KIN492 Test 3 Study Guide PDF

KIN492 Test 3 Study Guide Chapter 7 – Diabetes - Definition o A group of metabolic diseases characterized by: o the inability to produce sufficient amounts of insulin o or: o the inability to respond insulin properly - Alph...

KIN492 Test 3 Study Guide Chapter 7 – Diabetes - Definition o A group of metabolic diseases characterized by: o the inability to produce sufficient amounts of insulin o or: o the inability to respond insulin properly - Alpha vs Beta cell function o Alpha Cell:pancreatic alpha cells, When your blood sugar is too low, alpha cells release glucagon. This hormone signals your liver to release stored glucose into the bloodstream, raising your blood sugar levels. o Beta Cell: pancreatic beta cells, often in the center of clusters called “Islets of Langerhans.” produce insulin, When your blood sugar is too high, beta cells release insulin. This hormone helps your body’s cells absorb glucose from the bloodstream, lowering your blood sugar levels. - Type I vs Type II vs Gestational Diabetes o pathophysiology, prevalence, differences o type 1: immune attack on beta cells, not being able to produce sufficient insulin d/t beta cells not being there Pathophysiology: o “juvenile onset” o insulin dependent o beta cell destruction leading to insulin deficiency o autoimmune disease o idiopathic- no actual cause o type 2: increase blood glucose and body increases insulin in response, high glucose and high insulin also known as hyperglycemia and hyperinsulinemia, and eventually cells become insulin resistant Pathophysiology: o Adult onset o 90-95 percent of diabetics o includes insulin resistance, eventually insulin deficiency o includes insulin secretion defect and insulin resistance o strong genetic influence o Gestational diabetes glucose intolerance onset or first recognition with pregnancy 2-10% pregnancies increases future risk of T2DM for mother, maybe child  o Criteria for testing diabetes - Insulin signaling, sensitivity, resistance o - Hyperglycemia vs Hypoglycemia o values, risks, characteristics  o - Macrovascular, Microvascular (retinopathy/nephropathy), Neuropathy (peripheral/autonomic) o definitions, types, risks for exercise, history and physical exam o silent ischemia, resting tachy, low HRmax o Macrovascular- Large vessel disease Coronary arteries, cerebrum, and periphery Increases likelihood of CAD, indication for ECG o Microvascular- Small vessel disease retinopathy, small vessels in eyes. some risks for various activities neuropathy increases risk of CKD (chronic kidney disease). Some risk for high intensity exercise. o Neuropathy- diabetes can effect the periphreal and autonomic nervous systems Peripherial nevervous system; particular loss of sensation in lower extremities o loss of reflexes in legs and feet o increased rates of infection o loss of sensation Autonomic neuropathy: effects ANS regulation cardiovascular function o high resting HR o low HR max o rely on HRR method or RPE? o History & physical exam medical history: genetic/environmental links o participants have higher risk if: ▪ have first degree relative w/ diabetes ▪ are of a high risk race or ethnicity: african american, latino, native american, pacific islander  ▪ are women who delivered a baby weighing more than 9 pound or 4 kg or were diagnosed with gestational diabetes Medical history review o Acute and chronic complications ▪ Laboratory values: HbA1c, plasma glucose, lipids, proteinuria (protein in urine) ▪ Blood pressure o Self-monitoring blood glucose results o Body weight and body mass index Physical exam: o Physical exam focuses on potential diabetes complications ▪ – Elevated resting heart rate ▪ – Loss of sensation (especially lower extremities) ▪ – Loss of reflexes (especially lower extremities) ▪ – Foot sores or ulcers with poor healing ▪ – Excessive bruising ▪ – Retinal vascular abnormalities - HbA1c, blood glucose, OGTT 🡪 definition, normative values, differences o HbA1c: A measure of average blood glucose levels over the past 2-3 months. Normative value is less than 5.7% for non-diabetics. & > 6.5% for diabetes o Blood Glucose: Immediate measure of blood sugar levels. Normative fasting value is 70-99 mg/dL. & > 130mg/dl (7.0mmol/L) to confirm diabetes o OGTT: Oral glucose tolerance test, measures blood glucose levels before and after consuming a glucose drink. Normative value is less than 140 mg/dL 2 hours after the drink & > 200 mg/dl (11.1mmol/L) to confirm diabetes - Exercise Testing o Special considerations for Diabetics o Special Considerations: Exercise testing for individuals with diabetes should consider cardiovascular risk, o Presence of neuropathy, and blood glucose control. o ECG stress testing may be indicated for those with additional risk factors. o types of exercise: - Exercise Prescription o Any deviations from normal ACSM guidelines? o o Special considerations for Diabetics o Perform at optimal time of day (convenience and ability to assess/control blood glucose – Avoid peak insulin action – Avoid late evening if on insulin or oral medications that lower blood glucose and risk hypoglycemia – Perform at similar times each day to maintain steady glucose levels o Monitor for vascular or neurological complications o Assess feet, approve footwear o Monitor hydration o Common goals/benefits of exercise training o Improves insulin action (glucose control) o Increases fat oxidation o Improves body comp/weight Chapter 8 – Obesity - Definition o obesity- abnormal or excessive fat accumulation that presents risk to health - BMI calculation, stratification, o BMI- weight (kg)/ hieght^2 (m) o or o weight (lb) x 703 / height^2 (in.) - Adipocyte, adpiokines (leptin, adiponectin) o adipocyte- the primary cell type in adipose tissue, serves as triglycerides o adpiokines- adipose derived hormones o Leptin- hormone released by adipose tissue that controls satiety( suppresses appetite), and peripherally to effect metabolism; leptin resistance in obesity o Adiponectin- hormone that increases metabolism and energy expenditure o Ghrelin- hormone released from gastrointestinal tract, stimulating hunger. production is sensitive to stomach distension - Hormonal regulating hunger/satiety (leptin, ghrelin) - Risks associated with obesity, Android vs Gynoid fat distribution o risks: o addiction like process o life expectancy -7 years with things like  o Also see physical signs of: fatigue and dyspnea difficulty with physical activity o Android fat distribution: when fat is mainly stored around the abdomen and upper body. “apple-shaped” obesity. This type of fat distribution is more common in men and can be associated with a higher risk of health issues like heart disease and diabetes. o Gynoid fat distribution: when fat is mainly stored around the hips, thighs, and buttocks. “pear-shaped” obesity. This type of fat distribution is more common in women and is generally considered to be less risky for health compared to android adiposity. o - Target weight loss, and general benefits o NIH recommends 10% weight loss o BMI < 25 kg/m^2 considered normal weight o need to determine goals w/ respect to patient desires o females gnerally want more % weight loss and will not be happy with even half o Health benefits: decline in blood pressure in systolic and diastolic blood pressure in pts with hypertension decline up to 50% in fasting glucose in newly diagnosed pts >20% decline in all cause mortality >30% decline in deaths related to diabetes >40 decline in deaths related to obesity - Treatment options and efficacy o Diet therapy, set point theory o Calorie restriction- need caloric deficit, RMR + physical activity ~ 3,500 kcal deficit = 1 lb of fat  o types of diets hypocaloric, elicit 500 to 750 kcal/d deficit high protein low carbohydrate (akin’s esque) high fat, low carb, normal protein (ketogenic) time-restricted feeding, like limit window of eating to 8hrs o Set point theory weight loss lowers metabolic rate, making subsequent weight loss more difficult o Pharmacologic (appetite suppressant, absorption suppressant) o common approaches: reduce appetite reduce absorption of fats o most medications produce 5 to 10% of fat loss o Surgical o produces the greatest amount of weight loss and best long term weight maintenance possible >50% excess weight loss o some minor surgical risk o risk of regain! o Exercise o preventing becoming overweight or obese o minor additional rate of weight loss when combined with diet and behavior change o maintenance of weight loss suggests 2,500 to 2,800 kcal/wk expenditure for best maintenance may require 60 to 90 min/d - Exercise prescription o Goals  o o Special considerations o - Fit fat paradox o do you have to lose weight for benefits of exercise? o the fit fat paradox highlights the importance of physical fitness in overall health. o It suggests that being active and fit can reduce health risks and improve longevity, even if an individual is overweight or obese. o This underscores the value of incorporating regular physical activity into daily life for everyone, regardless of body weight. Chapter 10 – Hyperlipidemia and Dyslipidemia - Lipid Metabolism o Chylomicron, VLDL, IDL, LDL, HDL (relationship of size, density, pro/anti-atherogenic) o In order from size: o Chylomicron- produced when we absorb fat in the small intestine, largest in size, lowest in density. low protein:lipid ratio o VLDL- (very low density lipoprotein) precursor to IDL and LDL, primary transport mechanism for tryglycerides o IDL- (intermediate density lipoprotein) product of VLDL after delivery of triglycerides LPL o LDL- (low density lipoprotein) primary transporter of cholesterol o HDL- (high density lipoprotein) responsible for scavenging triglycerides from periphery and bringing it back to the liver o LPL o Lipoprotein lipase- enzyme located in capillaries responsible for liberating fatty acids from lipoproteins o LDL Receptor Pathway, Reverse Cholesterol Pathway o LDL receptor pathway- process by which lipids and triglycerides,etc are digested, processed, and circulated throughout the body o Reverse cholesterol pathway- process by which excess cholesterol is transported from the circulation and periphery back to the liver - Normative values o Total Cholesterol: 40 mg/dL for men, >50 mg/dL for women o LDL: