Diabetes Flashcards
The body’s preferred, primary energy source for cellular metabolism
Glucose
What are the functions of the Pancreas
Exocrine and Endocrine function: Somatostatin - regulates release of insulin and glucagon
What is the function of Insulin
Stimulates cellular absorption of glucose.
- transport glucose into cells
- turns glucose into fats
- promotes transport of glucose to liver
What is the function of Glucagon
Released during Hypoglycemia
Promotes conversion of glycogen into glucose: Raises blood sugar level
Type of DM that occurs when the immune system attacks the insulin-producing beta cells in the pancreas
Type 1 DM
Insulin resistance even though insulin present
AND Altered response to glucose
Results
Hyperglycemia
Onset: Adult (seen in obese children)
Gradual increase of resistance to insulin
Type 2 DM
What are the extrinsic risk factors of Type 2 DM?
obesity
sedentary lifestyle
diet
What are the intrinsic risk factors of Type 2 DM
Ethnicity: African-American, Asian, Pacific Islander, Latin
Males >45yo
HTN, Hyperlipidemia
Family history of DM
What are the treatments involved with Type 2 DM?
Medication: Oral and insulin injection
Nutritional Counseling
Stress management
Exercise
What are the delivery devices for insulin?
Insulin syringe
Insulin pen
Insulin pump
Jet injector
What are the effects of Stress Cortisol Release?
increases visceral obesity, low grade inflammation, leptin, and insulin resistance.
What benefits does exercise have on Type 2 DM?
Increases -beta-cell mass -insulin -insulin sensitivity -glucose uptake -glucose and fatty acid oxidation Decreases -glucagon -blood glucose -hemoglobin A1c -fat mass -hepatic glucose production
What is Gestational Diabetes?
Developed during pregnancy Causes Weight gain Genetic predisposition Resistance to insulin 2° hormone changes Low HDL, elevated triglycerides MAY be more likely to develop Type 2 DM later in life
Where is glycogen stored?
The Liver
T/F: During periods of hypoglycemia, glucagon is released by the pancreas.
True
What are the Big 3 Signs and Symptoms of DM?
Polydipsia (thirst) Polyuria (urination) Polyphagia (hunger) *also... Hyperglycemia Hyperglycosuria (high excretion of glucose in urine) Weight loss Increased appetite Nausea Blurred vision Amenorrhea (absence of menstrual period) ED
Created by the liver when the body has decreased glucose levels for use by cells, and used as an energy source for cellular function
Ketones
The effect of Ketones used as an energy source are?
Hyperglycemia
Hyperketonemia (ketones in blood)
Hyperketonuria (ketones in urine)
Ketoacidosis (lowers blood PH level acidic levels
What are the symptoms of Ketoacidosis?
headache confusion sleepiness, LOC weakness diarrhea shortness of breath arrythmia increased HR nausea vomiting
What are the Systemic Complications of DM?
- gradual destruction of small blood vessels and nerves throughout the body
- 2 degree sugar crystal formation during hyperglycemia
- Affects ALL systems
- PVD (LE blood flow)
What are the Neurologic complications of DM?
Sensory neuropathy (Paresthesia, pain, sensation loss)
Motor neuropathy (Muscle atrophy)
Autonomic neuropathy (Sweat/oil production, digestion, stress etc.)
Diabetic Neuropathy
(LE and feet)
Additional Systemic Complications of DM?
Integumentary Visual CNS Cardiac Digestive Renal (uncontrolled HTN) Dental Urinary/Reproductive Mental
What are the lab values for FPG (fasting plasma glucose)?
Mg/dL: Milligram per Deciliter
Normal: <100mg/dL
Prediabetic: 100 to 125mg/dL
Diabetic: >125mg/dL
What is the normal value for A1C Testing? *also known as hemoglobin A1C
Normal: 4 to 5.6%
At Risk: 5.7 to 6.4%
Diabetes: 6.5%
What are the symptoms of Hyperglycemia?
>200 - 300mg/dL gradual onset extreme thirst dry skin hungry need to urinate often blurry vision drowsy slow-healing wounds flushed, dry
What are the symptoms of Hypoglycemia?
>70mg/dL sudden onset extreme fatigue blurred vision sweating mood changes dizziness increased pulse shaky/trembling
When is exercise contraindicated for hypoglycemia or hyperglycemia?
hypo: < 70mg/dL
hyper: > 300mg/dL with ketones
What are some exercise guidelines for a patient that is hyperglycemic and on oral meds?
Oral
- 10 to 15 min of activity
- BG rises, STOP.
- BG drops, continue while rechecking BG every 10 to 15 min
What are some exercise guidelines for a patient that is hyperglycemic and on insulin?
Should be checked for ketones* (via urine dip stick or glucose meter)
If (+) ketones: avoid activity
If (-) ketones: participate with close BG monitoring
T/F? One cause of ketoacidosis is low blood glucose availability for tissues to use and is a medical emergency.
True
What are the benefits of exercise with Type 2 DM?
- Improve mild to moderate HTN
- Increased energy expenditure
- Cardio conditioning
- Increased strength and flexibility
- Improve well-being and quality of life.
What are Diabetic exercise risks?
hypoglycemia
hyperglycemia
onset/exacerbation of cardiovascular diseases
Autonomic neuropathy
Guidelines for Cardiovascular Training for DM patients.
- gradual increase of intensity
- 40 to 60% of MHR
- walking, aquatic, treadmill, bike, UBE, tai-chi
- 3 to 5x weekly
- build to 30 min
- 1000-2000 kcal/week
Guidelines for Resistance Training for DM patients.
- Gravity
- Free weights
- Elastic Bands
- Exercise Machines
- Aquatic Exercises (water as resistance)
- Gym Ball
10 to 15 reps/set
2 sets per major muscle group
1 min rest minimum
2-3x weekly
30 minutes
What should you educate the Diabetic patient on?
- foot care
- energy conservation
- reinforce functional activities of interest
What are the foot hygiene practices you should teach your patient?
- Inspect feet daily for injury or pressure areas
- Wash feet with mild soap
- Dry between toes
- Don’t go barefoot
- Caution with cutting toenails
- Need Podiatrist?
What are the Ulcer Prevention methods?
Control diabetes Foot hygiene Proper socks Proper shoes Pressure relief Wound care Monofilament testing
Complication of neuropathy resulting in a complex of sensory, motor, and autonomic changes that lead to structural and vascular changes
Charcot Foot
What are characteristics of Charcot Foot?
- Multiple osteoarthropathy
- joint dislocation
- pathological fractures
- osteopenia
- deformities (convex bottom of foot)
- gait pattern changes
- different pressure points
What are the important questions to ask a patient with DM prior to exercising?
How do you feel?
Did you monitor your glucose level this morning? What was it?
Did you take your diabetes med today?
Last time you ate?
Do you have a snack or glucose tablets with you?
Do you have your glucose monitor with you?
