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Questions and Answers
What is the recommended weekly energy expenditure for optimal weight loss maintenance?
Which of the following best describes the fit fat paradox?
What is one effect of autonomic neuropathy on cardiovascular function?
What is the correct order of lipoproteins based on size from largest to smallest?
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Which demographic factors increase the risk of developing diabetes-related complications?
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How many minutes of exercise per day may be needed for effective weight loss maintenance?
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What role do HDL and LDL play in lipid metabolism?
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What does HbA1c measure?
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What is a common physical exam finding in patients with diabetes complications?
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Which test assesses long-term glucose control in diabetic patients?
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What complication may arise due to neuropathy affecting the peripheral nervous system?
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Which group is considered at higher risk for developing diabetes?
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What physical symptom may indicate poor healing and is associated with diabetes complications?
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What is the primary characteristic of android fat distribution?
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What is one of the recommended health benefits of achieving a 10% weight loss?
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Which hormone is primarily involved in signaling satiety?
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What is the approximate caloric deficit required to lose 1 pound of fat?
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What type of dietary approach involves limiting the window of eating to 8 hours?
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Which of the following obesity treatment options has shown the greatest long-term efficacy?
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Which type of fat distribution is generally considered less risky for health?
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What is a common challenge related to weight loss due to the set point theory?
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Which effect from obesity can contribute to a reduction in life expectancy by approximately 7 years?
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What is a common misconception about weight loss medications?
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What fasting blood glucose level is indicative of diabetes?
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Which of the following is a role of leptin?
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What is the normative value for the Oral Glucose Tolerance Test (OGTT) two hours after ingestion of glucose?
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Which of the following is a special consideration for exercise testing in individuals with diabetes?
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What body composition assessment is associated with obesity?
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Which of the following is a benefit of exercise training in individuals with diabetes?
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Which hormone is primarily responsible for stimulating hunger?
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What is the primary cell type in adipose tissue?
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What characterizes the pathophysiology of Type 1 diabetes?
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Which of the following best describes Type 2 diabetes?
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What is the role of alpha cells in glucose regulation?
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Which condition is characterized by glucose intolerance during pregnancy?
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What distinguishes hyperglycemia from hypoglycemia?
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What increases the future risk of Type 2 diabetes after pregnancy?
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What type of vessel disease is associated with coronary arteries and major blood vessels?
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Which is a common characteristic of microvascular complications in diabetes?
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How does insulin signaling typically function in Type 2 diabetes?
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What is often the first step in diagnosing diabetes?
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Study Notes
Diabetes Definition
- A group of metabolic diseases characterized by the inability to produce sufficient amounts of insulin or the inability to respond to insulin properly.
Alpha vs Beta Cell Function
- Alpha Cells: When blood sugar is low, alpha cells release glucagon, signaling the liver to release stored glucose, raising blood sugar.
- Beta Cells: When blood sugar is high, beta cells release insulin, helping body cells absorb glucose, lowering blood sugar. Beta cells are often found in clusters called islets of Langerhans.
Type 1 vs Type 2 vs Gestational Diabetes
Type 1
- Pathophysiology: Immune attack on beta cells, preventing insulin production.
- Prevalence: "Juvenile onset"
- Characteristics: Insulin-dependent, beta cell destruction, autoimmune disease (or idiopathic).
Type 2
- Pathophysiology: Increased blood glucose and insulin, eventually leading to insulin resistance.
- Prevalence: 90-95 percent of diabetics, adult onset.
- Characteristics: Insulin resistance, insulin secretion defect, strong genetic influence.
Gestational Diabetes
- Pathophysiology: Glucose intolerance during pregnancy.
- Characteristics: Occurs in 2-10% of pregnancies, increases future risk of type 2 diabetes for the mother, and possibly the child.
Criteria for Testing Diabetes
- Fasting Plasma Glucose: ADA/CDC: 5.6-6.9 mmol/L (100-125 mg/dL); WHO: 6.1-6.9 mmol/L (110-125 mg/dL); Diabetes: 7.0 mmol/L (≥126 mg/dL)
- 2-Hour Plasma Glucose: 2.2-11.1 mmol/L (140-200 mg/dL); ≥ 11.1 mmol/L (≥200 mg/dL)
- HbA1c: 5.7-6.4% (39-47 mmol/mol); ≥6.5% (≥48 mmol/mol)
Hyperglycemia vs Hypoglycemia
- Hyperglycemia: Fasting blood glucose >130 mg/dL. Kidneys excrete glucose and water. Can lead to Diabetic Ketoacidosis (body metabolizes fat, producing ketones). Leads to organ damage.
- Hypoglycemia: Fasting blood glucose <70 mg/dL. Too much insulin or too little carbohydrates. Can lead to coma and death.
Macrovascular vs Microvascular vs Neuropathy (Diabetes)
- Macrovascular: large vessel disease (coronary arteries, cerebrum, and periphery)
- Microvascular: small vessel disease (retinopathy, nephropathy)
- Neuropathy: effects peripheral and autonomic nervous systems. Includes peripheral nerve damage in lower extremities (loss of sensation, reflexes, and increased risk of infections) and autonomic neuropathy.
Diabetes- Medical History and Physical Exam
- Medical History: Focus on acute and chronic complications, laboratory values (HbA1c, plasma glucose), lipids, proteinuria, blood pressure, body weight, and body mass index.
- Physical Exam: Elevated resting heart rate; loss of sensation (especially lower extremities); loss of reflexes (especially lower extremities); foot sores/ulcers; excessive bruising; retinal vascular abnormalities
Diabetes Exercise Testing
- Special Considerations: Exercise testing needs to consider cardiovascular risk, neuropathy, blood glucose control.
- ECG Stress Testing: May be indicated in those with additional risk factors.
- Types of Exercise: Cardio-respiratory, Resistance, Range of Motion.
Obesity (Chapter 8)
- Definition: Abnormal or excessive fat accumulation that risks health.
- Calculation: BMI= weight (kg)/ height^2 (m^2) or weight (lb) x 703 / height^2 (in^2).
- Classification: Body weight-related categories (underweight, normal, overweight, and various obesity classes). Table 8.1 (in the text) provides specific criteria.
- Adipocytes: Primary cell type in adipose tissue, stores triglycerides.
- Adipokines: Adipose-derived hormones.
- Leptin: Hormone suppressing appetite, affecting metabolism.
- Adiponectin: Increases metabolism and energy expenditure.
- Ghrelin: Hormone stimulating hunger, released from gastrointestinal tract.
Obesity- Pathophysiology
- Risks: Diabetes, hypertension, dyslipidemia, breathlessness, sleep apnea, gall bladder disease, heart disease, osteoarthritis, hyperuricemia, complications during pregnancy, and cancer.
- Fat Distribution: Android fat (abdomen, upper body) often more associated with health risks than gynoid fat(hips, thighs, and buttocks).
Obesity - Exercise Testing
- Types of Diets: High-protein, low-carb, hypocaloric, time-restricted feeding.
- Pharmacological: Appetite suppressants, fat absorption reducers.
- Surgical: Significant weight loss, but carries risk of complications, potentially permanent weight gain.
- Exercise is important for maintaining and improving health at any body weight.
Hyperlipidemia and Dyslipidemia
- Lipids: Chylomicron, VLDL, IDL, LDL, HDL (in order of size and density), with different roles in transporting lipids & cholesterol.
- LDL receptor: Pathway that removes cholesterol from bloodstream.
- Reverse Cholesterol Pathway: Pathway that transports cholesterol back to the liver.
Metabolic Syndrome
- Definition: Collection of interrelated cardiometabolic risk factors (more common when in the presence of overweight/obesity).. Leading to greater risk of atherosclerotic cardiovascular disease.
- Exercise Recommendation: Moderate intensity cardio exercise 150-250 min per week. Resistance exercise can supplement cardio exercise.
Peripheral Artery Disease
- Definition: Blockage of leg arteries leading to decreased blood flow to the muscles.
- Classifications: Fontaine (asymptomatic, mild-severe claudication, rest pain, ulceration, gangrene); Rutherford (based on tissue loss).
- Clinical Considerations: Inclaudication is the most common symptom.
- Exercise Considerations: Exercise testing and special considerations for PAD will need to consider the presence, severity, and stage of claudication.
- Important Considerations Duration, intensity, use of Borg 15 category scale or similar scales.
Asthma
- Pathophysiology: Airway inflammation and airflow limitation.
- Diagnosis: Spirometry measurement such as FEV1/FVC, flow volume loop.
- Special Considerations: Exercise testing needs to use and monitor BP, ECG, arterial oxygen saturation, dyspnea (Borg scale).
- Exercise Prescription: Walking, running, swimming, or other aerobic exercise (at intensity just below the anaerobic threshold). Exercise precautions.
Cancer (Chapter 21)
- Definition: Uncontrolled cell growth.
- Types of cancer: Carcinoma, sarcoma, leukemia, lymphoma.
- Differentiation: Benign (slow-growing, isolated) and malignant (faster-growing, invasive).
- Pathophysiology: Tumor growth, angiogenesis, metastasis.
- Treatment Options: Surgery, radiation, chemotherapy, biotherapy
- Exercise Testing: Special considerations for both cancer types and related conditions.
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Description
This quiz covers the definitions, cell functions, and differences between Type 1, Type 2, and Gestational diabetes. It examines the underlying pathophysiology and characteristics of each type, providing a comprehensive overview of diabetes. Test your understanding of these metabolic diseases and their clinical implications.
