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PT663 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the main exocrine function of the pancreas?

A

To produce digestive enzymes, controlled by pancreatic acinar cells.

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2
Q

What is the endocrine function of the pancreas?

A

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

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3
Q

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

A

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

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4
Q

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

A

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

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5
Q

What percentage of islet cells are beta cells?

A

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

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6
Q

What is the function of delta cells in the pancreas?

A

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

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7
Q

How does insulin lower blood glucose levels?

A

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

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8
Q

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

A

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

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9
Q

Define gluconeogenesis.

A

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

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10
Q

What hormones counter-regulate insulin?

A

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

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11
Q

Describe the sequence of glucose metabolism after a meal.

A

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

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12
Q

What is GLUT4, and where is it found?

A

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

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13
Q

What is the normal blood glucose range in healthy individuals?

A

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

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14
Q

How do counterregulatory hormones prevent hypoglycemia?

A

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

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15
Q

What is diabetes mellitus?

A

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.

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16
Q

How many people in the US have diabetes and prediabetes?

A

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

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17
Q

What is prediabetes?

A

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.

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18
Q

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

A

About 25% of older adults have diabetes.

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19
Q

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

A

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

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20
Q

What are the three types of diabetes?

A

Type I, Type II, and Gestational diabetes.

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21
Q

What characterizes Type I diabetes?

A

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.

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22
Q

What characterizes Type II diabetes?

A

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

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23
Q

What is gestational diabetes?

A

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

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24
Q

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

A

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

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25
Q

Describe the pathogenesis of Type I diabetes.

A

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

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26
Q

Describe the pathogenesis of Type II diabetes.

A

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

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27
Q

Which type of diabetes is most common?

A

Type II diabetes, representing the majority of diabetes cases.

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28
Q

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

A

Hemoglobin A1C measurement.

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29
Q

What does the Hemoglobin A1C measure reflect?

A

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

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30
Q

What Hemoglobin A1C levels indicate prediabetes and diabetes?

A

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

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31
Q

What is a fasting plasma glucose test?

A

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

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32
Q

What fasting plasma glucose levels indicate prediabetes and diabetes?

A

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

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33
Q

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

A

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

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34
Q

Describe the process of the OGTT.

A

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

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35
Q

What OGTT results indicate prediabetes and diabetes?

A

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

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36
Q

What are the classic signs and symptoms of diabetes?

A

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

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37
Q

What causes polyuria in diabetes?

A

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

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38
Q

How does diabetes lead to polyphagia?

A

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

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39
Q

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

A

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

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40
Q

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

A

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

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41
Q

What is the potential danger of untreated diabetic ketoacidosis?

A

It can lead to severe complications, including coma.

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42
Q

Why is monitoring hemoglobin A1C levels important in diabetes management?

A

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

43
Q

What are macrovascular complications of diabetes?

A

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

44
Q

What is the relationship between diabetes and metabolic syndrome?

A

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

45
Q

What are some common microvascular complications of diabetes?

A

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

46
Q

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

A

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

47
Q

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

A

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

48
Q

What is the economic impact of diabetes on individuals?

A

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

49
Q

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

A

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

50
Q

How does hyperglycemia contribute to blood vessel issues in diabetes?

A

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

51
Q

What role do reactive oxygen species play in diabetes complications?

A

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

52
Q

What factors are associated with increased complications in diabetes?

A

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

53
Q

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

A

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

54
Q

What are macrovascular complications in diabetes?

A

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

55
Q

How does diabetes contribute to cardiovascular diseases?

A

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.

56
Q

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

A

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

57
Q

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

A

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

58
Q

What is the consequence of thrombosis in people with diabetes?

A

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

59
Q

What is peripheral vascular disease (PVD) in diabetes?

A

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.

60
Q

What are gangrenes in the context of PVD?

A

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

61
Q

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

A

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.

62
Q

Why is early detection of macrovascular complications important in diabetes?

A

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

63
Q

What are microvascular complications of diabetes?

A

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

64
Q

What causes nephropathy in people with diabetes?

A

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.

65
Q

How does diabetes cause retinopathy?

A

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

66
Q

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

A

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.

67
Q

What is sensory neuropathy, and how is it tested?

A

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

68
Q

What is motor neuropathy, and what are its effects?

A

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

69
Q

What is Charcot neuroarthropathy?

A

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.

70
Q

How does autonomic neuropathy affect the skin in diabetes?

A

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

71
Q

What is the relationship between diabetes and musculoskeletal complications?

A

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.

72
Q

How does diabetes affect muscle tissue?

A

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

73
Q

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

A

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

74
Q

What gastrointestinal complications can occur in diabetes?

A

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

75
Q

How is diabetes linked to mental health issues?

A

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

76
Q

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

A

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

77
Q

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

A

Below 7%.

78
Q

Why do individuals with Type 1 diabetes need exogenous insulin?

A

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

79
Q

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

A

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

80
Q

What emerging treatments are being researched for Type 1 diabetes?

A

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

81
Q

What is the typical approach to managing Type 2 diabetes?

A

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

82
Q

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

A

Monotherapy with metformin.

83
Q

How does metformin work?

A

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

84
Q

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

A

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

85
Q

Which diabetes medication has a low risk of causing hypoglycemia?

A

Metformin.

86
Q

Which diabetes medication carries a higher risk of hypoglycemia?

A

Sulfonylureas.

87
Q

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

A

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

88
Q

What role do diet and lifestyle play in diabetes management?

A

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

89
Q

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

A

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

90
Q

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

A

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

91
Q

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

A

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

92
Q

How can activity monitors be used in diabetes management?

A

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

93
Q

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

A

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

94
Q

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

A

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

95
Q

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

A

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

96
Q

What physiological benefits does exercise provide for people with diabetes?

A

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

97
Q

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

A

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

98
Q

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

A

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

99
Q

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

A

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

100
Q

How should hypoglycemia be managed during exercise?

A

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

101
Q

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

A

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

102
Q

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

A

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

103
Q

How should insulin timing be managed in relation to exercise?

A

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

104
Q

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

A

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

PT663 (22 decks)

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