Diabetes

Question 1

Insulin Function

Answer 1

• Produced in pancreas
• Insulin comes into cells and binds to receptor, reaction happens on inside to open a gate to allow glucose to get into cells to be used for energy
• So if there is no insulin to make this reaction happen then glucose is not getting into the cells

Question 2

DM 1

Answer 2

• 5% of cases
• Chronic disorder characterized by hyperglycemia and disruption in metabolism of carbs, fats, and proteins
• Occurs because of little or no insulin being produced by pancreas
• Found in children, young adults, people under 30 years of age

Question 3

DM 2

Answer 3

• 95% of cases
• Chronic condition that affects how the body metabolized glucose
• Patients body does not respond correctly to insulin
• Known as insulin resistance
• Insulin receptors become insensitive because the patients blood sugar is raising like crazy because patient is still eating so much of the foods that they shouldn’t, so receptors are basically overloaded and dont respond to the insulin anymore so it builds up in the bloodstream

Question 4

Top Signs & Symptoms of Diabetes

Answer 4

• Polydipsia (thirsty)
• Polyuria (increased urination)
• Fatigue / lethargy (because glucose cannot get into cell)
• Prolonged diabetes can lead to renal failure, cardiac consequences, or neuropathies (retinal is pt cant see or peripheral is glove and stocking issues)

Question 5

Hemoglobin A1C

Answer 5

• Indicates average blood sugar level for past 2-3 months by measuring percentage of blood surface attached to hemoglobin
• Normal = <5.7%
• Pre-Diabetes = 5.7-6.4%
• Diabetes = >6.5%

Question 6

Fasting Blood Glucose

Answer 6

• Indicates blood sugar level after not eating for 8 hours
• Normal = 70-100 mg/dL
• Pre-Diabetes = 101-125 mg/dL
• Diabetes = >126 mg/dL

Question 7

Semmes-Weinstein Monofilaments

Answer 7

• Sensory told used to test impairments in sensory function
• Taken to perpendicular skin until it bends
• Pt has to let you know when they feel the monofilament (do not ask them “do you feel this”)
• 4.17 (1g force) = normal sensation — if patient cannot feel this then they are a fall risk
• 5.07 (10g force) = protective sensation — if patient cannot feel this then they are at a risk for ulcers

Question 8

Diabetes Impairments

Answer 8

• Blood sugar control
• Skin control
• Sock color should be white so we can see if there is drainage or blood
• Endurance / deconditioning
• Weakness

Question 9

Safe glucose levels for exercise..

Answer 9

• 100-250 mg/dL

Question 10

Glucose 70-100 mg/dL & Exercise

Answer 10

• NO exercise below 70 — give pt carbohydrate snack
• If 70-100 and symptoms are present, NO exercise and give 15g absorbable snack (honey, fruit juice, hard candy, noooo bread) and re-test in 15 minutes
• Can exercise with 70-100 if symptoms are not present but retested every 15 minutes

Question 11

Glucose 250-300 mg/dL & Exercise

Answer 11

• Avoid exercise if above 250 and ketones are present (diabetic ketoacidosis)
• Can exercise if above 250 if ketones are not present and there are no symptoms but must recheck every 15 minutes
• NO exercise if above 300 and symptoms are present (call EMS)

Question 12

Peak Insulin Times

Answer 12

• Do NOT exercise patient during peak insulin time (contraindicated) — insulin will drop the blood sugar so we do not want patient to pass out on us
• Peak insulin time is 45 minutes (short acting is 15 minutes)
• Post exercise hypoglycemia — patient should eat carb snack after exercise (this is when bread can be used)

Question 13

Diabetes Pre-Exercise Considerations

Answer 13

• Always monitor blood glucose before exercise
• 100-250 mg/dL is normal
• Eat within 1 hour of exercise (because exercise makes the blood glucose drop)
• Do NOT inject insulin into muscles we are going to exercise!
• Do not inject insulin in repeated locations (scar tissue will build up and insulin doesn’t get through as well which puts patient at risk for hypoglycemia)

Question 14

During and Post-Exercise Considerations

Answer 14

• Exercise duration — 40-60 minutes
• Eat a absorbable snack every 30 minutes
• Monitor blood glucose every 30 minutes
• Increase caloric intake 12-24 hours after exercise to avoid post exercise hypoglycemia

Question 15

Hypoglycemia Quick Check

Answer 15

• Sweating
• Weakness
• Convulsions / seizures
• Irritable
• “cold/clammy/convulsions”

Question 16

Hyperglycemia Quick Check

Answer 16

• Lethargy
• Thirsty
• Fruity
• Polyuria (increased urination)
• “hot/dry”