Diabetes Education Certification Physical Activity & Exercise 2 — Questions and Answers
Question 1: A patient with type 2 diabetes asks how soon after starting an exercise program they can expect to see improvements in insulin sensitivity. What is the most accurate response?
- Insulin sensitivity improves only after 6 months of consistent exercise
- A single bout of exercise can improve insulin sensitivity for up to 24–48 hours (Correct answer)
- Insulin sensitivity only improves with aerobic exercise lasting more than 60 minutes
- Benefits to insulin sensitivity require weight loss first
Correct answer: A single bout of exercise can improve insulin sensitivity for up to 24–48 hours
Even a single session of moderate-intensity exercise can enhance insulin sensitivity for 24–48 hours, independent of weight loss.
Question 2: Which mechanism primarily explains why resistance training improves glucose control in people with type 2 diabetes?
- Increased glucagon secretion during exercise
- Reduced hepatic glucose output during rest
- Increased muscle mass leading to greater glucose disposal capacity (Correct answer)
- Decreased gastrointestinal absorption of carbohydrates
Correct answer: Increased muscle mass leading to greater glucose disposal capacity
Resistance training builds skeletal muscle mass, which is the primary site of insulin-mediated glucose uptake, increasing overall glucose disposal.
Question 3: A patient with type 1 diabetes is planning a 45-minute afternoon swim. Her pre-exercise blood glucose is 140 mg/dL. What is the most appropriate guidance?
- Cancel exercise because blood glucose is too high
- Proceed with exercise; the blood glucose level is acceptable (Correct answer)
- Administer a correction bolus before swimming
- Eat 30 grams of fast-acting carbs immediately before starting
Correct answer: Proceed with exercise; the blood glucose level is acceptable
A pre-exercise blood glucose of 140 mg/dL is within the safe range (100–250 mg/dL) for most patients with type 1 diabetes to begin aerobic exercise.
Question 4: What is the primary concern with high-intensity anaerobic exercise (e.g., sprinting) in a patient with type 1 diabetes?
- It causes immediate hypoglycemia during the activity
- It triggers a catecholamine surge that can raise blood glucose acutely (Correct answer)
- It has no effect on blood glucose levels
- It reduces insulin requirements for the following 48 hours
Correct answer: It triggers a catecholamine surge that can raise blood glucose acutely
Anaerobic exercise triggers catecholamine release, which stimulates hepatic glucose production and can cause transient hyperglycemia.
Question 5: For a sedentary adult with type 2 diabetes and no contraindications, which exercise prescription aligns with ADA guidelines?
- 150 minutes per week of moderate-intensity aerobic activity with no more than 2 consecutive rest days (Correct answer)
- 30 minutes of vigorous aerobic activity once per week
- 60 minutes daily of low-intensity walking only
- Resistance training 5 days per week with no aerobic component
Correct answer: 150 minutes per week of moderate-intensity aerobic activity with no more than 2 consecutive rest days
The ADA recommends at least 150 minutes per week of moderate-intensity aerobic exercise spread over at least 3 days, with no more than 2 consecutive days without activity.
Question 6: A patient with type 2 diabetes reports that interrupting prolonged sitting with 3-minute light walking breaks every 30 minutes significantly improves his glucose levels. What physiological mechanism best explains this?
- Increased pancreatic beta-cell insulin secretion during movement
- Muscle contractions facilitate GLUT4 translocation independent of insulin (Correct answer)
- Reduced cortisol levels from standing versus sitting
- Enhanced hepatic glycogen synthesis from brief activity bouts
Correct answer: Muscle contractions facilitate GLUT4 translocation independent of insulin
Muscle contractions during movement promote GLUT4 transporter translocation to the cell surface via an insulin-independent pathway, enhancing glucose uptake.
Question 7: Which condition is considered an absolute contraindication to vigorous exercise in a patient with diabetes?
- Mild peripheral neuropathy
- Proliferative diabetic retinopathy with recent vitreous hemorrhage (Correct answer)
- Microalbuminuria less than 30 mg/day
- Well-controlled hypertension (BP 130/80 mmHg)
Correct answer: Proliferative diabetic retinopathy with recent vitreous hemorrhage
Proliferative retinopathy with vitreous hemorrhage or retinal detachment risk is an absolute contraindication to vigorous exercise due to risk of further hemorrhage.
Diabetes Education Certification Physical Activity & Exercise 2
A patient with type 2 diabetes asks how soon after starting an exercise program they can expect to see improvements in insulin sensitivity.
What is the most accurate response?