(1-6) are the potential benefits of exercise on diabetes.
1. improve body's ability to use glucose in blood
2. incr. no. of insulin receptors
3. decr insulin resistances in cells
4. decr risk of accelerated atherosclerosis
5. incr HDL
6. dec. VLDL and total cholestero/HDL ratio
What are the microvascular complications of diabetes?
1. retinopathy
2. kidney failure
3. nerve damage
What are the macrovascular complications of diabetes?
1. reduced blood circulation
2. heart attack
3. stroke
1. type 1 diabetes is due to the autoimmune B-cell destruction (in the pancreas), which leads to insulin ___.
2. type 2 diabetes is due to a progressive loss of B-cell insulin secretion frequently due to insulin ___
1. insulin deficiency
2. insulin resistance
Gestational Diabetes Mellitus (GDM) occurs during ___.
- maternal hepatic glucose production increases by 15-30% to meet fetal demand.
- the mothers pancreas produces sufficient insulin but the insulin is ___, restricting glucose uptake by the cells causi
- insulin resistant (mother)
- placenta
- overweight
insulin is needed for the uptake of ___ by ___, which contribute the most to glucose disposal (removal from blood)
glucose, skeletal muscle
how does the onset of regular exercise directly impact the cellular level on insulin signalling and glucose transport pathways?
1. exercise increases insulin sensitivity to glucose
2. exercise causes insulin levels to drop
3. and glucagon and catecholamine levels to rise
4. this facilitates the breakdown and consumption of stored glycogen as fuel
5. increasing the blood glucose us
what is the benefit of increasing glucose uptake by the cell?
it helps with ATP production (aerobic and anaerobic)
aerobic exercise increases the no. of ___ in muscle fibers.
- this promotes more cellular respiratory activity
- and increases the ___ enzymes in the mitochondria (which help with lipid oxidation)
mitochondria,
- aerobic enzymes (B-oxidation enzymes)
what is metabolic inflexibility?
- it is the impaired ability to increase ___ in response to the presence of increased fat availability and to switch between ___as the primary fuel substrate.
- metabolic inflexibility is associated with increased ___ (IMC
fat oxidation,
fat and carbs
- IntraMyoCellularLipids
Mitochondrial dysfunction in patients with T2DM is associated with ___ levels (thus linked to metabolic inflexibility and insulin insensitivity)
- reduced expression of ___and ___ which activates transcription factors that regulates metabolic processes
-
IMCL
- PGC-1a and PGC-1b
- type 2a, decreased oxidative capacity of muscle fibers
- decreased mitochondria density within cells
During a fasting plasma glucose test, ___ suggests impaired fasting glucose (IFG)
5.6-6.9mmol/dL (100-125mg/dL)
During a fasting plasma glucose test, ___ suggests T2DM.
>/= 7 Momo/dL (>/= 125mg/dL)
During a fasting plasma glucose test, ___ is the normal expected value
</= 5.5 Momo/dL (100mg/dL)
How does high visceral adiposity (VAT) and FFA metabolism compromise insulin sensitivity?
1. High VAT associated with increased FFA flux and increased insulin insensitivity
2. Increased IMCL (present within FFA) associated with increased peripheral insulin insensitivity
3. Metabolites of FA metabolism compromises insulin sensitivity
- they act
Impaired insulin response is associated with (12)
1. Reduced glucose uptake
2. Enhanced FFA release
___ adipose tissue is the most lipolytically active depot (storage place) however, it is unlikely to contribute to FA[O] by muscles during exercise
Intra-abdominal
Most FA that muscles is exposed to during exercise comes from ___>
Subcutaneous adipose tissue
Maintenance/enhancement of FFM associated with (123)
- fat free mass
1. Increased insulin sensitivity
2. Increased HDL
3. Improved psychosocial well-being
How does exercise therapy affect T2DM?
1. Enhanced insulin signalling and GLUT4
2. Activation of AMPK (AdenosineMonoPhosphate-activated protein kinase)
- stimulates energy-generating processes e.g. CHO uptake and FFA[O]
- decreases energy storing processes
3. Increase in mitochondrial biogenes
Resistance training has shown to improve metabolic health in T2DM patients via ___ insulin resistance (according to Gordon et al, 2009)
Decreasing
Resistance training has shown to (1-3) in the Rx of diabetes and obesity (according to Tresieras and Balady, 2009)
1. Enhance insulin sensitivity and glucose uptake
2. Increase in FFM resting energy expenditure (metabolism?)
3. Increase mobilisation of visceral adipose tissue and abdominal subcutaneous adipose tissue
The specifics of resistance training determines the effects of exercise on T2DM patients.
Mainly, different levels of intensity will have different effects on the recruitment of muscle fibers and the energy pathways.
In most strengthening protocols, ___ i
Moderate intensity,
1. Type 2a, oxidative pathways
2. Mitochondrial oxidative capacity
Continuous LM INTENSITY exercise training is as effective as MH INTENSITY exercise training at lowering blood ___ in obese T2DM patients (according to Hansen et al, 2009)
Blood HbA1c.
- this measures the blood sugar level
in a study conducted to determine the effects of exercise training amount and intensity effects on metabolic syndrome (by Johnson et al, 2007), the ___ intensity group showed the greatest improvement in their metabolic profile.
- there was maximal fat oxi
Moderate intensity ( greatest improvement on metabolic syndrome)
In a study comparing the effects of Aerobic interval training (AIT) vs continuous moderate exercise (CME) as Rx for metabolic syndrome (Tjonna et al, 2008),
The results show that there was greater improvement in (1) and HDL-C in the ___ group compared to
1. Aerobic, AIT
2. Endothelial fxn
3. Fatty acid transporter
4. Decrease in lipogenic enzymes
Limitations:
- might not be suitable for obese patients with metabolic syndrome
- safety considerations of high intensity exercises
In a study comparing the effectiveness of endurance training vs interval training and its effects on substrate metabolism and insulin sensitivity (by Venables and Jeukendrup, 2008),
Continuous training showed an increase in (12) compared to interval train
Continuous training improved:
1. Fat oxidation
2. Insulin sensitivity
Theory:
- use of IMCL (IntraMyoCellularLipids; whose presence causes insulin insensitivity), hence decreasing the accumulation of metabolites thereby improving insulin sensitivity
The diabetes prevention program (DPP) highlights the importance of lifestyle therapy in the prevention of development of T2DM.
Lifestyle therapy = ?
Lifestyle therapy = dietary interventions + behaviour modification + exercise therapy
- . 150 mins/week of mod. Intensity physical activity
- no more than 48 hrs between exercise
List the diabetes complications and limitations to exercise (1-4)
1. Peripheral vascular disease
2. Retinopathy
- avoid strenuous exercise (e.g. anaerobic ex, valsalva manoeuvre, head down activities)
3. Nephropathy
- avoid activities which cause BP rise to 180-200
4. Neuropathy (peripheral vs autonomic)
Peripheral (sen