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ClinE 470 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the process of glycogenesis and which hormones regulate this process?

A

The conversion of glucose to glycogen due to an increase in insulin and a decrease in glucagon.

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2
Q

What is the process of glycogenolysis and which hormones regulate this process?

A

The conversion of glycogen to glucose due to a decrease in insulin and an increase in glucagon.

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3
Q

What is the process of gluconeogenesis and which hormones regulate this process?

A

The conversion of lactic acid and/or amino acids to glucose due to a decrease in insulin and an increase in glucagon.

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4
Q

What is the process of ketogenesis and which hormones regulate this process?

A

The conversion of fatty acids to ketones due to a decrease in insulin and an increase in glucagon.

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5
Q

What is the process of lipolysis and which hormones regulate this process?

A

The conversion of triglycerides to glycerol and fatty acids due to a decrease in insulin and an increase in glucagon.

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6
Q

What is the process of lipogenesis and which hormones regulate this process?

A

The conversion of glucose and/or amino acids to lipids due to an increase in insulin and a decrease in glucagon

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7
Q

Which cells produce insulin and where are they found?

A

Beta cells located in the islets of Langerhans in the pancreas.

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8
Q

Which cells produce glucagon and where are they found?

A

Alpha cells located in the islets of Langerhans in the pancreas.

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9
Q

What proteins does insulin activate and what does this do?

A

Insulin causes the translocation of transporter proteins such as GLUT4 to move to the surface of the cell membrane - these facilitate the influx of glucose into the cell.

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10
Q

Define diabetes.

A

Abnormal glucose metabolism resulting from defects in insulin release and/or action,

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11
Q

What percentage of diabetes cases are type 1 and type 2?

A

Type 1 accounts for 5-10% of diabetes cases.

Type 2 accounts for 90-95% of diabetes cases.

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12
Q

What are the causes of type 1 diabetes and who does the disease mainly affect?

A

The cellular-mediated autoimmune destruction of the pancreatic beta cells meaning that no insulin production can occur.
This can occur abruptly in anyone, but it is often a juvenile onset (under 35). There may be a family history.
It can occur in thin/normal weight individuals

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13
Q

What are the treatments for someone with type 1 diabetes?

A

Insulin will be required to be injected.

Diet and exercise adjustments can be beneficial in the regulation of blood sugar levels too.

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14
Q

What are the causes of type 2 diabetes and who does the disease mainly affect?

A

The progressive loss of insulin secretion in line with an increase in insulin resistance.
Insulin resistance occurs most likely due to a high level of fat deposition.
A family history of the disease may be a contributing factor.
It is most likely to occur in those over 40, although there is an increase in juvenile cases as obesity rates rise.
The onset is gradual and can go unseen for up to 10 years.

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15
Q

What are the treatments for someone with type 2 diabetes?

A

It requires weight loss, diet change and exercise.

It can require oral hyperglycemic drugs and in some cases insulin.

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16
Q

What are the modifiable risk factors of type 2 diabetes?

A

Weight, Inactivity, A previously identified glucose intolerance, metabolic syndrome, diet and smoking.

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17
Q

What are the non-modifiable risk factors of diabetes?

A

Ethnicity, family history, age, gender, a history of gestational diabetes and inflammation.

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18
Q

What is a normal blood sugar level? (In HbAC1, fasting levels and 2hr plasma glucose terms)

A

HbAC1 = <5.7%
Fasting glucose levels = <5.6 mmol/L
2hr Plasma glucose levels = <7.8 mmol/L

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19
Q

What is a prediabetes diagnosis blood sugar level? (In HbAC1, fasting levels and 2hr plasma glucose terms)

A

HbAC1 = <5.7-6.4%
Fasting glucose levels = 5.6-6.9 mmol/L
2hr Plasma glucose levels = 7.8-11 mmol/L

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20
Q

What is a diabetes diagnosis blood sugar level? (In HbAC1, fasting levels and 2hr plasma glucose terms)

A

HbAC1 = >6.5%
Fasting glucose levels = >7 mmol/L
2hr Plasma glucose levels = > 11.1 mmol/L

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21
Q

Describe the onset of type 2 diabetes.

A

Resistance to insulin starts to occur as influencing factors such as fat deposition increases.
The body adapts by increasing insulin production thus maintaining homeostasis.
However, as resistance continues more and more insulin is needed - the pancreas becomes overloaded and insulin production can fall thus a rise in blood glucose levels.

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22
Q

What is hyperglycemia and what are the symptoms?

A

Too much glucose in the blood.

The symptoms are increased urine output, headache, fatigue and weakness.

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23
Q

What is Hyperosmolar Nonketonic Syndrome?

A

Dehydration caused by high blood sugar levels - it can lead to decreased mentation and even coma.

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24
Q

What is Diabetic Ketoacidosis and what are the symptoms?

A

When insulin is very low or absent fat metabolism increases and ketone production in the liver rises.
This can cause abdominal pain, nausea, vomiting, rapid or deep breathing, sweet/fruity smelling breath and can lead to coma or even death.

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25
Q

What is hypoglycemia?

A

Too little glucose in the blood - it can also be termed ‘insulin shock’.

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26
Q

What symptoms does hypoglycemia lead to and why?

A

Shakiness, weakness, sweatiness, nervousness, anxiety and tingling mouth and fingers occurs due to an increase in stress hormones (adrenaline and cortisol)

Headaches, visual disturbances, confusion, amnesia, seizures and comas can occur due to a decreased availability of glucose to the brain (Neuroglycopenia).

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27
Q

What glucose level is considered hypoglycemic?

A

When blood glucose drops to 3.3-3.89 mmol/L

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28
Q

What can cause hypoglycemia?

A

Too much insulin or antidiabetic agent
Too little CHO intake or missed meals
Too much/excessive exercise

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29
Q

What causes Macrovascular disease and what is the risk of this condition?

A

Insulin resistance and consequent hyperglycemia and hyperinsulinemia contribute to vascular injury and the progression of atherosclerosis.
It leads to an increased risk of CAD, stroke and peripheral artery disease.

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30
Q

What is retionopathy?

A

Damage to the small blood vessels that supply the retina at the back of the eyes.

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31
Q

What are the symptoms of retinopathy?

A

Blurred vision, spots in the vision or sudden loss of sight.

32
Q

What is nephropathy?

A

Damage to the small blood vessels that supply the kidneys.

33
Q

What are the side effects of nephropathy?

A

Compromised ability for the kidneys to filter the blood therefore the loss of ability for blood fluid and salt regulation.
The condition is also linked to kidney disease.

34
Q

What is Neuropathy?

A

Nerve damage caused by chemical changes associated with hyperglycemia.

35
Q

Where does peripheral neuropathy affect and what are the symptoms?

A

Typically this occurs in the legs and hands.
The symptoms are pain, loss of tendon reflexes, numbness, muscular atrophy, decreased healing ability and possible gangrene/amputation.

36
Q

Where does autonomic neuropathy affect and what are the symptoms?

A

It can affect any system of the body.

Common symptoms include gastrointestinal distress, diarrhea, constipation and erectile dysfunction.

37
Q

What is cardiovascular automatic neuropathy?

A

This is when neuropathy affects the cardiovascular system.
It is characterized by a high resting heart rate, attenuated response to exercise, abnormal blood pressure and the redistribution of blood during exercise.

38
Q

What does the Nurses Health Study show?

A 
Higher PA (through self-reported questionnaire) caused a drop in the risk of diabetes.
The intensity of the exercise matters - walking at a brisk pace (4.8 mph) rather than a slow pace (3.2 mph) can decrease type 2 diabetes risk.
39
Q

What did the diabetes prevention study in Finland find?

A

An active lifestyle (meeting the PA guidelines) caused a 58% decrease in the progression towards type 2 diabetes.

40
Q

What did the diabetes prevention program in the US find?

A

Meeting the PA guidelines led to a 58% reduced risk of diabetes compared to a placebo. PA was also found to be a more effective interventional treatment for those with diabetes than drugs (Metformin).

41
Q

What are the acute effects of exercise which benefit those with diabetes?

A

Increased translocation of GLUT4
Increased blood flow
Increased Insulin sensitivity (likely due to more GLUT4)

42
Q

How long can the acute effects of exercise in reducing blood sugar levels last - and which study found this?

A

According to Van Dijk et al 2013 the acute affects of a single bout of exercise can last up to 24 hours.

43
Q

What are the chronic adaptations to exercise which benefit those with diabetes?

A

Increased GLUT4 production in the muscle cells (seen by Heath et al 1983)
Increased muscle mass (glucose storage capacity)
Increased capillary density (glucose delivery capacity)
Improved transport of regulatory enzymes
Improved body composition
Lowered blood pressure
Improved vasomotor control and endothelial function (Lower risk of CVD)

44
Q

At what level do glucose levels need to be before an exercise screening can take place?

A

5.5 mmol/L - if below this wait until the blood glucose levels are raised, through glucose ingestion, before starting exercise.

45
Q

What should you check for if a patient is hyperglycemic before exercise screening?

A

Ensure the patient has no detrimental symptoms and check their ketone level (symptoms are likely if glucose is 13.88-16.65 mmol/L)

46
Q

Apart from current glucose levels what else should be checked before undertaking an exercise screening for diabetes patients?

A

One should check for signs of retinopathy, and screen for vascular and neurological complications of the disease.
Cardiovascular and metabolic syndrome (i.e. Blood pressure) risk should also be checked.

47
Q

What are the aerobic fitness recommendations for one with type 2 diabetes?

A

Prolonged activity that uses large muscle groups.
This could be continuous or in the form of HITT training.
At least 150 minutes a week moderate activity or 75 minutes vigorous activity or a mixture - Same as recommendations for non-diabetic.
3-7 days a week - no more than 2 consecutive days rest
Increase vigorous exercise - if no contraindications.

48
Q

What are the resistance exercise recommendations for one with type 2 diabetes?

A

Moderate to vigorous exercise of 6-15 reps to 1RM.
1-3 sets of 8-10 exercises a session - this can include the use of resistance machines, free weights, resistance bands and/or body weight.
A minimum of 2 non-consecutive days a week - 3 preferable.
To start with use less weight and more reps and build up the intensity
An increase in resistance can follow with increased sets and training frequency.

49
Q

What are the flexibility exercise recommendations for one with type 2 diabetes?

A

A range of static, dynamic and other stretching (e.g. yoga) exercises
Stretches should be done to the point of tightness or slight discomfort
Balance exercises of light to moderate intensity - e.g. standing on one leg, core resistance or tai chi
Hold static stretches or do dynamic stretches for 10-30 seconds with 2-4 reps.
Do flexibility or balance training 2-3 times a week
Increase duration and frequency over time.

50
Q

What aerobic training precautions are needed for one with type 2 diabetes?

A

Ensure warm up and cool down
Consider any peripheral neuropathy issues (e.g. sores and ulcers)
Monitor pre-post glucose levels to avoid hypo/hyper glycemia
If one wants to perform vigorous exercise ensure a stress test has been done.

51
Q

What resistance training precautions are needed for one with type 2 diabetes?

A

Do not perform this if one has high blood pressure
Avoid the Vasalva Maneuver
Do not perform if one has retinopathy

52
Q

What flexibility training precautions are needed for one with type 2 diabetes?

A

Ensure appropriate modification of exercises to account for those with joint limitations, obesity or pregnancy.
Avoid ballistic stretches due to the increased risk of muscular/skeletal injury.

53
Q

What clinical considerations are needed for someone with peripheral neuropathy?

A

Loss of feeling can be very dangerous.
There can be an increased risk of injury and infection
Non-weight baring exercises such as swimming, cycling, chair exercises and rowing should be recommended.

54
Q

What clinical considerations are needed for someone with autonomic neuropathy?

A

Transitions into and out of activity needs to be carefully monitored due to dysfunction of nerves leading to abnormal heart rate, blood pressure and blood flow.
Focus should be on low intensity exercise with use of the RPE scale.
An active cool down is needed to reduce post exercise hypertension
Ensure one is well hydrated and avoid exercise in hot/cold conditions due to thermoreglulatory problems.

55
Q

What clinical considerations are needed for someone with retinopathy?

A

Decrease the severity/intensity of all activities. Focus on limiting the increase in systolic blood pressure, jarring exercises or breath holding.
Ensure no heavy lifting, no competitive sports and no activities that involve lowering the head.

56
Q

What clinical considerations are needed for someone with neuropathy?

A

The individual is likely to have high blood pressure which means that only low to moderate intensity activity should be done - avoiding strenuous or resistance based exercise.

57
Q

What are the benefits of day-day inter-lifestyle activities according to the SIT study? (Pulsford et al 2016)

A

Glucose and insulin concentration was significantly improved when one stood for 2 minutes 3 times an hour and further improved when one walked for 2 minutes 3 times an hour.
This shows light activity within one’s daily life can still lead to a reduced diabetes risk.
This type of activity is something that everyone can do.

58
Q

How many people currently have a diabetes diagnosis in the UK?

A

4.5 million people (an increase of 1.6 million from 1996)

This does not include those with prediabetes, glucose intolerances or un-diagnosed diabetes cases.

59
Q

What is the estimated number of diabetes cases by the year 2025?

A

5 million people (a rise of half a million from now).

60
Q

What is prediabetes?

A

Where glucose levels are above the normal range but not high enough to be classified as diabetes.
Affected individuals have a heightened risk of getting type 2 diabetes but may prevent/delay the onset through PA and other lifestyle changes.

61
Q

What percentage weight loss is recommended for one with prediabetes?

A

5-7% loss through PA and dietary adjustments.

62
Q

How long does glucose uptake stay elevated after an prolonged exercise bout?

A

2 hours - insulin independant uptake

48 hours - insulin dependant uptake

63
Q

How long does glucose uptake stay elevated after an acute (20 minute intense or 60 minute light) exercise bout?

A

There are improvements in insulin action for up to 24 hours.

64
Q

What is the name of the largest randomized trial evaluating (and finding positive results) of a PA intervention as a treatment for type 2 diabetes?

A

The look AHEAD (Action for Health in Diabetes) Trial.

65
Q

What are the recommendations for youth (aged 10-17) with type 2 diabetes according to the TODAY study

A

Due to limited data, it is advised that these individuals ensure they meet the daily physical guidelines of 60 minutes a day.

66
Q

How long should an aerobic training session last and what frequency should it be done?

A

Ideally 10 continuous minutes with the end goal of 30 minutes a day or more most days of the week.

67
Q

What is the main measure of glycemic control and what does it tell us?

A

Glycosylated haemaglobin - it gives an overall indication of glycemic control over the past 12 weeks.

68
Q

What effects did a structured aerobic exercise program have on glycemic control according to Umpierre et al?

A

Analysis of 23 studies showed a structured aerobic program caused a 0.73% improvement in glycosyated haemaglobin concentration.
In comparison oral medication has a 0.5-2% improvement.

69
Q

What does Madden 2013 state the benefits of resistance exercise are?

A

An increase muscle mass and increased GLUT4 expresion

70
Q

What effect does diabetes have on lean body mass and muscle quality?

A

A reduced lean body mass and muscle quality occurs - thought to be due to the poor vascular supply and peripheral neuropathy.

71
Q

How might diabetes affect mental health?

A

It can lead to impaired emotional well-being and an increased risk of depression.

72
Q

What affects does diabetes have on vascular stiffness?

A

An accelerated rate of vascular stiffening that occurs naturally as one ages. This can increase CVD risk.

73
Q

What are the Americal Diabetes Association exercise guidelines?

A

More than 150 minutes exercise a week.

74
Q

Is there a difference in the effects of endurance or strength training for diabetes control?

A

There is not much evidence of any differences. Both having a similar level of benefit for glycemic control. This can be of benefit to an exercise practitioner who can then tailor an exercise program to what the client prefers.

75
Q

Define metabolic syndrome.

A

A clustering of cardio-metabolic risk factors associated with insulin resistance.

76
Q

What cardio-metabolic risk factors contribute to metabolic syndrome.

A

Increased central obesity, increased blood pressure, increased triglycerides, decreased HDLs and increased fasting plasma glucose.

77
Q

What should determine the ratio of endurance to resistance training in a patient’s exercise program?

A

The patients co-morbidities such as musculoskeletal issues or CAD due to no current evidence for an ideal ratio.

ClinE 470 (9 decks)

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