Diabetes Flashcards
Type I Diabetes
- deficiency of insulin production from destruction of beta cells in pancreas
- typically insulin dependent
-5-10% of all diabetes
Absolute Insulin Deficiency
body can’t make insulin
Relative Insulin Deficiency
body can’t use insulin
3 Types of Diabetes
- Type 1
- Type 2
- Gestational
Diabetic Ketoacidosis
- lack of insulin causes build up of glucose in blood, so body uses fat for ATP
- ketones are a byproduct of using fats & they make blood acidic
-causes fruity (alcoholic) breath
Type 2 Diabetes
- hyperglycemia due to incr insulin resistance in cells
- decrease insulin uptake
- pancreas keeps making insulin but Mm can’t use it
90-95% of all diabetes
Patients with Type I Diabetes are prone to:
-diabetic ketoacidosis
Ketones
- byproduct of fat metabolism
- make blood more acidic
- drink lots of water to flush out
Gestational Diabetes
- due to contra-insulin effects of pregnancy
- diagnosed with oral test in 2nd trimester
- usually resolves post partum, but 50% develop type 2 diabetes
Normal Glucose Levels
70-105 mg/dL
Insulin
-allows glucose to enter cells of insulin sensitive tissue
Retinopathy
- damage to small vessels in retina
- 90% of people with diabetes for ?25 years have some changes
- can be treated and prevented
Type 2 Diabetes and GLUT 4
-insulin can’t make GLUT 4 transport to cell membrane
EXERCISE can stimulate GLUT 4 to go to membrane
When to do Ex’s Testing
- Type 1 & >30 years old
- Type 1 for >15 years
- Type 2 & >35 years old
- Type 2 for >10 years
- any risk factor for CAD
- Suspected/Known CAD
- Microvascular/neurological diabetic complications
- PVD peripheral vascular disease
How Insulin Controls Glucose Levels
- pancreatic beta cells release insulin in blood in response to glucose
- insulin binds to protein & cause GLUT 4 to move cell to edge
- GLUT 4 helps diffusion of glucose into cell
Exercise & GLUT 4
exercise causes GLUT 4 to transfer to cell membrane so glucose can enter cell from blood
Exercise Recommendation for Type 2
- no exercise if blood sugar is >400mg/dL
- burn 1000 kcal/week minimum
- burn >2000 kcal/week if goal is weight loss
Type 1 Diabetes:
- if exercise is planned
- if exercise is unplanned
- planned: decrease insulin prior
- unplanned: eat additional (15g) CHO prior
Benefits of Exercise with Type 2 Diabetes
-increase insulin sensitivity, may not lead to incr glycemic control
Overall Exercise Benefits
- decr cardiovascular risk factors
- incr cardiovascular benefits
- decr body fat
- decr stress
- prevent type 2 diabetes
For each hour of exercise:
additional 15g of CHO needed before or after exercise
If exercising >60 min
-may need to test blood sugar during ex’s
complete Exercise ____prior to bedtime to _____
- 2 hours
- prevent nocturnal hypoglycemia
Hypoglycemia S/Sx
- drowsiness
- confusion
- irritability
- unable to concentrate
- loss consciousness
- convulsions
- poor coordination
- blurred/double vision
- slurred speech
- tremors
- nervousness
- sweating
- excessive hunger
- fatigue
Kussmaul respiration
- fast and deep
- to compensate for ketoacidosis (breathing off excess CO2)
Complications of Diabetes
- atherosclerosis
- retinopathy
- neuropathy
S/Sx Diabetes
- polyuria
- polydipsia
- polyphagia
- weight loss
- fatigue
- M cramps
- irritability
- blurry vision
- headache
- nausea
Type 2 Risk Factors
- > 40 years old
- minorities
- family Hx
- decreased SES
- inactivity
- obesity (abdominal)
Glucose Tests
- 2 hour glucose tolerance test
- glycosylated hemoglobin
HbA1C
-glycosylated hemoglobin
Glycosylated Hemoglobin
- HbA1C
- average blood glucose over 3 months
- measure how much Hb is bound to glucose
-Normal: <6%
Medications
- Insulin
- oral hypoglycemic agents
Diabetic Ketoacidosis Occurs at:
- glucose levels of 300-700 mg/dL
- because too little insulin in conjunction with too much glucagon, catecholamines, cortisol or growth hormone
1% Change in HbA1C=
-30mg glucose
- 6%=135mg/dL
- 9%=240mg/dL
Hypoglycemic Shock
- glucose level s
- -Treatment: ingest glucose
2 Stages of Retinopathy
- nonproliferative
- praliferative
Nonproliferative Retinopathy
- (early stages)
- clucose damage to vessels cause fluid to leak & cause retina to swell
- blurred vision
- treated with laser surgery
Proliferative Retinopathy
(more severe)
- abnormal blood vessels grow over retina surface & rupture & bleed into vitreous humor
- scar tissue form & cause detachment of retina from back of eye
- result in loss of vision
- surgery can help
Benefits of Exercise with Type 1 Diabetes
- incr insulin sensitivity
- little/no effect on HbA1C
- doesnt decr number of hypoglycemic events
Do NOT ex’s if:
-glucose >250mgdL & ketones are present
symptoms of nocturnal hypoglycemia
-headache next morning
-bad dreams
-perspiring
restless sleep
Hyperglycemia S/Sx
- weakness
- incr thirst
- dry mouth
- frequent bud decr volume of urine
- abdominal tenderness
- acetone breath
- kussmaul respirations
Contradincidations for Exercise
- glucose >250
- glucose <100mg/dL
- illness/infection
- active retinal hemorrage or Tx for retinopathy
Exercise & Type I diabetes
- check glucose before and after to determine how much used
- end e’s glucose should be >110mg/dL
Ex’s Type I
a. frequency
b. intensity
c. time
d. type
a. 7 days/week
b. 45-80% MHR, 10-16 RPE
c. 20-30 min
d. large muscle groups
Ex’s Type 2
a. frequency
b. intensity
c. time
d. type
a. 5 days/week
b. 45-70% MHR, 10-14 RPE
c. 40-60 min
d. large Mm groups
