Diabetes

KIN 4306

autoimmune destruction of beta cells leading to absolute insulin deficiency

type 1 diabetes

progressive insulin resistance and eventual loss of insulin secretion

type 2 diabetes

placental hormones block insulin action, usually beginning around 20-24 weeks of pregancy

gestational diabetes

what are modifiable risk factors for T2DM

physical inactivity

high blood pressure

overweight

have prediabetes

what are non-modifiable risk factors for T2DM

age 45 or older

parent or sibling with diabetes

what defines prediabetes (ADA)? (fasting plasma glucose, HbA1C, OGTT)

FPG: 100-125 mg/dL

HbA1C: 5.7%-6.4%

OGTT: 140-199 mg/dL

what are the ADA diagnostic criteria for diabetes? (FPG, 2-hr OGTT, HbA1C, Random PG)

FPG: 126 mg/dL or more

2-hr OGTT: 200 mg/dL or more

HbA1C: >6.5 %

Random PG: 200 mg/dL or more + symptoms of hyperglycemia

high blood glucose

hyperglycemia

what are the symptoms for hyperglycemia?

• excessive thirst

• increased hunger

• increased urination

• fruity breath

low blood glucose

hypoglycemia

what are the symptoms of hypoglycemia?

• shaking or tremors

• mouth tingling

• nausea

what is the optimal pre-exercise blood glucose range?

90-250 mg/dL

what do sulfonylureas do?

stimulate beta cells in the pancreas to release insulin

what are the exercise effects for sulfonylureas?

• increase the risk of hypoglycemia during exercise

• increase sensitivity to light

what is the suffix for sulfonylureas?

“g” “-ide”

what does metformin do?

decreases hepatic glucose production

increases sensitivity to insulin

what are the exercise effects of metformin?

• increased HR and RPE

what do DPP-4 Inhibitors do?

prevent breakdown of GLP1 and GIP (incretins)

what is the suffix for DPP-4 inhibitors

-gliptin

what are the exercise effects for DPP-4 inhibitors?

no exercise effects

what do GLP1 and GIP receptor agonists do

activate receptors for GLP1/GIP on tissues

what is the suffix for GLP1 and GIP receptor agonists

-glutide

what are the exercise effects of GLP1/GIP receptor agonists

• tachycardia

• hypotension

what is the resistance frequency for healthy adults?

2 or more non-consecutive d/wk

what is the recommended resistance intensity for healthy adults?

60-70%

RPE 6-7

RIR 4-3

what is the recommended frequency for aerobic exercise for T2DM?

3-7 d/wk

what is the recommended intensity for aerobic exercise for T2DM?

moderate to vigorous

what is the recommended frequency for resistance training for T2DM?

2 or more d/wk

what is the recommended intensity for resistance training for novice and experienced individuals with T2DM?

novice: 50-69%

experienced: 70-85%

what is the recommended progression for resistance training for individuals with T2DM?

load —> reps —> sets —> frequency

what is the recommended frequency for flexibility and balance for individuals with T2DM?

2-3 days/wk

what is the recommended intensity for flexibility and balance for individuals with T2DM?

flexibility: slight discomfort

balance: RPE 10-14

what is the recommended time for flexibility and balance training for individuals with T2DM?

flexibility: hold for 10-30 sec

balance: any duration

what type of flexibility and balance training should be incorporated for individuals with T2DM?

flexibility: static or dynamic

balance: lower body and core training

when should T2D individuals exercise?

within 2 hours after a meal

what snack is recommended after exercise?

complex carbohydrates

what should you do for individuals with T1DM exercising more than 60 min at mod-vig intensity?

add 10-15 g CHO every 30 mins

what are contraindications related to blood glucose

<70 mg/dL

250 mg/dL or more with ketones

350 mg/dL or more without ketones

individuals with risk or diagnosed retinopathy should avoid:

• vigorous aerobic or resistance intensity

• jumping activities

• head down exercises

• valsalva maneuver

nerve damage that is caused by prolonged high blood and tissue glucose

autonomic neuropathy