EXSS3070 Special Populations: Type Two Diabetes

Vocabulary flashcards for reviewing lecture notes on Type 2 Diabetes.

Pathology

The study of disease.

Type 1 Diabetes

Often juvenile onset, approximately 10% of diabetes, onset usually occurs by age 20, idiopathic, autoimmune destruction of β‐cells, treated with exogenous insulin.

Type 2 Diabetes

85‐95% of diabetes cases, usual onset > 40 yrs, however increasing incidence of adolescent cases, characterised by insulin resistance, treated by hypoglycaemic medication; people with type 2 diabetes for a long time often require exogenous insulin later in life.

Fasting Plasma Glucose (FPG)

No caloric intake for at least 8 hours.

Random Plasma Glucose

Any time of the day, without regard to the interval since the last meal.

Glucagon

Glucose homeostasis raises blood sugar using this hormone.

Insulin

Glucose homeostasis lowers blood sugar using this hormone.

Effects of Insulin Resistance on Muscle

Reduced insulin signalling causes reduced glucose transport into muscle which leads to reduced glucose uptake and storage.

Effects of Insulin Resistance on Fat Cells

Reduced insulin signalling causes reduced glucose uptake, and increased lipolysis leading to reduced glucose uptake and storage and increased FFA release into the blood.

Biguanides (Metformin)

First line treatment for diabetes, sensitizes liver to insulin (reduces glycogenolysis and gluconeogenesis), does not cause weight gain, minimal risk of hypoglycaemia.

α-Glucosidase Inhibitors (Acarbose)

Slow digestion and absorption of carbohydrates, on its own, does not cause hypoglycaemia, but if it does occur due to other medication, treatment must be with glucose.

DPP-4 Inhibitors (Linagliptin, Sitagliptin)

Stimulate incretin secretion which in turn stimulates insulin secretion from the pancreas, on their own do not cause hypoglycaemia, but risk is elevated if treated together with a sulphonylurea.

Sulphonylureas (Gliclazide, Glimepride)

Lower blood glucose by stimulating insulin release from the pancreas; can cause weight gain and hypoglycaemia.

Meglitinides (Mitiglinde, Nateglinide)

Increases insulin secretion from the pancreas, can cause hypoglycaemia.

Thiazolidinediones (Rosiglitazone, Pioglitazone)

Increase sensitazation of peripheral tissues (fat, muscle; can cause weight gain, however may re-distribute fat away from the waist, contraindicated in those with liver disease.

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, and very low risk of hypoglycaemia unless used with SU or insulin.

Incretin Mimetics (Byetta, Exenatide)

Stimulates secretion of insulin, downregulates glucagon, and reduces appetite; not suitable for those taking exogenous insulin; hypoglycaemia a risk when taking together with sulphonylurea

United States Diabetes Prevention Program

Weight loss >7% of body weight via diet/exercise, physical activity 150 min/wk (supervised 2x/wk), healthy diet (reduce calories 500-1000kcal/d).

Acute Exercise's Physiological Responses

Improves insulin sensitivity, facilitates glucose uptake, aids in glucose homeostasis.

Chronic Exercise's Physiological Responses

Improves cardiovascular function, improves blood lipids and lipoproteins, lowers BP, decreases body mass, fat mass, and body fat distribution, affects fat-free mass, improves insulin sensitivity, improves glucose control (T2DM only), increases metabolism, enhances postprandial thermogenesis.

RT Benefits

Resistance exercise training in older adults with T2D results in 10%–15% improvement in strength, bone mineral density, lean mass, blood pressure, blood lipids, and insulin sensitivity along with threefold greater reductions in A1C