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PT in Specific Groups > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is HbA1c and HGO?

A

Glycosylated haemoglobin (glucose bound irreversibly)

Hepatic glucose output

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2
Q

IFG and IGT?

A

Impaired fasting glucose

Impaired glucose tolerance

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3
Q

What is ketosis?

A

Excessive ketones (by-products of fat/protein metabolism) in blood

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4
Q

MGU?

A

Muscle glucose uptake

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5
Q

What is a nephropathy?

A

Damage to small blood vessels of kidneys

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6
Q

What is a neuropathy?

A

Damage to small blood vessels of nerves

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7
Q

OGTT and what does it entail?

A

Oral glucose tolerance test.

  • High-carb diet for 3/7 before test
  • Fasting blood sample
  • Very high glucose drink given
  • Blood sample 2/24 later
  • Analyse for glucose/insulin conc
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8
Q

Plasma V?

A

Venous plasma

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9
Q

Polyuria?

A

excessive urine formation

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10
Q

Retinopathy?

A

damage to small blood vessels of the eyes

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11
Q

WB-C?

A

whole blood capillary

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12
Q

Define diabetes mellitus (4pts)

A
  • metabolic disorder
  • multiple aetiology
  • disturbed CHO, fat, prtn metabolism
  • – From defects in insulin secretion, action, or both
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13
Q

How is glycaemia assessed? (3)

A
  1. BGL - immediate
  2. OGTT - glycaemic response
  3. HbA1c - BGL control over 2-3/12 (gold standard)
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14
Q

Why use HbA1C and what is a non-diabetic range?

A

Effectiveness of glycaemic therapy.

3-6%

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15
Q

Values for normal fasting and 2-hr PG

A

Fasting < 7.8 mM

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16
Q

Normal ranges for IFG and IGT

A 
IFG = 5.6 - 6.9
IGT = 7.8 - 11.0
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17
Q

Who has pre-diabetes? What is the risk involved?

A

Either or both IFG and IGT - BGL not in diabetic range

Greater risk for macrovascular disease

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18
Q

What percentage of Australians have disordered glycaemia?

A

25%

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19
Q

What is type 1 DM? (5)

A
  • pancreatic islet destruction
  • absolute insulin deficiency
  • prone to ketosis
  • early childhood onset
  • insulin resistant with some long-standing
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20
Q

How is T1DM usually treated?

A

Insulin

Exercise considered beneficial for reduced CV risk

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21
Q

What is type 2 DM? (2)

A
  • resistant to insulin
  • fasting hyperglycaemia
  • higher glucose/insulin on OGTT
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22
Q

Risk factors for T2DM

A

Obese
Hypertension
Hyperlipidaemia

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23
Q

T2DM treatment (goal, Rx)

A

Reduce HbA1c - limit/reduce diabetic complications

  • Exercise
  • Low GI
  • Oral hypoglycaemics (+/- insulin)
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24
Q

Who does gestational diabetes (GD) affect?

A

~6-9% pregnant women

30-50% greater risk of developing T2DM

25
Q

Risk factors for GD (5) and when should screening be done?

A

Risk factors

  • > 30yo
  • Obesity
  • Family Hx
  • PHx GDM or IGT
  • High-risk group (e.g. polynesian, middle eastern, indian, asian)

Screen at 26-28wks

26
Q

DM diagnostic (Fasting/2hr)

A 
Fasting = 7.0+
2hr = 11.1+
27
Q

GD diagnosis

A 
OGTT
- Fasting >5.3mM
- 1hr > 10mM
- 2hr > 8.6mM
- 3hr > 7.8mM
GDM if 2 or more
28
Q

Short-term complications of diabetes

A

Hyperglycaemia
Ketosis
Hypoglycaemia (BGL<2.5mM)
Infection

29
Q

5 symptoms of HYPERglycaemia

A 
Thirst+++
Polyuria
Fatigue
Blurred vision
Delayed infection healing
30
Q

5 symptoms of HYPOglycaemia

A 
Hunger
Anxiety
Trembling
Blurred vision (same)
Confusion
31
Q

Long-term complications of diabetes (MACRO)

A
  • CVD
  • PVD -> ischaemic pain
  • foot/leg ulcers
  • amputations
32
Q

Long-term complications of diabetes (MICRO)

A

Retinopathy –> blindness

Neuropathy (nerves to organs e.g. heart, genitourinary)

Nephropathy –> renal failure

Alveolar microangiopathy - lung damage

33
Q

For T1DM - does the evidence suggest intensive (3-4 daily insulin injections) or conventional (1-2 daily)?

A

Insulin - very strongly

HbA1c much lower (7.3 vs 9.1%)
- complication risk related to this level

34
Q

How does a 1% drop in HbA1c do in T2DM?

A

Less death, microvascular disease, MI, stroke, PVD

35
Q

HbA1c target for DM?

A

6% desirable but hard to achieve due to episodes of hpoglycaemia.

Therefore, 7% advocated

36
Q

Does SBP affect T2DM?

A

Each 10mmHg = 11-25% in different complication risks

37
Q

When is ECG monitoring need with exercise testing?

A

Pts previously sedentary with 10yr risk of a coronary event 10% or more.

38
Q

When is assessment needed for DM patients commencing exercise?

A

If new exercise entails more than brisk walking

39
Q

Risk factors considered before exercise testing

A 
Age > 40
OR
Age >30 and:
- T1D or T2D > 10yr
- HT
- Smoker
- Dyslipidaemia
- Nephropathy

Regardless of age:

  • Known/suspected CAD, cerebrovascular disease, PVD
  • Autonomic neuropathy
  • Advanced nephropathy with renal failure
40
Q

Non-diabetic response to exercise

A
  • decreased insulin + increased catechols = increased hepatic glucose output
  • increased muscle glucose uptake
  • HGO = MGU so BGL stable
41
Q

T1DM exercise response depends on: (6)

A
  • Time/dose of last injection
  • Prior metabolic control
  • Complications
  • Nutrition
  • Fitness
  • Intensity/duration
42
Q

(Formula) Over-insulinisation in T1DM =

A

Hypoglycaemia

- dec HGO + inc MGU = dec BGL

43
Q

To prevent over-insulinisation in T1DM (4)

A
  • Reduce insulin dose 30-80% before ex
  • Inject away from active mm
  • Monitor BGL
  • Simple CHO during, complex after
44
Q

Characteristics of under-insulinisation in T1DM

A

Inc BGL

  • poor control at rest
  • hyperglycaemic etc
  • ex worsens metabolic condition if BGL > 14-16 mM
45
Q

Under-insulinisation prevention in T1DM

A

Insulin

Delay exercise until metabolic control

46
Q

Effects of exercise with T2DM (2)

A
  • dec BGL (may still be above normal)

- improved insulin sensitivity?

47
Q

Exercise recommendations for T2DM

A

Daily exercise (aerobic and/or resistance)

48
Q

Pre-diabetes exercise training

A

Diet and brisk walking = 58% lower incidence of diabetes

49
Q

Aerobic exercise recommendations to improve glycaemic control, assist weight, and reduce CVD risk

A

150min/wk of moderate intensity exercise (40-60%VO2 max or 50-70% HRmax)

and/or

at least 90min/wk of vigorous exercise (>60%VO2 max or >70% HRmax)

3 days/wk; no > 2 consecutive exercise-free days

50
Q

Aerobic exercise for greater CVD risk reduction

A

4hrs+ mod-vigorous aerobic/resistance exercise

51
Q

Resistance exercise recommendations (no CIs)

A

3/wk, progress to 3x8-10RM

- all major mm groups

52
Q

Metabolic precautions/considerations (4)

A
  • Hyperglycaemia, ketosis
  • Hypoglycaemia (esp children)
  • False warnings (BGL perceived lower)
  • Hot weather
53
Q

Neurological precautions/considerations (2)

A

Autonimic neuropathy - use RPE

Peripheral neuropathy

54
Q

Vascular precautions/considerations (4)

A
  • Proliferative retinopathy
  • Nephropathy
  • Myocardial blood vessel changes
  • Careful with SBP increments
55
Q

Orthopaedic precautions/considerations (4)

A

Ulcers
Feet
Obesity
OA

56
Q

PT role in diabetes management (3)

A
  1. Institute/monitor/advise/educate on ex progs
  2. Check BGL before commencing
  3. Refer to podiatrist if req
57
Q

Other PT Rx in diabetes

A

Effects of:

  • Angiopathy (Heart, PVD, amputations)
  • OA
  • Tissue stiffening effects (glycosylation); e.g. frozen shoulder
58
Q

Education in diabetes

A
  • Exercise
  • Weight control
  • Foot care
  • MDT approach

PT in Specific Groups (5 decks)

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