Unit 3 Week 4: Metabolic Conditions

• diabetes mellitus • dyslipidemia • obesity • metabolic syndrome

a group of disease characterized by increased glucose in the blood (hyperglycemia) - type I: reduced insulin secretion - type II: increase insulin resistance

• macrovascular disease (CAD, HTN, PAD) • microvascular disease (retinopathy, nephropathy) • neuropathies (peripheral, autonomic)

• most canadians living with diabetes are type II • acquired in adulthood • increased in age, male sex, Indigenous

• diabetes commonly leads to nerve damage (neuropathy) • neuropathy occurring in the autonomic nervous system may impair the typical symptoms (ie angina) associated with MI which is called a ‘silent ischemia’

• there’s an evolution of symptoms of CAN in diabetes • pts have reduced variability in HR and resting tachycardia in early phase of parasympathetic dysfunction, which underlie the reduced exercise tolerance and the increased arrhythmogenesis • later stages of CAN involve sympathetic denervation and cause hemodynamic dysregulation and silent MI

commonly measured by ‘glycated hemoglobin’ (HbA1C) >/= 6.5% **these is a ‘pre-diabetes’ classification (high normal = at risk of DM)

• covered in sugar • reduces affinity of oxygen • left shift curve • hypoxia

insulin is released to bind insulin receptor, takes sugar out of blood stream

body releases glucagon to increase sugars

the hormone is taken up by receptor on outside of cells and ignites a cascade that allows glucose to enter the cell, removing it from the blood stream = normal blood glucose

• there’s an impairment on the receptor on the outside of the cell so the cells don’t recognize insulin • that means the ignition cascade does not occur and glucose cannot enter the blood stream • leads to high blood glucose levels and insulin resistance

Lifestyle Modification - dietary (limit alcohol, eat fiber rich fruits/veggies/whole grains) - exercise (>150 mins mod or >75 mins vigorous, >2 resisted exercise per week) - weight management - smoking cessation

• METFORMIN to reduce insulin resistance *low risk for hypoglycemia

• insulin to increase insulin availability *risk of hypoglycemia with exercise

5 mins every 30 mins had the best response as interrupting prolonged sitting *this is much more effective than 30 mins in morning and at night

• exercise has a proportional ‘insulin-like’ hypoglycemic effect • it reduces blood glucose independent of insulin

**In hyperglycemia (high blood sugar) In insulin resistance or type 2 diabetes: - Insulin doesn’t move GLUT4 to the membrane effectively - Glucose stays in the blood → hyperglycemia Exercise bypasses this problem - Muscle contraction still activates GLUT4 - Glucose uptake improves despite poor insulin signaling

• increased function of B cells in the pancreas • increased insulin ‘sensitivity’ of body cells (muscle, liver, etc.)

most asymptomatic people with diabetes do NOT need clearance to participate in light to moderate intensity UNLESS signs of macrovascular or microvascular disease

yes they do

• sedentary clients with diabetes desiring vigorous intensity

• evaluate an individual’s response to exercise (ie intensity of exercise producing any symptoms of hypoglycemia) • individualize exercise prescription (e.g. do a submax test and prescribe within that)

• > 40 with/without CVD risk factors other than diabetes • > 30 and: type I/II with >10 yr duration, hypertension, smoking, dyslipidemia, proliferative or preproliferative retinopathy • any of the following regardless of age: known CVD, coronary artery, or peripheral artery disease/ autonomic neuropathy, advanced nephropathy with renal failure **could be at risk of silent ischemia