Diabetes

Question 1

What is the main exocrine function of the pancreas?

Answer 1

To produce digestive enzymes, controlled by pancreatic acinar cells.

Question 2

What is the endocrine function of the pancreas?

Answer 2

Production of hormones like insulin and glucagon, controlled by the islets of Langerhans.

Question 3

What do alpha cells in the pancreas produce, and what is their function?

Answer 3

Alpha cells produce glucagon, which helps increase blood glucose levels.

Question 4

What do beta cells in the pancreas produce, and why is it important?

Answer 4

Beta cells produce insulin, which reduces blood glucose levels by enhancing the entry of glucose into cells.

Question 5

What percentage of islet cells are beta cells?

Answer 5

About 65% to 80% of the islets of Langerhans cells are beta cells.

Question 6

What is the function of delta cells in the pancreas?

Answer 6

Delta cells release somatostatin, which regulates levels of both glucagon and insulin.

Question 7

How does insulin lower blood glucose levels?

Answer 7

By enhancing glucose import into cells and stimulating glycogen production in the liver.

Question 8

What process does glucagon stimulate when blood glucose levels are low?

Answer 8

Glycogenolysis, which is the breakdown of glycogen reserves into glucose.

Question 9

Define gluconeogenesis.

Answer 9

The process where nonfuel tissues like adipose tissue and muscle are converted into glucose, increasing blood glucose levels.

Question 10

What hormones counter-regulate insulin?

Answer 10

Glucagon, epinephrine, cortisol, glucocorticoids, and growth hormone.

Question 11

Describe the sequence of glucose metabolism after a meal.

Answer 11

Glucose is absorbed, causing hyperglycemia, which stimulates the pancreas to release insulin, facilitating glucose entry into cells and reducing blood glucose levels.

Question 12

What is GLUT4, and where is it found?

Answer 12

GLUT4 is a glucose transporter found on muscle and fat cells that allows glucose to enter the cells.

Question 13

What is the normal blood glucose range in healthy individuals?

Answer 13

Typically 80 to 100 milligrams per 100 ml, seldom rising above 160 mg after meals.

Question 14

How do counterregulatory hormones prevent hypoglycemia?

Answer 14

By preventing the opening of glucose transporter cells, keeping glucose levels higher in the bloodstream.

Question 15

What is diabetes mellitus?

Answer 15

A condition where either there is insufficient insulin production by the pancreas, or peripheral tissues are not using insulin effectively, often progressing to a combination of both.

Question 16

How many people in the US have diabetes and prediabetes?

Answer 16

About 34 million have diabetes, and 88 million have prediabetes.

Question 17

What is prediabetes?

Answer 17

A condition with high blood glucose levels that are not high enough to be classified as Type II diabetes, often progressing to Type II diabetes within about 10 years without intervention.

Question 18

What is the prevalence of diabetes among older adults in the US?

Answer 18

About 25% of older adults have diabetes.

Question 19

How many people worldwide have diabetes, and what percentage of the adult population does this represent?

Answer 19

Approximately 420 million people, or about 10% of the adult population.

Question 20

What are the three types of diabetes?

Answer 20

Type I, Type II, and Gestational diabetes.

Question 21

What characterizes Type I diabetes?

Answer 21

A lack of insulin production by the body, also known as insulin-dependent diabetes mellitus, typically developing due to a genetic predisposition and immune response.

Question 22

What characterizes Type II diabetes?

Answer 22

Insulin resistance, where cells fail to respond properly to insulin, often associated with physical inactivity, overweight, and modifiable lifestyle factors.

Question 23

What is gestational diabetes?

Answer 23

A type of diabetes that occurs when pregnant women without a prior history of diabetes develop high blood glucose levels.

Question 24

What is the role of physical activity in managing Type II diabetes?

Answer 24

It helps reduce insulin resistance and mitigate risk factors like obesity, making it a key component in managing Type II diabetes.

Question 25

Describe the pathogenesis of Type I diabetes.

Answer 25

It involves genetic predisposition and an immune response that leads to beta cell destruction due to environmental insults, resulting in reduced insulin production.

Question 26

Describe the pathogenesis of Type II diabetes.

Answer 26

It involves genetic predisposition, obesity, and physical inactivity, leading to insulin resistance and overproduction of insulin, eventually resulting in beta cell exhaustion and hyperglycemia.

Question 27

Which type of diabetes is most common?

Answer 27

Type II diabetes, representing the majority of diabetes cases.

Question 28

What is the most common method for diagnosing Type 2 diabetes and prediabetes?

Answer 28

Hemoglobin A1C measurement.

Question 29

What does the Hemoglobin A1C measure reflect?

Answer 29

A three-month average of blood glucose levels, less susceptible to daily fluctuations.

Question 30

What Hemoglobin A1C levels indicate prediabetes and diabetes?

Answer 30

Prediabetes: 5.7-6.4%; Diabetes: 6.5% and higher.

Question 31

What is a fasting plasma glucose test?

Answer 31

A test measuring blood glucose levels after an overnight fast of about 8 hours.

Question 32

What fasting plasma glucose levels indicate prediabetes and diabetes?

Answer 32

Prediabetes: 100-125 mg/dL; Diabetes: above 126 mg/dL.

Question 33

What is the oral glucose tolerance test (OGTT) used for?

Answer 33

It is the gold standard for diagnosing Type 1 and gestational diabetes.

Question 34

Describe the process of the OGTT.

Answer 34

After fasting for 8 hours, an individual ingests 75 grams of glucose, and blood glucose is measured again after 2 hours.

Question 35

What OGTT results indicate prediabetes and diabetes?

Answer 35

Prediabetes: 140-199 mg/dL; Diabetes: above 200 mg/dL.

Question 36

What are the classic signs and symptoms of diabetes?

Answer 36

Polyuria (frequent urination), polydipsia (frequent thirst), and polyphagia (excessive hunger).

Question 37

What causes polyuria in diabetes?

Answer 37

Excess glucose in the blood is excreted through the kidneys, leading to frequent urination.

Question 38

How does diabetes lead to polyphagia?

Answer 38

Insufficient insulin causes protein breakdown and a mistaken sense of hunger, leading to excessive eating.

Question 39

What is ketoacidosis, and which type of diabetes is it most common in?

Answer 39

A condition where high levels of ketones from fat breakdown lead to acidosis, more common in Type 1 diabetes.

Question 40

Why should high ketone levels in diabetes be a concern for physical activity?

Answer 40

High ketone levels, especially with blood glucose levels over 250 mg/dL, indicate risk and may warrant a pause in exercise.

Question 41

What is the potential danger of untreated diabetic ketoacidosis?

Answer 41

It can lead to severe complications, including coma.

Question 42

Why is monitoring hemoglobin A1C levels important in diabetes management?

Answer 42

It provides insight into how well a patient is managing their diabetes over time.

Question 43

What are macrovascular complications of diabetes?

Answer 43

Large-vessel complications, including increased risk for cardiovascular diseases, atherosclerosis, stroke, and peripheral artery disease.

Question 44

What is the relationship between diabetes and metabolic syndrome?

Answer 44

Diabetes is part of metabolic syndrome, which also includes obesity, dyslipidemia, and hypertension, significantly increasing the risk of cardiovascular diseases.

Question 45

What are some common microvascular complications of diabetes?

Answer 45

Nephropathy (kidney issues), retinopathy (eye-related problems), and neuropathy (issues in the peripheral nervous system affecting sensory, motor, and autonomic functions).

Question 46

What role can physical therapists (PTs) play in managing diabetes complications?

Answer 46

PTs can help manage, prevent, and assess musculoskeletal impairments associated with diabetes.

Question 47

How does the duration of diabetes affect the risk of complications?

Answer 47

Longer history of diabetes and poor control (e.g., high A1C levels like 9% or 10%) increase the likelihood of complications.

Question 48

What is the economic impact of diabetes on individuals?

Answer 48

Diabetes doubles healthcare costs and increases the risk of early mortality compared to those without diabetes.

Question 49

What are Advanced Glycation End Products (AGES), and how do they relate to diabetes?

Answer 49

AGES are formed from excess glucose and proteins and accumulate in various tissues, contributing to both micro- and macrovascular complications in diabetes.

Question 50

How does hyperglycemia contribute to blood vessel issues in diabetes?

Answer 50

It activates protein p-kinases, increases reactive oxygen species, and alters matrix protein production, affecting blood vessel health.

Question 51

What role do reactive oxygen species play in diabetes complications?

Answer 51

They contribute to changes in the extracellular matrix turnover and damage blood vessels, leading to complications.

Question 52

What factors are associated with increased complications in diabetes?

Answer 52

The chronicity of diabetes and poor blood glucose control are major factors contributing to complications.

Question 53

What is the prevalence of chronic kidney disease, foot problems, and eye damage among people with diabetes according to the NHANES data?

Answer 53

There is a 20% to 30% increase in the risk or prevalence of these conditions among individuals with diabetes.

Question 54

What are macrovascular complications in diabetes?

Answer 54

Large-vessel diseases or large-vessel complications, including cardiovascular disease, stroke, and peripheral vascular disease.

Question 55

How does diabetes contribute to cardiovascular diseases?

Answer 55

Increased fat breakdown and higher levels of circulating free fatty acids lead to endothelial dysfunction, resulting in earlier and more extensive changes in blood vessels.

Question 56

What is the role of reactive oxygen species in macrovascular complications?

Answer 56

They contribute to abnormal signaling cascades, inflammation, and damage to blood vessel walls, increasing the risk of cardiovascular diseases.

Question 57

How does the renin-angiotensin system affect people with diabetes?

Answer 57

Abnormal stimulation leads to vasoconstriction and inflammation, contributing to cardiovascular complications.

Question 58

What is the consequence of thrombosis in people with diabetes?

Answer 58

Platelet activation and deposition within arteries lead to an increased risk of cardiovascular diseases.

Question 59

What is peripheral vascular disease (PVD) in diabetes?

Answer 59

A condition where reduced blood flow causes pain and cramping during walking, often relieved by rest, but can cause pain even at rest in severe cases.

Question 60

What are gangrenes in the context of PVD?

Answer 60

Poorly healing wounds that can result from severe peripheral vascular disease, potentially leading to amputation.

Question 61

How is the ankle-brachial index (ABI) used in assessing PVD?

Answer 61

ABI measures the ratio of systolic blood pressure at the ankle to the arm, indicating the compressibility of arteries; lower compressibility suggests greater risk of vascular issues.

Question 62

Why is early detection of macrovascular complications important in diabetes?

Answer 62

They are often more severe and more common, requiring close monitoring to prevent serious outcomes like coronary artery disease and stroke.

Question 63

What are microvascular complications of diabetes?

Answer 63

Complications affecting small blood vessels, including nephropathy (kidney issues), retinopathy (eye issues), and neuropathy (nerve issues).

Question 64

What causes nephropathy in people with diabetes?

Answer 64

Atherosclerosis of the renal artery leads to reduced renal perfusion and thickening of glomerular tissue, which can progress to end-stage renal disease requiring dialysis.

Question 65

How does diabetes cause retinopathy?

Answer 65

Thinning of retinal walls can lead to hemorrhages, scarring, retinal detachment, and microaneurysms, contributing to vision loss.

Question 66

What is peripheral neuropathy, and why is it a concern in diabetes?

Answer 66

Damage to the peripheral nerves, leading to sensory loss and increased risk of foot ulcers, which are a leading cause of non-traumatic lower extremity amputation.

Question 67

What is sensory neuropathy, and how is it tested?

Answer 67

It causes pain or numbness, often in a stocking and glove pattern, and is assessed using the Semmes-Weinstein Monofilament test on the feet.

Question 68

What is motor neuropathy, and what are its effects?

Answer 68

Weakness in small foot muscles can lead to deformities like claw toe and bunions, increasing the risk of ulcers and further complications.

Question 69

What is Charcot neuroarthropathy?

Answer 69

A condition where the small bones and joints in the feet become deranged due to severe trauma, leading to swelling and warmth in the affected foot.

Question 70

How does autonomic neuropathy affect the skin in diabetes?

Answer 70

It leads to dry, cracked skin and callus formation, increasing the risk of foot ulcers.

Question 71

What is the relationship between diabetes and musculoskeletal complications?

Answer 71

Diabetes is associated with foot, hip, shoulder, and back pain, frozen shoulder, carpal tunnel syndrome, and trigger finger due to changes in connective tissue and muscle strength.

Question 72

How does diabetes affect muscle tissue?

Answer 72

It leads to fatty infiltration of muscles, reduced muscle strength, and muscle wasting, particularly in the calf and shoulder.

Question 73

What are common gait and functional changes in people with diabetes?

Answer 73

Slower gait speed, shorter step lengths, wider base of support, and issues with balance.

Question 74

What gastrointestinal complications can occur in diabetes?

Answer 74

Gastroparesis, constipation, fecal incontinence, and a higher prevalence of non-alcoholic fatty liver disease.

Question 75

How is diabetes linked to mental health issues?

Answer 75

People with diabetes have a higher prevalence of depression, Alzheimer’s, dementia, and lower executive function.

Question 76

Why is screening for mental health important in patients with diabetes?

Answer 76

Mental health conditions can impact recovery and treatment adherence, requiring appropriate referrals for comprehensive care.

Question 77

What is the target Hemoglobin A1c level for individuals with diabetes?

Answer 77

Below 7%.

Question 78

Why do individuals with Type 1 diabetes need exogenous insulin?

Answer 78

Because they do not produce enough circulating insulin, requiring external administration through injections or insulin pumps.

Question 79

What are basal and bolus doses in insulin therapy for Type 1 diabetes?

Answer 79

Basal doses provide a constant insulin level throughout the day, while bolus doses are given in response to meals, hyperglycemia, or corrections.

Question 80

What emerging treatments are being researched for Type 1 diabetes?

Answer 80

Oral insulin medications and pancreatic islet cell transplantation, though they are still in early research stages.

Question 81

What is the typical approach to managing Type 2 diabetes?

Answer 81

A multi-pronged approach including exercise, diet control, and medication.

Question 82

What is the first-line treatment for Type 2 diabetes when Hemoglobin A1c is less than 9%?

Answer 82

Monotherapy with metformin.

Question 83

How does metformin work?

Answer 83

It lowers glucose production in the liver and improves the body’s sensitivity to insulin.

Question 84

What is the recommended treatment if Hemoglobin A1c levels are high?

Answer 84

Combination therapy with metformin and either sulfonylureas or TZDs, or starting insulin alongside medications if levels are very high.

Question 85

Which diabetes medication has a low risk of causing hypoglycemia?

Answer 85

Metformin.

Question 86

Which diabetes medication carries a higher risk of hypoglycemia?

Answer 86

Sulfonylureas.

Question 87

What should clinicians monitor before starting an exercise plan for patients with diabetes?

Answer 87

Blood glucose levels to avoid hypoglycemia during exercise, especially if the patient is on insulin or multiple medications.

Question 88

What role do diet and lifestyle play in diabetes management?

Answer 88

They are crucial for managing the disease, with recommendations from the American Diabetes Association including nutrition counseling and lifestyle coaching.

Question 89

Why is it important to consider the number of medications and their side effects in diabetes management?

Answer 89

To ensure proper control of blood sugar levels and to manage risks like hypoglycemia during treatment and exercise.

Question 90

What is the recommended amount of aerobic exercise for people with diabetes?

Answer 90

150 minutes per week of moderate-intensity physical activity at 50% to 75% of maximum heart rate.

Question 91

What types of exercises can be included in an aerobic program for diabetes?

Answer 91

Treadmill walking, outdoor walking, water aerobics, bicycling, circuit training, and high-intensity interval training.

Question 92

How can activity monitors be used in diabetes management?

Answer 92

Aiming for 10,000 steps a day and progressively increasing activity by 10% every two weeks based on the individual’s current activity level.

Question 93

What is the recommendation for resistance training in people with diabetes?

Answer 93

At least three times a week at 50% to 75% of one rep max, targeting major muscle groups.

Question 94

Why are non-traditional exercises like yoga and tai chi beneficial for people with diabetes?

Answer 94

They help improve balance, flexibility, and joint mobility, reducing the risk of falls.

Question 95

How should exercise be adapted for individuals with diabetes and peripheral neuropathy?

Answer 95

Monitor feet before, during, and after exercise, and include both weight-bearing and non-weight-bearing exercises as appropriate.

Question 96

What physiological benefits does exercise provide for people with diabetes?

Answer 96

Increased insulin sensitivity, increased capillarization, improved mitochondrial oxidative capacity, and enhanced glucose transport into cells.

Question 97

What is the role of GLUT4 transporters in exercise for people with diabetes?

Answer 97

Exercise increases the expression of GLUT4 transporters in muscle cells, improving glucose uptake from the bloodstream.

Question 98

Why is it important to monitor blood glucose levels before exercising?

Answer 98

To avoid hypoglycemic episodes, especially if the patient is on insulin or multiple medications.

Question 99

What precautions should be taken when starting an exercise program for a patient with diabetes?

Answer 99

Use appropriate footwear, exercise in a safe environment, avoid peak insulin times, and adjust insulin doses if necessary.

Question 100

How should hypoglycemia be managed during exercise?

Answer 100

Provide a carbohydrate snack if blood glucose is low before exercise and monitor for symptoms like sweating, tachycardia, or shakiness.

Question 101

What should be done if a patient with diabetes has high blood glucose levels before exercise?

Answer 101

Consult their physician and check for ketones, avoiding exercise if ketone levels are high.

Question 102

Why is it important to consider comorbidities like hypertension when prescribing exercise?

Answer 102

Patients may be on medications like beta blockers, which require using perceived exertion scales for exercise intensity.

Question 103

How should insulin timing be managed in relation to exercise?

Answer 103

Avoid exercising during peak insulin times, typically 2 to 4 hours after injection, and adjust the insulin dose as exercise increases.

Question 104

What types of exercise should be included in a comprehensive diabetes exercise plan?

Answer 104

Aerobic, resistance, balance, and flexibility exercises for optimal management of diabetes.