivery and a small but sig’ reduced risk of prematurity