Cardiovascular Exercise for Diabetes Module 3
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Questions and Answers

What is a key effect of exercise on glucose transport?

  • Decreases muscle contraction
  • Inhibits glucose uptake in skeletal muscle
  • Stimulates glucose transport independent of insulin (correct)
  • Reduces insulin sensitivity

One session of exercise can reduce insulin sensitivity.

False (B)

What substance accumulates as a result of exercise that aids in glucose transport?

Ca2+

Individuals who exercise regularly are often referred to as having the ________ paradox.

<p>athlete's</p> Signup and view all the answers

Match the components with their roles in exercise-related glucose transport:

<p>GLUT-4 = Facilitates glucose uptake AMPK = Signaling molecule activated during exercise CaMK = Activated by calcium during muscle contraction AS160 = Regulates GLUT-4 translocation</p> Signup and view all the answers

What does a single session of exercise do to intramyocellular triglyceride (IMTG) synthesis?

<p>Increases IMTG synthesis (B)</p> Signup and view all the answers

Reactive oxygen species (ROS) play a role in the signaling cascade for GLUT-4 movement.

<p>True (A)</p> Signup and view all the answers

What enzyme expressions may increase following exercise to aid in fat storage?

<p>DGAT1 and mGPAT</p> Signup and view all the answers

What is the target for LDL (bad) cholesterol level in mmol/L?

<p>2.0 (B)</p> Signup and view all the answers

Regular physical activity should be performed at least two consecutive days a week.

<p>False (B)</p> Signup and view all the answers

What medication enhances insulin secretion in diabetic patients?

<p>Sulfonylurea</p> Signup and view all the answers

The A1C blood test measures average blood sugar levels over the past _____ days.

<p>120</p> Signup and view all the answers

Match the medications with their types:

<p>Metformin = Oral anti-hyperglycemic Humalog = Insulin Rosiglitazone = Oral anti-hyperglycemic Glyburide = Sulfonylurea</p> Signup and view all the answers

What is the recommended minimum duration of moderate-intensity exercise per week for diabetes management?

<p>150 minutes (C)</p> Signup and view all the answers

Hyperglycemia was observed in some well-controlled diabetics.

<p>True (A)</p> Signup and view all the answers

What lifestyle change is encouraged to help manage diabetes and associated risks?

<p>Smoking cessation</p> Signup and view all the answers

What is a direct benefit of chronic exercise training in diabetics?

<p>Increases insulin action and blood glucose control (C)</p> Signup and view all the answers

Chronic exercise prevents lipid-induced insulin resistance.

<p>True (A)</p> Signup and view all the answers

What are the two main types of exercise mentioned that benefit diabetics?

<p>Aerobic and resistance training</p> Signup and view all the answers

Insulin stimulates the movement of ____ to increase glucose transport.

<p>GLUT-4</p> Signup and view all the answers

What is a key characteristic of Type 1 diabetes?

<p>Destruction of beta cells in the pancreas (D)</p> Signup and view all the answers

Match the following benefits of exercise with their corresponding effects:

<p>Reduces risk of obesity = Indirect benefit of exercise Enhances insulin action = Direct benefit of exercise Improves cardiovascular fitness = Indirect benefit of exercise Reduces blood sugar levels = Direct benefit of exercise</p> Signup and view all the answers

Gestational diabetes is a form of diabetes that is only seen in children.

<p>False (B)</p> Signup and view all the answers

What effect does a high lipid environment have on insulin?

<p>It results in insulin resistance (B)</p> Signup and view all the answers

What are the two main types of diabetes?

<p>Type 1 and Type 2</p> Signup and view all the answers

Only acute exercise influences glucose transport in diabetics.

<p>False (B)</p> Signup and view all the answers

Type 2 diabetes is primarily caused by ________ resistance.

<p>insulin</p> Signup and view all the answers

Match the type of diabetes to its description:

<p>Type 1 = Autoimmune destruction of insulin-producing cells Type 2 = Insulin resistance and impaired insulin secretion Gestational Diabetes = Glucose intolerance during pregnancy</p> Signup and view all the answers

What is the goal of exercise training in diabetes prevention?

<p>Prevention of diabetes-related complications</p> Signup and view all the answers

What role does exercise play in the management of diabetes?

<p>It can be used as a treatment goal to improve insulin sensitivity. (B)</p> Signup and view all the answers

What effect does acute exercise have on plasma glucose levels in diabetics?

<p>Reduces plasma glucose levels (C)</p> Signup and view all the answers

Acute exercise can bypass mechanisms underlying lipid-induced insulin resistance.

<p>True (A)</p> Signup and view all the answers

Complications from exercise in diabetics are non-existent.

<p>False (B)</p> Signup and view all the answers

What is the main treatment goal for patients with Type 2 diabetes?

<p>Regulate blood glucose levels</p> Signup and view all the answers

What is the role of GLUT-4 in relation to exercise and glucose transport?

<p>GLUT-4 translocation to the plasma membrane increases during exercise, facilitating glucose uptake.</p> Signup and view all the answers

Acute exercise enhances both insulin and exercise stimulated __________ transport.

<p>glucose</p> Signup and view all the answers

Match the following effects of acute exercise with their outcomes:

<p>Reduces plasma glucose = Prevention of hyperglycemia Induces GLUT-4 translocation = Increased glucose uptake Prevents lipid induced insulin resistance = Improved insulin sensitivity Enhances lipid storage = Reduction of reactive lipids</p> Signup and view all the answers

What percentage increase in mGPAT and DGAT1 concentration was observed after exercise?

<p>35% (C)</p> Signup and view all the answers

Hyperglycemia is not a concern in well-controlled type II diabetics.

<p>False (B)</p> Signup and view all the answers

Name one key benefit of acute exercise in relation to lipid metabolism.

<p>Reduction of reactive lipids and promotion of proper lipid storage.</p> Signup and view all the answers

What is the suggested exercise frequency for maximizing cardiovascular benefits in individuals with diabetes?

<p>Greater than 3 days per week (D)</p> Signup and view all the answers

Resistance exercise has no metabolic benefits for individuals with Type 2 Diabetes Mellitus.

<p>False (B)</p> Signup and view all the answers

What is recommended for food intake for someone on hypoglycemic medication before exercising for 1 hour?

<p>An additional 15 g of carbohydrates (CHO)</p> Signup and view all the answers

During exercise, if glucose utilization is greater than glucose production, it can result in __________.

<p>hypoglycemia</p> Signup and view all the answers

What should individuals with diabetes consider regarding exercise?

<p>Individual exercise plans should be tailored according to complications. (A)</p> Signup and view all the answers

Individuals without diabetes maintain glucose homeostasis through normal hormonal and metabolic processes during exercise.

<p>True (A)</p> Signup and view all the answers

What is the most common problem for diabetics who exercise?

<p>Imbalance between glucose utilization and production</p> Signup and view all the answers

Match the exercise duration with the recommended carbohydrate intake:

<p>1 hour = 15 g CHO</p> <blockquote> <p>60 minutes = 15 to 30 g CHO 30 minutes = No additional intake needed 2 hours = 30 to 60 g CHO</p> </blockquote> Signup and view all the answers

Flashcards

Type 2 Diabetes

A metabolic disorder where the body doesn't respond properly to insulin, leading to high blood sugar.

Blood Glucose Control

The process of maintaining stable blood sugar levels.

Insulin

A hormone that helps move glucose from the blood into cells.

Hyperglycemia

High blood sugar levels.

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Glucose Transport

The movement of glucose into cells.

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GLUT-4

A protein that helps transport glucose into cells, especially muscle cells.

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Exercise & Blood Glucose

Exercise can directly help lower blood glucose levels, independent of insulin.

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Type 1 Diabetes

An autoimmune disease where the body attacks and destroys insulin-producing cells in the pancreas.

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A1C Test

A blood test measuring your average blood sugar level over the past 120 days. It indicates long-term blood sugar control.

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Blood Pressure Target

Aim for a blood pressure reading below 130/80 mmHg for diabetic individuals.

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LDL Cholesterol Target

Keep your 'bad' cholesterol (LDL) below 2.0 mmol/L for diabetic individuals.

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Drugs to Protect the Heart

Consult your healthcare team about medications to protect your heart, especially if you have diabetes.

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Exercise & Eating for Diabetes

Regular physical activity, healthy eating, and maintaining a healthy body weight are crucial for managing diabetes.

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Screening for Complications

Regularly check your heart, feet, kidneys, and eyes for complications related to diabetes.

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Smoking and Diabetes

Quitting smoking is essential for individuals with diabetes to improve overall health.

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Goal Setting for Diabetes Management

Set realistic goals for managing diabetes, including stress management, to live well with the condition.

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Athlete's Paradox

Individuals who exercise regularly are insulin sensitive despite having high levels of intramuscular triglycerides (IMTG).

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Exercise & Insulin Sensitivity

A single session of exercise markedly improves insulin sensitivity, even in obese individuals.

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Exercise & IMTG Repartitioning

Exercise preferentially directs fatty acids towards storage as IMTG, reducing their accumulation as metabolically unfavorable metabolites.

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Exercise & Lipogenic Enzymes

Exercise could increase the expression of lipogenic enzymes like DGAT1 and mGPAT, promoting IMTG synthesis.

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Exercise & Fatty Acid Availability

The mechanism of exercise-induced insulin sensitivity enhancement might be more relevant when fatty acid availability is high.

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Exercise & Insulin Resistance

A single session of exercise can protect against fatty acid-induced insulin resistance the next day.

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Ca2+

Calcium ions are elevated during muscle contraction, contributing to the signaling cascade that regulates glucose transport.

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ROS

Reactive oxygen species, like free radicals, are produced during exercise and participate in the signaling cascade stimulating glucose uptake.

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Glycemic Instability in Type 2 Diabetes

People with type 2 diabetes often experience frequent fluctuations in blood sugar even when they are considered 'well controlled.' This means they might have high blood sugar levels for a significant portion of the day.

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Acute Exercise and Blood Glucose

Engaging in physical activity, even for a short time, can directly reduce blood sugar levels in people with type 2 diabetes. This effect is independent of insulin.

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GLUT-4 Translocation

Exercise stimulates the movement of GLUT-4, a protein that helps transport glucose into cells, to the cell surface. This makes it easier for glucose to enter the cells.

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Lipid-Induced Insulin Resistance

Excess fat in the body can interfere with the way insulin functions, making it harder for glucose to enter cells. This is called insulin resistance.

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Acute Exercise and Insulin Resistance

Even with excess fat, exercise can help overcome insulin resistance by promoting the movement of GLUT-4 to the cell surface, allowing glucose to enter the cells.

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Reactive Lipids

Excess fat in the body can lead to the formation of harmful substances called reactive lipids that contribute to insulin resistance.

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Proper Lipid Storage

Exercise helps promote the storage of fat in a healthy way, reducing the formation of reactive lipids that cause insulin resistance.

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Insulin and Exercise-Stimulated Glucose Transport

Exercise enhances both insulin's effect and the direct movement of glucose into cells, improving glucose control.

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Insulin Resistance

When your body's cells don't respond properly to insulin, making it harder to take up glucose from the blood.

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High Lipid Environment

Excess fat in the body can lead to insulin resistance, making it harder to control blood sugar.

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Exercise & Glucose Transport

Both acute (short-term) and chronic (long-term) exercise can increase glucose transport into muscle cells.

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Exercise & Reactive Lipids

Exercise can reduce the formation of harmful reactive lipids that contribute to insulin resistance.

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Benefits of Exercise in Diabetes

Regular physical activity can improve blood sugar control, cardiovascular health, and reduce diabetes-related complications.

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Exercise Prescription for Diabetes

A tailored exercise plan that considers individual needs, goals, and current fitness levels.

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ECG Stress Test

A test that monitors heart activity during exercise to assess cardiovascular health in diabetics.

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Exercise & Glucose Homeostasis

During moderate exercise, a delicate balance must be maintained between glucose utilization (using glucose for energy) and glucose production (releasing glucose from the liver) to keep blood sugar levels stable.

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Exercise & Diabetes

In individuals with diabetes, the body's response to exercise is altered. Insulin and other hormones regulating glucose don't act normally, potentially leading to blood sugar imbalances.

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Common Diabetes Exercise Problem

The most frequent issue for diabetic individuals exercising is low blood sugar (hypoglycemia). This occurs when glucose utilization outpaces glucose production.

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Hypoglycemia Explained

Hypoglycemia happens because insulin levels might remain high or the liver's ability to release glucose is impaired, despite the body needing more energy.

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Exercise & Blood Sugar Levels

Blood sugar levels fluctuate depending on the intensity and duration of exercise. Knowing how your body reacts is key.

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Exercise & Diabetic Complications

Exercise recommendations for people with diabetes vary based on individual factors such as medication, complications, and fitness goals.

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Carbohydrate Intake & Exercise

Diabetics on hypoglycemic medications need to adjust carbohydrate intake before and after exercise to avoid dangerously low blood sugar levels.

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Goal: Normal Blood Sugar

The ideal outcome of exercise for diabetics is to maintain normal blood sugar (normoglycemia).

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Study Notes

Module 3: Cardiovascular Exercise Principles, Week 3

  • Module covers cardiovascular exercise principles specifically for those with diabetes.
  • The module's learning objectives focus on defining diabetes, understanding physiological processes related to blood glucose regulation, and designing effective exercise strategies for managing type 2 diabetes.

Exercise Prescription for Common Chronic Conditions (Diabetes)

  • Learning Objectives include defining diabetes, identifying physiological processes involved in blood glucose regulation, identifying the treatment goal for diabetes and the role of exercise, describing complications of exercise in diabetics, and designing exercise strategies for Type 2 diabetes management.

Diabetes

  • A chronic metabolic disease characterized by hyperglycemia due to insulin secretion defects and/or inability to utilize insulin.
  • Types of Diabetes:
  • Type 1: Autoimmune disease in children and adults caused by beta cell destruction in the pancreas, stopping insulin production.
  • Type 2: Metabolic disease resulting from insulin resistance in peripheral tissue and defective insulin secretion.
  • Gestational Diabetes: Glucose intolerance during pregnancy due to contra-insulin effects.

Blood Glucose Control in Type 2 Diabetes

  • Blood glucose control is impaired in Type 2 diabetes.

24 hour Blood Glucose Control

  • Van Dijk et al. (2015) detailed 24-hour blood glucose control.

Overview of Glucose Transport in Skeletal Muscle

  • Glucose transport in skeletal muscle involves several steps.
  • Glucose is transferred into blood, insulin, exercise in cytosol, GLUT-4 vesicles.
  • Exercise stimulation can enhance glucose transport independently of insulin.

Prevalence and Diagnosis

  • Prevalence of diagnosed diabetes in Canada among 1+ year old individuals, broken down by age group and sex for 2014-2015.

Diagnostic Criteria

  • Information on how diabetes is diagnosed.

Type 2 Diabetes: Progressive Development

  • Focus on the role of insulin-sensitizing agents in Type 2 diabetes care, practical implications on cardiovascular disease prevention.

Insulin Stimulated Glucose Transport

  • Elevated circulating glucose triggers the release of insulin from the pancreas.
  • Insulin binds to receptors on target tissues, such as skeletal muscle.
  • This stimulates glucose uptake in skeletal muscle, a significant percentage of total uptake.

Pathophysiology of Insulin Resistance

  • Adipose tissue (AT) develops insulin resistance before skeletal muscle.
  • Healthy adipose tissue, adipocyte hypertrophy, inflammation, ROS emission, and lipolysis can result in the increased release of fatty acids.
  • The accumulation of reactive lipids impairs insulin signaling.

The Effect of Excess Lipids on Insulin Signaling

  • Increased circulating lipids result from adipose tissue insulin resistance.
  • Lipid transport begins to accumulate in skeletal muscle.
  • Excess lipids, in skeletal muscle produce reactive lipids, which impair insulin signaling. This leads to insulin resistance and hyperglycemia.

Diabetic Complications

  • Chronic complications include peripheral neuropathies (somatic and autonomic), nephropathies, retinopathies, macro/microvascular complications, diabetic foot ulcers, and infections.
  • Acute complications include hyperglycemia (manifestations), hypoglycemia (potential causes, common symptoms) and diabetic ketoacidosis.

Acute Complications and Causes

  • Hyperglycemia, Diabetic Ketoacidosis, Hyperglycemic Hyperosmolar Nonketotic Syndrome are possible causes.

Exercise-Induced Glucose Transport and Complications

  • Acute exercise can reduce plasma glucose levels for extended time in diabetics.
  • Exercise-induced hypoglycemia. This can last 48 hours and is a common issue in those who exercise without proper glucose monitoring.

Exercise Prescription in Diabetes

  • Glucose control goals of exercise training in diabetes.
  • Prevention of diabetes related complications.
  • CVD risk factor reduction.

Diabetes Mellitus: Exercise Testing

  • ECG stress testing may be indicated to evaluate individuals with diabetes, who have been sedentary, or desire vigorous intensity activities
  • Silent ischemia( a condition that can cause chest pain) in people with diabetes might be undetected by routine testing.
  • CVD risk assessments should be conducted annually.
  • Consider complications, when conducting exercise testing.

Benefits of Combined Exercise

  • Exercise frequency of greater than 3 times a week is recommended for diabetes patients.
  • Benefits of maintaining a healthy weight are emphasized.

Individualized Exercise Programming (for diabetes)

  • Exercise prescriptions need to be personalized based on medication, complications, goals and expected benefits of the programs.

General Exercise Prescription for Diabetes

  • Essential information on exercise programming for diabetes management.

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Exercise Prescription for Diabetes PDF

Description

This quiz focuses on cardiovascular exercise principles for individuals with diabetes, particularly type 2. You will explore the physiological processes related to blood glucose regulation, effective exercise strategies, and the treatment goals for managing diabetes. Test your understanding of the role of exercise in diabetes management.

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