Diabetes

Question 1

What is diabetes

Answer 1

Diabetes Mellitus is a systemic metabolic disorder characterized by a tendency to chronic hyperglycemia
Type 1 is an autoimmune disease as immune system doesn’t recognize B cells as self so attack until no insulin is produced or micro secretions (2 yrs)
B cells die so 100% reliability on manufactured insulin maintained by constant glucose monitoring
Genetic from HLA antigen and environmental from viral antigen Coxachie B (also baby exposure, stress, geographical)
Inflammatory disease increasing inflammation 4X and has micro (long term) and macro vascular effects

Question 2

What is hypoglycemia

Answer 2

Low blood glucose

Limited brain fuel, potential coma particularly in sleep

Question 3

What is hyperglycemia

Answer 3

High blood glucose
leads to glucose toxicity which has bi products from the ETC (reactive O species) which has negative effects on cells e.g. inflammation

Question 4

Normal role of insulin

Answer 4

Promote glucose uptake from cells after meal

Question 5

Insulin pen

Answer 5

90% patients
Unlike pump which continuously administers
Only lasts in system fro 12 hours so needs administration of background insulin

Question 6

Carbohydrate counting

Answer 6

Meta analysis shows better than nothing
But we eat a varied diet including protein and fat
Randomly estimated
Westernized diet has a constant fed state

Question 7

Intensive insulin therapy over conventional

Answer 7

Lowers HB1c (glycosylated haemoglobin)
76% reduced risk of diabetes related complications
54% less progression
30 years had 30% reduced CVD risk but unrepresented baseline
73% increase risk of being overweight so CVD benefits cancelled out
32% increase in metabolic syndromes increasing CVD risk (blood pressure/bad cholesterol)

Question 8

Increasing insulin dose after eating fat

Answer 8

Fat has delayed high blood glucose 90 mins
Increases hepatic resistance
Increase does risks hypo
So administer a as normal then more later on

Question 9

4 main pathophysiological steps associated with exercise induced hypo

Answer 9

1.Unregulated injected insulin-2/3X too high preworkout
2.Type 1 have defective counter regulatory hormones
3,Increased insulin sensitivity and increased glucose uptake
4.Decreased symptomatic awareness

Question 10

How does the type of exercise effect blood glucose?

Answer 10

Intermittent training increases stress response (more adrenaline) so higher glucose preservation
Aerobic has more glucose uptake and no hormones so lower BG
No difference on long term hypo risk
Resistance and aerobic has no difference

Question 11

Recommendations to reduce exercise induced hypoglycemia

Answer 11

1. Reduce insulin dose with CHO before meal so higher glucose reducing hypo risk
2. Replace CHO (high GI) lost after exercise to replenish glucose lost during exercise (not 100% safe)
3. Reduce post insulin dose 25-50% for increased insulin sensitivity to prevent hypo
4. Reduce basal insulin dose 20% to later preserve glucose (100% safe)