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Pathophysiology of Diabetes Mellitus

Pathophysiology of Diabetes Mellitus. Chronic metabolic disease Absolute or relative deficiency of insulin resulting in hyperglycemia Risk factors for diabetics Microvascular complications Retinopathy and/or nephropathy Macrovascular disease Various neuropathies

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Pathophysiology of Diabetes Mellitus

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  1. Pathophysiology of Diabetes Mellitus • Chronic metabolic disease • Absolute or relative deficiency of insulin resulting in hyperglycemia • Risk factors for diabetics • Microvascular complications • Retinopathy and/or nephropathy • Macrovascular disease • Various neuropathies • Both autonomic and peripheral • Silent ischemia • ST segment depression without angina

  2. Diabetes Mellitus • IDDM  Type I or Juvenile Onset diabetes • NIDDM  Type II or Adult Onset diabetes • Gestational  Pregnancy • Secondary  Caused by the presence of other diseases • Impaired Glucose Tolerance

  3. Type I Diabetes • Absolute deficiency of insulin •  # of insulin-producing pancreatic beta cells • Insulin injection or pump • Hyperglycemia leads to ketoacidosis • Physiological cause • Autoimmune response against beta cells • Triggers of this response are unknown! • Possible viruses or toxins • Usually occurs before 30 yrs of age! • Can occur at any age!! • 10 to 15% of all diabetics are Type I

  4. Type II Diabetes • Relative insulin deficiency • Insulin ineffectiveness • Hyperglycemia • Pathophysiology is unclear! No known cause! • 80% of Type II diabetics are obese! • Usually occurs after the age of 40!

  5. Gestational Diabetes • Occurs during pregnancy • Contrainsulin effects of pregnancy • Diagnosed through OGTT • 2nd or 3rd trimester • Risk factors • Family history • Previous delivery of large babies • Obesity • Resolves postpartum • Approx 50% develop Type II later in life!

  6. Secondary Diabetes • Pancreatic disease (Chronic pancreatitis) • Hormonal conditions • Cushing’s syndrome or acromegaly • Prednisone and chlorothiazides • Insulin receptor abnormalities • Genetic syndromes • Laurence-Moon-Bardet-Biedl syndrome • Myotonic dystrophy

  7. Impaired Glucose Tolerance • Fasting plasma glucose lower than normal diabetic value • 2 hour OGTT results range • 140 to 200 mg per dl • IGT individuals are at increased risk of developing diabetes

  8. Effects on the Exercise Response • Insulin levels in diabetics respond abnormally to exercise! • Peripheral glucose utilization vs hepatic production is disturbed! • Several important factors • Medication used for lowering blood glucose • Timing of medication • Blood glucose level prior to exercise • Timing, amount, and type of previous food intake • Presence & severity of diabetic complications • Intensity, duration, & type of exercise

  9. Effects of Exercise Training • Exercise is a cornerstone of diabetic care!! • Possible improvement in blood glucose control • Improved insulin sensitivity • Lower medication requirement • Reduction in body fat • Cardiovascular benefits • Stress reduction • Prevention of Type II diabetes onset

  10. Exercise Guidelines • Basic ACSM guidelines • 4-6 days or daily • 20-60 minutes • 50-85% of VO2 • Recent research guidelines • In Type II diabetics, short bouts after eating! • 1 hour of exercise requires 15 additional grams of CHO • In Type II, increase caloric expenditure • Reduce level of obesity • Resistance training • Monitor blood glucose prior, during, & post workout

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