Diabetes & Exercise: Epidemiology, Physiology, and Management Strategies

What are the major chronic diseases associated with diabetes?

Diabetes is a major cause of heart and blood vessel diseases (CVD) and chronic kidney disease (CKD).

What percentage of heart disease, stroke, and type 2 diabetes could be prevented by lifestyle changes?

80% of heart disease, stroke, and type 2 diabetes (T2DM) could be prevented.

How many people are diagnosed with diabetes daily in Australia?

Around 298 people are diagnosed with diabetes every day.

What proportion of Australian adults have diabetes or pre-diabetes?

1 in 4 adults have diabetes or pre-diabetes.

What is the annual cost of diabetes to the Australian healthcare system?

It costs the healthcare system about 14 billion AUD annually.

What is predicted to be the number-one health system cost in Australia in 5 years?

The cost of diabetes is predicted to be the number-one health system cost.

How many registered cases of diabetes are there in New South Wales (NSW) and the Australian Capital Territory (ACT)?

There are roughly 430,000 registered cases.

By how many years does Type 1 Diabetes Mellitus (T1DM) reduce life expectancy on average?

People with T1DM lose about 12 years of life expectancy on average.

What percentage of Australians with diabetes do not receive proper diabetes education?

Nearly 50% of Australians with diabetes don't get proper diabetes education.

How many new diabetes diagnoses and deaths occurred in 2016 in Australia?

In 2016, there were 106,753 new diagnoses and 15,000 deaths.

What is the national prevalence of diabetes in Australia?

About 1.2 million people have diabetes, which is around 5% of the population.

What percentage of Type 2 Diabetes Mellitus (T2DM) cases are undiagnosed?

Up to 50% of T2DM cases are undiagnosed.

What is the annual cost range per patient with T2DM?

The annual cost per patient with T2DM ranges from 10,000 to 50,000 AUD.

What are the two main functions of the pancreas?

The pancreas has exocrine (producing digestive enzymes) and endocrine (producing hormones) functions.

What is the weight of the pancreas?

The pancreas weighs about 0.25 kg.

How many islets of Langerhans are in the pancreas?

The endocrine part consists of about 100,000 small clusters called islets of Langerhans.

How many beta cells are in each islet of Langerhans?

Each islet contains roughly 12,000 beta cells.

What is the range of blood glucose levels that beta cells can sense?

Beta cells can sense blood glucose changes within ±2 mg·dL.

What is the daily endogenous secretion of insulin?

The body naturally produces 40 to 50 units of insulin daily.

What happens to insulin release after meals?

Insulin release occurs in two phases: an initial quick release within minutes, followed by a steady release as long as blood sugar remains high.

What is the effect of insulin on skeletal muscle?

Insulin increases glucose entry into cells, glycogen production, amino acid uptake, and decreases protein breakdown.

What is the effect of insulin on the liver?

Insulin increases glycogen and fat production, decreases gluconeogenesis and ketogenesis.

What is the effect of insulin on adipose tissue?

Insulin encourages the storage of triglycerides and regulates the balance between fat breakdown and release.

What is Type 1 Diabetes Mellitus (T1DM)?

T1DM is an autoimmune disease where the immune system destroys beta cells, leading to a complete lack of insulin.

What percentage of global diabetes cases does T1DM account for?

T1DM accounts for about 5-10% of global diabetes cases.

What is the primary treatment for Type 1 Diabetes Mellitus (T1DM)?

Lifelong insulin injections or an insulin pump.

What characterizes Type 2 Diabetes Mellitus (T2DM)?

It often starts with insulin resistance, which can progress to insufficient insulin production by β-cells.

What percentage of all diabetes cases does Type 2 Diabetes Mellitus account for in Australia?

90% of all diabetes cases and 86% of Australian cases.

What lifestyle factors are strongly linked to the development of Type 2 Diabetes Mellitus?

Inactive lifestyle, unhealthy eating, and obesity.

What is Gestational Diabetes Mellitus (GDM)?

High blood glucose levels first noticed during pregnancy, usually between weeks 24 to 28.

What hormones contribute to insulin resistance during pregnancy in GDM?

Oestrogen, progesterone, leptin, cortisol, placental lactogen, and growth hormone.

What is the long-term risk associated with Gestational Diabetes Mellitus for mothers and children?

Increased risk of developing Type 2 Diabetes Mellitus.

What is pre-diabetes?

An intermediate state where blood glucose levels are higher than normal but not yet high enough for a diabetes diagnosis.

What percentage of people with pre-diabetes will develop Type 2 Diabetes Mellitus within 10 years without lifestyle changes?

33%.

What are the two diagnostic criteria for pre-diabetes?

Impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).

What are the fasting plasma glucose levels for normal, pre-diabetes, and diabetes?

Normal: <6.1, Pre-diabetes: 6.1-6.9, Diabetes: ≥7.0.

What does HbA1c measure?

The average blood sugar level over about 3 months.

What does a low score on the AUSDRISK questionnaire indicate?

Rescreening in 1-5 years.

What is the normal process of insulin signaling?

Insulin attaches to its receptor, triggering a chain reaction that leads to GLUT-4 moving to the cell surface to allow glucose entry.

What substances can block the insulin signaling pathway in obesity?

Fatty-acyl-CoA, ceramides, and inflammatory chemicals.

What are the classic symptoms of hyperglycemia?

Frequent urination (polyuria), excessive thirst (polydipsia), and increased hunger (polyphagia).

What is diabetic ketoacidosis (DKA)?

A condition caused by excessive fat breakdown leading to high ketone levels and acidosis.

What are Kussmaul respirations?

Deep, labored breaths taken to eliminate excess CO2 and acids during DKA.

What electrolytes are commonly lost during hyperglycemia?

Sodium (Na+), chloride (Cl−), and potassium (K+).

What triggers hypoglycemia?

Taking too much insulin, skipping meals, or prolonged strenuous exercise.

What are the sympathetic symptoms of hypoglycemia?

Dizziness, shaking, fast heartbeat, sweating, and hunger.

What are neuroglycopenic symptoms of hypoglycemia?

Confusion, seizures, coma, and potentially death if untreated.

What is the immediate treatment for hypoglycemia?

Consume a quick source of glucose or receive intravenous (IV) dextrose.

What is retinopathy?

Damage to the eyes that can lead to vision loss, a complication of chronic hyperglycemia.

What are the micro-vascular complications of chronic hyperglycaemia?

Retinopathy (eye damage), nephropathy (kidney damage leading to chronic kidney disease), and neuropathy (nerve damage causing foot ulcers, amputations, and gastroparesis).

What are the macro-vascular complications associated with chronic hyperglycaemia?

Coronary artery disease (CAD), cerebrovascular accident (stroke), and peripheral arterial disease (PAD).

What factors exacerbate the risks of macro-vascular complications in chronic hyperglycaemia?

High blood pressure (hypertension), unhealthy cholesterol levels (dyslipidaemia), a tendency for blood clots (pro-thrombotic state), and ongoing insulin resistance.

What is the typical onset age for Type 1 Diabetes Mellitus (T1DM)?

Childhood or early adulthood.

What is the typical onset age for Type 2 Diabetes Mellitus (T2DM)?

Mid-life, with rising cases in youth.

What is the primary aetiology of Type 1 Diabetes Mellitus?

Autoimmune destruction of β-cells.

What is the primary aetiology of Type 2 Diabetes Mellitus?

Insulin resistance with possible β-cell failure.

How does body habitus at onset differ between T1DM and T2DM?

T1DM typically presents with lean body weight and weight loss, while T2DM usually presents with overweight or obesity.

What is the insulin requirement for patients with Type 1 Diabetes Mellitus?

Immediate and lifelong insulin therapy.

What is the insulin requirement for patients with Type 2 Diabetes Mellitus?

May eventually require insulin; early management can include oral medications.

What is the tendency to ketosis in Type 1 Diabetes Mellitus?

High tendency to develop ketosis.

What is the tendency to ketosis in Type 2 Diabetes Mellitus?

Low tendency unless under severe stress.

What are the key management pillars for Type 1 Diabetes Mellitus?

Lifestyle changes, oral/GLP-1/SGLT-2 medications, and possibly insulin.

What are the key management pillars for Type 2 Diabetes Mellitus?

Exogenous insulin, carbohydrate counting, exercise, and self-monitoring.

What happens to β-cell function in Type 1 Diabetes Mellitus over time?

β-cell destruction occurs gradually before symptoms appear, leading to nearly zero insulin levels and rapid blood sugar rise.

What happens to insulin resistance in Type 2 Diabetes Mellitus over time?

Progressive increase in insulin resistance, leading to hyper-insulinaemia followed by β-cell failure.

What is the function of sulfonylureas in diabetes management?

They stimulate remaining β-cells to release more insulin.

What is the role of biguanides (e.g., metformin) and thiazolidinediones in diabetes management?

They improve how well the liver and muscles respond to insulin.

What is the function of α-glucosidase inhibitors in diabetes management?

They slow down carbohydrate digestion in the intestine, helping to lower blood sugar spikes after meals.

What is a significant cause of insulin resistance related to physical activity?

Not being physically active.

What is crucial for managing exercise in diabetes patients?

Consideration of the risk of low blood sugar and weight management.

What percentage of people with diabetes do not receive proper education?

About 50%.

What is the impact of economic costs related to diabetes?

Highlights the need for public health policies to prevent obesity and inactivity.

What is the daily natural insulin production range?

40 to 50 units.

What random blood glucose level indicates a hyperglycaemic crisis?

11.1 mmol/L along with symptoms.

What is the HbA1c treatment target for many adults with diabetes?

Usually < 7.0%, individualized for each person.

What is the OGTT diagnostic cut-off for diabetes?

A 2-hour value of 11.1 mmol/L.

What are the prevalence figures for new diabetes cases in Australia?

298 new cases per day, costing 14 billion AUD per year.