KIN 434 EXAM REVIEW QUESTIONS
AND ANSWERS
What is Diabetes Mellitus? What are its diagnostic criteria? - Answer-Blood glucose
is regulated by what? What do "low" and "high" levels of insulin influence? Defined
as a group of metabolic disorders of glucose regulation and utilization. Blood glucose
is regulated by insulin. Insulin regulates blood glucose and influences cell growth.
Increased production of insulin keeps blood glucose within normal range. Insulin
alters membrane transport of glucose.◦ Low insulin - less glucose leaves the
bloodstream and enters into the body tissues o High insulin - more glucose leaves
the bloodstream and enters into the body tissues Type 1 Causality is immune-
mediated or idiopathic. o Immune-mediated = the immune system attacks beta cells
(cells of the pancreas), resulting in a decrease production of insulin; starts to occur
most often in childhood and adolescence (but could occur at any age); requires
insulin supplementation. o Idiopathic (no defined causality) = is only present in a
small number of people; mostly occurs in those of Asian or African ancestry; is
strongly inherited; there is a lack of evidence of beta cell autoimmunity; insulin
supplementation is sporadic. Response to insulin is normal, there is no resistance.
Type 2The muscle cells in the body and the liver become less sensitive (also known
as becoming more resistant) to insulin. ◦ Production of insulin can decrease, which
elevates blood glucose as well.◦ Abdominal fat can negatively influence insulin
sensitivity - increased abdominal fat can decreased insulin sensitivity. Progression of
insulin resistance can cause pancreatic dysfunction and increase the development of
Metabolic Syndrome (MS).
What are the "chronic" complications of Diabetes Mellitus? - Answer-Large Vessel
Vascular Disease (Macro-angiopathies)Coronary artery disease - can cause angina,
infarction, etc. Cerebrovascular disease - can cause transient ischemic attack,
stroke, etc. Peripheral vascular disease - can cause claudication pain Small Vessel
Vascular Disease (Micro-angiopathies) Nephropathy - damage to the capillaries to
kidney glomerulin. Retinopathy - damage to the blood vessels to the retina
Neuropathy: nerve tissue damage o Autonomic - affects the autonomic nervous
system (i.e., HR) Peripheral - affects sensation in the extremities (usually lower)
What are the "treatment options" (primary and secondary) for Diabetes Mellitus? Be
able to describe or identify the examples of the secondary treatment options. -
Answer-Primary Treatments: A. Oral Agents- Function to stimulate pancreatic insulin
secretion, increase carb absorption, reduce liver glycogenolysis, or increase insulin
sensitivity.Also known as antiglycemicsUsed primarily by Type 2 patientsExample
drugs: metformin, glucophage, glucovance B. Function to provide external insulin
source.Provided by injection and/or implantable pumps. Preparations vary greatly on
speed of onset, peaking, and effective duration.Used by all Type 1 and some Type 2
patients Example drugs: lispro, lente, lantus Secondary Treatments: A. Regularly
exercising: • This potentiates insulin action and blood glucose utilization• Improves
insulin sensitivity and production B. Having a healthy diet, preferably one ideal for a
diabetic• e.g., Carbs = 55-60% (or less), Fat = 30%, Protein = 10-15% (or more)•
Different diets depending on medical recomendation C. Self-monitoring of glucose
levels• Type 2 Diabetes controlled = 1 x daily (morning time)• Type 2 Diabetes
, uncontrolled = 3 x daily• Type 1 Diabetes controlled = 3-5 x daily(most)D.
Participating in diabetic counseling: • Involves behavior change implementation,
nutrition and dietary education, weight management, etc.• Can be hospital based,
weight watchers, etc. E. Daily being physical Activity - general activity, not just
exercise..• Activities such as housework, recreation, job-related labor, etc.• Effective
in glucose management for Type 2 and reducing risk factor Type1 and 2.• Provides
acute glycemic control (up to 48 hrs) by providing an insulin-like action (increased
cellular uptake of glucose). Provides chronic glycemic control by decreasing insulin
resistance through increased number of insulin receptors.
What is Metabolic Syndrome? What does it cause, and what two problems can the
condition cause or worsen? What are the diagnosis criteria for this condition? -
Answer-It is a disorder of energy utilization and storage, diagnosed by a co-
occurrence of three out of five of the following medical conditions: abdominal
(central) obesity, elevated blood pressure, elevated fasting plasma glucose, high
serum triglycerides, and low high-density cholesterol levels. This disorder causes
endothelial dysfunction (atherosclerotic lesions), thus increases the risk of
developing CVD. Two problems this condition can cause or worsen:◦ Excess blood
clotting◦ Low grade chronic inflammation throughout the body The two most
important risk factors for metabolic syndrome are◦ Insulin Resistance◦ Central
Obesity (the body has a "apple-shape")Other risk factors include:◦ Aging◦ Genes that
make you more likely to develop this condition ◦ Hormone changes◦ Lack of exercise
What is Renal Failure and what can it influence? - Answer-Starts as "chronic kidney
disease" and can progress to "end-stage renal disease". This is the permanent
failure of kidney function due to physical injury or disease. "Chronic kidney disease"
is diagnosed when "glomeruli filtration rate" is < 60 mL/min per 1.73 m2 (flow of
plasma through the kidney glomeruli) for more than three months. End Stage Renal
disease" occurs when the diseased kidneys start to require renal replacement
therapy (dialysis). Can influence loss of waste product clearance, hypertension,
metabolic acidosis, anemia, peripheral neuropathy, muscle weakness, autonomic
dysfunction, elevated triglycerides and reduced HDL-C, etc.. Medications will be
prescribed to help treat these different side effects.
What are the roles of a clinical/special populations exercise professional? - Answer-
From CEPA (Clinical Exercise Physiology Association): o Provides exercise training
as a therapeutic benefit for individuals with cardiovascular disease, pulmonary
disease, metabolic disorders, and other medical conditions. o Provides a medically
supervised environment for a exercise program or service (i.e., exercise testing) that
is directed by a licensed physician.
Why are special precautions important? - Answer-Ensures safety during exercise
testing and exercise participation. Acknowledges specific aversive effects exercise
may influence (i.e., injury, medical emergency). Guarantees exercise's therapeutic
effectiveness for specific medical conditions.
Why is supervision important? What is "key" with supervision? - Answer-Supervision
ensures safety of the exercise testing and participation in the exercise setting,
especially when the participant: ◦ Is considered "high-risk" for acute cardiovascular
event occurrence. ◦ Has had a heart and/or vascular surgery ,or an invasive
AND ANSWERS
What is Diabetes Mellitus? What are its diagnostic criteria? - Answer-Blood glucose
is regulated by what? What do "low" and "high" levels of insulin influence? Defined
as a group of metabolic disorders of glucose regulation and utilization. Blood glucose
is regulated by insulin. Insulin regulates blood glucose and influences cell growth.
Increased production of insulin keeps blood glucose within normal range. Insulin
alters membrane transport of glucose.◦ Low insulin - less glucose leaves the
bloodstream and enters into the body tissues o High insulin - more glucose leaves
the bloodstream and enters into the body tissues Type 1 Causality is immune-
mediated or idiopathic. o Immune-mediated = the immune system attacks beta cells
(cells of the pancreas), resulting in a decrease production of insulin; starts to occur
most often in childhood and adolescence (but could occur at any age); requires
insulin supplementation. o Idiopathic (no defined causality) = is only present in a
small number of people; mostly occurs in those of Asian or African ancestry; is
strongly inherited; there is a lack of evidence of beta cell autoimmunity; insulin
supplementation is sporadic. Response to insulin is normal, there is no resistance.
Type 2The muscle cells in the body and the liver become less sensitive (also known
as becoming more resistant) to insulin. ◦ Production of insulin can decrease, which
elevates blood glucose as well.◦ Abdominal fat can negatively influence insulin
sensitivity - increased abdominal fat can decreased insulin sensitivity. Progression of
insulin resistance can cause pancreatic dysfunction and increase the development of
Metabolic Syndrome (MS).
What are the "chronic" complications of Diabetes Mellitus? - Answer-Large Vessel
Vascular Disease (Macro-angiopathies)Coronary artery disease - can cause angina,
infarction, etc. Cerebrovascular disease - can cause transient ischemic attack,
stroke, etc. Peripheral vascular disease - can cause claudication pain Small Vessel
Vascular Disease (Micro-angiopathies) Nephropathy - damage to the capillaries to
kidney glomerulin. Retinopathy - damage to the blood vessels to the retina
Neuropathy: nerve tissue damage o Autonomic - affects the autonomic nervous
system (i.e., HR) Peripheral - affects sensation in the extremities (usually lower)
What are the "treatment options" (primary and secondary) for Diabetes Mellitus? Be
able to describe or identify the examples of the secondary treatment options. -
Answer-Primary Treatments: A. Oral Agents- Function to stimulate pancreatic insulin
secretion, increase carb absorption, reduce liver glycogenolysis, or increase insulin
sensitivity.Also known as antiglycemicsUsed primarily by Type 2 patientsExample
drugs: metformin, glucophage, glucovance B. Function to provide external insulin
source.Provided by injection and/or implantable pumps. Preparations vary greatly on
speed of onset, peaking, and effective duration.Used by all Type 1 and some Type 2
patients Example drugs: lispro, lente, lantus Secondary Treatments: A. Regularly
exercising: • This potentiates insulin action and blood glucose utilization• Improves
insulin sensitivity and production B. Having a healthy diet, preferably one ideal for a
diabetic• e.g., Carbs = 55-60% (or less), Fat = 30%, Protein = 10-15% (or more)•
Different diets depending on medical recomendation C. Self-monitoring of glucose
levels• Type 2 Diabetes controlled = 1 x daily (morning time)• Type 2 Diabetes
, uncontrolled = 3 x daily• Type 1 Diabetes controlled = 3-5 x daily(most)D.
Participating in diabetic counseling: • Involves behavior change implementation,
nutrition and dietary education, weight management, etc.• Can be hospital based,
weight watchers, etc. E. Daily being physical Activity - general activity, not just
exercise..• Activities such as housework, recreation, job-related labor, etc.• Effective
in glucose management for Type 2 and reducing risk factor Type1 and 2.• Provides
acute glycemic control (up to 48 hrs) by providing an insulin-like action (increased
cellular uptake of glucose). Provides chronic glycemic control by decreasing insulin
resistance through increased number of insulin receptors.
What is Metabolic Syndrome? What does it cause, and what two problems can the
condition cause or worsen? What are the diagnosis criteria for this condition? -
Answer-It is a disorder of energy utilization and storage, diagnosed by a co-
occurrence of three out of five of the following medical conditions: abdominal
(central) obesity, elevated blood pressure, elevated fasting plasma glucose, high
serum triglycerides, and low high-density cholesterol levels. This disorder causes
endothelial dysfunction (atherosclerotic lesions), thus increases the risk of
developing CVD. Two problems this condition can cause or worsen:◦ Excess blood
clotting◦ Low grade chronic inflammation throughout the body The two most
important risk factors for metabolic syndrome are◦ Insulin Resistance◦ Central
Obesity (the body has a "apple-shape")Other risk factors include:◦ Aging◦ Genes that
make you more likely to develop this condition ◦ Hormone changes◦ Lack of exercise
What is Renal Failure and what can it influence? - Answer-Starts as "chronic kidney
disease" and can progress to "end-stage renal disease". This is the permanent
failure of kidney function due to physical injury or disease. "Chronic kidney disease"
is diagnosed when "glomeruli filtration rate" is < 60 mL/min per 1.73 m2 (flow of
plasma through the kidney glomeruli) for more than three months. End Stage Renal
disease" occurs when the diseased kidneys start to require renal replacement
therapy (dialysis). Can influence loss of waste product clearance, hypertension,
metabolic acidosis, anemia, peripheral neuropathy, muscle weakness, autonomic
dysfunction, elevated triglycerides and reduced HDL-C, etc.. Medications will be
prescribed to help treat these different side effects.
What are the roles of a clinical/special populations exercise professional? - Answer-
From CEPA (Clinical Exercise Physiology Association): o Provides exercise training
as a therapeutic benefit for individuals with cardiovascular disease, pulmonary
disease, metabolic disorders, and other medical conditions. o Provides a medically
supervised environment for a exercise program or service (i.e., exercise testing) that
is directed by a licensed physician.
Why are special precautions important? - Answer-Ensures safety during exercise
testing and exercise participation. Acknowledges specific aversive effects exercise
may influence (i.e., injury, medical emergency). Guarantees exercise's therapeutic
effectiveness for specific medical conditions.
Why is supervision important? What is "key" with supervision? - Answer-Supervision
ensures safety of the exercise testing and participation in the exercise setting,
especially when the participant: ◦ Is considered "high-risk" for acute cardiovascular
event occurrence. ◦ Has had a heart and/or vascular surgery ,or an invasive
