Exercise

Question 1

what is type 2 diabetes, how does it occur?

Answer 1

it occurs when a hormone called insulin is either not produced in sufficient amounts or doesn’t work properly, resulting in high blood sugar levels, known as hyperglycemia

Question 2

where is insulin produced

Answer 2

insulin is produced by beta cells in the pancreas

Question 3

what are the risk factors for diabetes?

Answer 3

having a BMI over 25, BP above 140/90 (stage 2), living a sedentary life (causes insulin resistance, as the muscles don’t use as much glucose for energy), poor diet (refined carbs, processed fat, and high in sugar) black adults over 45 are twice more likely to develop diabetes than white adults (NIH, 2018)

Question 4

why is important to try to stabilise blood sugar levels

Answer 4

• it prevents long-term complications such as heart disease, nerve damage, eye problems
• Avoids short-term symptoms such as fatigue, excessive thirst and urination, blurred vision
• Preventing risk of other diseases such as hypertension, high cholesterol, increased risk of infection (high blood sugar can weaken the immune system)

Question 5

what does HbA1c levels measure?

Answer 5

it measures average blood sugar levels over 2-3 months, providing long-term indicator of blood sugar control

Question 6

what would the Hb1Ac reading be for diabetes? for indicating diabetes and the ideal measurement for controlling diabetes

Answer 6

48mmol/L

Question 7

what would you write in the first paragraph of diabetes case study?

Answer 7

what measurements have already been provided, risk factors (why they most likely have that condition), the definition of diabetes, note if their blood glucose levels have been fluctuating, indications (such as symptoms), dangers of fluctuation BSL (long-term complications, short term symptoms, increased risk of other diseases), comment on diet briefly, what is their HbA1c levels, then say what it should be (48mmol/L), then finally say what medication they have been prescribed

Question 8

why is a bad diet problematic for diabetics?

Answer 8

causes frequent blood sugar spikes, which can worsen insulin resistance. This means glucose can’t get into the cells to be used as energy, so it stays in the blood. The body tried to make more insulin to force the glucose in, but over time the pancreas gets tired and can’t keep up - leading to high blood sugar. Additionally it causes wiehgt gain, ultimately leading to poor glyceamic control

Question 9

what is the contraindication for exercising with diabetes (measured using the glucometer aka finger-prick glucose monitor)

Answer 9

avoid exercise if blood sugar levels are lower than 3.8mmol/L (dizziness, shaky, dizziness) or higher than 13mmol/L (cause tiredness, dehydration), blurred vision)

Question 10

what is the contraindication for exercising in terms of blood pressure?

Answer 10

> 180/110

Question 11

if neuropathy is present what exercises should be avoided?

Answer 11

avoid full weight bearing exercises such as single leg exercises

Question 12

what other measurements could be taken to ensure safety of participation?

Answer 12

finger prick test to assess blood sugar levels, blood pressure, and potentially resting heart rate

Question 13

does metformin affect exercise prescription and timings around exercise? what does metformin do?

Answer 13

no, it doesn’t affect the timing of exercise. It is typically taken at breakfast and dinner to help improve insulin sensitivity, allowing for better blood sugar control

Question 14

does glimepiride impact when exercise should be performed? what does this medication do?

Answer 14

Yes, it can! Glimepiride is typically taken with breakfast to help stimulate the pancreas to release more insulin. This can increase the risk of hypoglycemia, especially a few hours after taking the medication. Since exercise also lowers blood sugar, it’s advisable to wait a couple of hours after eating lunch before exercisising to help minimise the risk of low blood sugar levels

Question 15

why is it best to exercise a couple of hours after eating?

Answer 15

blood sugar levels are likely to be highest after eating, therefore making exercise more exercise more effective at lower blood sugar levels whilst reducing the risk of hypoglycemia

Question 16

what are the ideal/safe levels for glucometer before exercise?

Answer 16

between 4-10 mmol/L

Question 17

what precautions should be taken for exercising?

Answer 17

They should always have a fast acting carbohydrate with them in case of a hypo, they should stay hydrated throughout, exercise is well regulated temperature controlled room if possible. If neuropathy is present, exercises should be modified to accommodate loss of sensation by incorporating seated and low-impact exercises. single leg exercises should be avoided, due to diabetes being prone to poor circulation, and nerve damage increasing the risk of foot ulcers, injury, poor healing, and instability

Question 18

what exercise would you recommend to someone with a sedentary lifestyle?

Answer 18

i would recommend breaking up prolonged periods of sitting every 30 minutes (Diabetes care, 2022) - try to relate it to their job, like walk around the office? walk during phone calls? standing desk perhaps? This will not only improve glucose metabolism but also help reduce cardiovascular risk and support weight management

Question 19

what other measurements would be a good idea to take?

Answer 19

the exact value of HbA1c levels, glucometer to measure blood sugar levels at the present moment (but this is more for measurement straight before exercise), and blood pressure (this is because hypertension is commonly associated with diabetes due to overlapping risk factors)

Question 20

what is hypertension?

Answer 20

it occurs when the force exerted on the artery walls remains constantly high as a result of plaque build-up in the arteries and/or losing their natural elasticity through aging causing the hard to work harder to pump blood around on the body, placing greater strain on the heart

Question 21

what aerobic exercise would you suggest for a diabetic?

Answer 21

guildeines set by ACSM (2020) suggest moderate intensity aerobic exercise (40-50% HRR or 11-12 RPE) for at least 150 minutes a week, spread across 3-7 days. the intensity is kept relatively low due to being overweight/obese, likely elevated resting heart rate, and the increased strain on the the heart from lack of exercise, reduce aerobic capacity, and excessive weight. Therefore exercising at lower intensities is safer and avoid the risk of cardiovascular events

Question 22

why is hypertension commonly associated with diabetes?

Answer 22

Due to overlapping risk factors such as obesity, sedentary lifestyle, and poor diet

Question 23

why should diabetics work at lower intensities to begin with (40-50% HRR or 11-12 RPE)?

Answer 23

reduce the risk of excessively elevating the heart rate. Additionally, high intensity is more prone to hypoglycemia due to the rapid use of glucose by muscles, making moderate intensity a safer option for managing blood glucose levels during exercise. However, once the individual is more trained, I would recommend gradually increasing both the intensity and volume of exercise to encourage further progression in aerobic fitness

Question 24

what other forms of exercise would be recommended other than aerobic for diabetics?

Answer 24

resistance, flexibility, or balance training or even a combination of them all

Question 25

what resistance training would you recommend, intensity, and how often?

Answer 25

free weights, machines, bands. Working at 50-60% 1RM, completing 8-10 exercises involving the major muscle groups. 2-3 days per week with no more than 2 consecutive days

Question 26

why is resistance training good for diabetics?

Answer 26

improves insulin sensitivity, when you build muscle, you're more efficient at using glucose meaning you'll need need less insulin to lower blood blood sugar after meals

Question 27

why is flexibility training good for diabetics?

Answer 27

improves circulation which is often poor in diabetics, reducing likelihood of neuropathy, by increasing blood flow to the nerves. Tight muscles can cause pain and stiffness therefore working on flexibility will help relieve this as well as it being a good tool for stress reduction

Question 28

what type of flexibility would you recommend? how often should it be performed? Duration?

Answer 28

static, dynamic, or PNF stretching, balance exercises such as yoga and Thai Chi. 2-3 days per week usually done when muscles are warmed up, stretch for 10-30 seconds for a total of 2-4 reps

Question 29

how will exercise intensity be measures to ensure they aren't overdoing it?

Answer 29

using HRR but most probably RPE due to it being self monitored

Question 30

what measures would you take to measure progression?

Answer 30

HbA1c levels - to determine how much their blood sugar levels have changed from baseline measures (a reduction shows better glycemic control) BMI and waist-to-hip ratio - reducing these will improve insulin sensitiviity and gylcemic control, reduces BP and reduce risk of cardiovascular disease cardiovascular fitness through the 6-minute walk test to assess improvement in endurance and functional capacity. These improvements are likely to have a significant impact on the individual, both physically and psychologically, enhancing their quality of life