Diabetes Flashcards
What is Diabetes?
Chronic, systemic disorder characterized by HYPERglycemia and disruption of the metabolism / utilization of carbohydrates, proteins, and fats
Type 1 risk factors
Family history, presence of autoantibodies, environmental factors
Type 2 risk factors
obesity, sedentary lifestyle, age, race, family history, etc
Weight risk factor
the more fatty tissue you have, the more resistant your cells become to insulin.
Inactivity risk factor
The less active you are, the greater your risk.
Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
Family history risk factors
Your risk increases if a parent or sibling has type 2 diabetes.
Race or ethnicity risks factor
Although it’s unclear why, certain people — including Black, Hispanic, American Indian and Asian American people — are at higher risk.
Type 1
5%
absolute deficiency in production and secretion of insulin
autoimmune disease
Type 2
95%)- (NIDDM)
cellular resistance to insulin action and inadequate compensatory insulin secretory response
Signs and symptoms type 1
Polyuria, polydipsia, weight loss with polyphagia, blurred vision, ketonuria, weakness/fatigue
May initially present as diabetic ketoacidosis (DKA).
Signs and Symptoms type 2
Polyuria and polydipsia
Blurred vision, fatigue, paresthesias, skin infections, foot pain, high blood lipid levels
Obesity is often seen versus weight loss
Pre-Diabetes
Hyperglycemia classification that falls between “normal” and true diagnosis of DM
Gestational Diabetes
Glucose intolerance detected during pregnancy
Monitor diet and occasionally insulin therapy
HbA1C
bA1c is a test that measures the amount of glycated hemoglobin in
your blood. Glycated hemoglobin is a substance in red blood cells
formed when blood sugar (glucose) attaches to hemoglobin.
- Indicates blood sugar control over a 2–3 month period
- Normal value is 6% or less. Goal for DM is around 6-7%
Type 1 meds
Diet
Injectable Insulin
type 2 meds
Diet
Exercise
Oral Medications
Injectable Insulin
Atherosclerosis - Macrovascular
Cerebrovascular Disease
CAD
PVD
Renal artery stenosis
Atherosclerosis - Microvascular
Nephropathy
Retinopathy
Infection/Impaired wound healing
Diabetic Foot Ulcers/Amputations
Orthopedic
Periarthritis
Hand stiffness
Limited joint mobility
Flexor tenosynovitis
Dupuytren’s contracture
RSD
Neuropathic
Autonomic
Peripheral
Diabetic Amyotrophy
Carpal Tunnel
Charcot’s Joint
Heart disease and stroke - diabetes
Heart disease and stroke account for about 65% of deaths in people with diabetes.
Retinopathy (microvascular) - diabetes
Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year making diabetes the leading cause of new cases of blindness in adults 20-74 years of age
type 1 diabetes - Retinopathy (microvascular) - diabetes
therapy that keeps blood sugar WNL as reduces damage to the eyes by 76%
Nephropathy (microvascular)
Diabetes is the leading cause of kidney failure, accounting for 44% of new cases.
type 1 diabetes - Nephropathy (microvascular)
therapy that keeps blood sugar levels as close to normal as possible reduces damage to the kidneys by 35% to 56%
Neuropathy
About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.
Neuropathy - NS damage
impaired sensation or pain in the feet or hands - peripheral neuropathy
slowed digestion - gastropathy
carpal tunnel syndrome – ischemia of the median nerve
look at what causes neuropathy
x
Impaired Wound Healing - rule of 15
15% of diabetics develop foot ulcers
15% of those ulcers lead to osteomyelitis
15% of all ulcers lead to amputation
Impaired Wound Healing
Influenced by the macro-and microvascular effects and neuropathic effects of DM
Charcot Foot Deformity contributing factors
peripheral neuropathy and microvascular effects.
Charcot Foot Deformity - result in what
Results in microfracture and eventual collapse of the midfoot
Resultant deformity unequally distributes plantar pressures during gait, placing person at even greater risk for ulceration
Charcot Foot Deformity - idiopatheic or sudden
Resultant deformity unequally distributes plantar pressures during gait, placing person at even greater risk for ulceration
when should you refer for a diabetic foot
Any warm, swollen diabetic foot should be taken very seriously and NWB recommended until dx of Charcot Foot can be confirmed with x-ray.
what is the treatment of choice for charcots foot
NWB protection
Treatment for diabetes charcot foot
Total Contact Cast
Patellar Tendon-bearing brace
Hypoglycemial
<70mg/d
Hypoglycemial in what type
type 1
Hypoglycemial signs and
Perspiration
Nervousness
Weakness
Pallor
Tachycardia
Palpitations
Shakiness/trembling
Blurred vision
Confusion
Emotional lability
Treating Low Blood Glucose
first check their blood sugar if possible
Treatment is to ingest some form of sugar, preferably not combined with fats
sugar - examples
Glucose tablets
Sugar packet
Candy
Orange juice
treating Low Blood Glucose
- patient passes out
it is an emergency and 911 should be called
Hyperglycemia
(>250mg/dl)
Hyperglycemia - sign and sym
Lethargic
Confusion
Thirst
Polyuria
Flushed/dry skin
Dry mucous membranes
Rapid but weak HR
Fruity/acetone breath
Diminished reflexes
Acute hyperglycemia most commonly occurs in what Type
Type 2 diabetics as a response to infection or poor glycemic control.
what can hyperglycemia develope into
ketoacidosis or HHNK - if so call 911
Carbohydrate-Containing Foods
Starchy foods like bread, cereal, rice, and crackers
Fruit and juice
Milk and yogurt
Dried beans like pinto beans and soy products like veggie burgers
Starchy vegetables like potatoes and corn
Sweets and snack foods like sodas, juice drinks, cake, cookies, candy, and chips
how many grams fo carbs per meal
45-60 grams per meal.
this can be adjusted based on the indivduals needs
lowLow glycemic index-
vegetables, berries, peanuts
High glycemic index
white bread, Rice Krispies, mashed potato, pretzels > table sugar
metabolic syndrome and diabetes
Some studies have shown that exercise is more beneficial than medication (metformin) in treating metabolic syndrome, a precursor to diabetes.
Overall Benefits of Exercise for persons with Type 2 DM
Lowers blood sugar
Increases insulin sensitivity
Improves lipid profile
Promotes weight loss/maintenance
Reduces dose/overall need for insulin or oral meds
ACSM Guidelines for Exercise for Individuals with Type 2 DM - Aerobic Exercise
At least 3x/week (preferred 5x/week) with no more than 2 consecutive
40-60% VO2 max
150min/week
ACSM Guidelines for Exercise for Individuals with Type 2 DM - resistance
2x/week on non-consecutive days
50-80% 1RM
include all major muscle groups; 10-15 reps progressing to higher weight, less reps
Exercise for Type 1 DM for Type 1 DM
Exercise has not been proven to aid in glycemic control in type 1 diabetics.
Benefit of exercise is primarily protective cardiovascular effects.
prevent the complication of hypoglycemia
