Diabetes

Question 1

3 components to exam for patients with diabetes

Answer 1

glucose abnormalities, autonomic neuropathy, vascular complications

Question 2

Where are the insulin receptors primarily reside?

Answer 2

muscle cell.

Question 3

How do you diagnose diabetes

Answer 3

2 consecutive high fasting glucose levels.

Question 4

oral glucose tolerance test

Answer 4

fast for 8 hours. then orally drink sugary drink. Then they monitory your blood glucose incrementally for 8 hours.

Question 5

HbA1c

Answer 5

a way to monitor how well pts are monitoring diabetes. Measure of long term glucose control. over the last 3 mo

Question 6

normal fasting blood glucose

Answer 6

80-100 mg/DL

Question 7

diabetic fasting blood glucose

Answer 7

+126 mg/DL

Question 8

hypoglycemia

Answer 8

lethargic, drowsy, downregulation of the nervous system, confusion, irritability. Wendy is more concerned with hypo than hyper. easier to quick fix hyperglycemia.

Question 9

Diabetes target goals

Answer 9

HbA1c <7%, BP-135/80, Blood glucose 70-130 before meals.

Question 10

T/F huge effect on HbA1c with exercise

Answer 10

T. especially long term.

Question 11

Ketoacidosis

Answer 11

Occurs when there is not enough insulin (usually type 1). Body still needs glucose for energy but insulin is not available for glucose metabolism.

Question 12

Early sign of ketoacidosis

Answer 12

thirst, dry mouth, frequent urination, high blood glucose levels, high urine ketone levels, sweet breath

Question 13

Later signs of ketoacidosis

Answer 13

constant fatigue, dry or flushed skin, nausea, vomiting, abdominal pain, difficulty breathing, difficulty concentrating, confusion.

Question 14

elevated resting heart rate or orthostasis could indicate

Answer 14

autonomic neuropathy

Question 15

autonomic neuropathy

Answer 15

damage to sympathetic/parasympathetic nerves

Question 16

with diabetes there is a low grade inflammatory component that make nerves

Answer 16

hyper excitable

Question 17

High levels of glucose ends up damaging

Answer 17

nerves (smallest to largest)

Question 18

damage to autonomic system causes increase in

Answer 18

blood pressure

Question 19

If the autonomic system is compromised, we know that

Answer 19

peripheral nerves are starting to go or will soon

Question 20

gait analysis autonomic neuropathy

Answer 20

weaving

Question 21

macrovascular complications of diabetes

Answer 21

coronary artery disease, peripheral arterial disease, stroke

Question 22

microvascular complications of diabetes

Answer 22

nephropathy, neuropathy, retinopathy

Question 23

how is PAD most often missed

Answer 23

not removing shoes/socks during an exam

Question 24

____% of patients that have diabetes have diabetic neuropathy

Answer 24

50

Question 25

Hyperalgesia

Answer 25

Pain that is much more pain that you would feel normal.

Question 26

Allodynia

Answer 26

something that shouldn't hurt but does hurt

Question 27

If they cannot feel a 10 g monofiliment

Answer 27

They cannot tell if there is a stone in their shoe (protective sensation). A-delta fibers

Question 28

Where do you apply the tuning fork when testing vibratory sense in diabetes?

Answer 28

Base of great tonail

Question 29

tinel testing

Answer 29

tapping over a nerve looking to see if the sensation runs down the length of the nerve, it should not

Question 30

what will happen regarding intrinsic mm with pts with diabetes

Answer 30

they will become weak and lose your normal nice arch.

Question 31

Why are certain msk conditions more prevalent in pts with diabetes

Answer 31

chronic inflammation leading to fibrosis (collogen disorders) Limited mobility

Question 32

adhesive capsulitis is a fancy word for

Answer 32

frozen shoulder

Question 33

when referring to msk conditions, compared to pts without diabetes, pts with diabetes will have the following:

Answer 33

younger age, less painful, responds less well to treatment, takes longer to resolve

Question 34

Cardinal sign for hand syndrome in diabetes patients

Answer 34

prayer sign. they will have a space between their hands.

Question 35

Hand syndromes are more prevalent in patients with

Answer 35

Type 1 diabetes

Question 36

Most syndromes associated with diabetes have to do with

Answer 36

collagen issues

Question 37

The anterior longitudinal ligament ossifies and causes decreased ROM. Eventually they will ossify

Answer 37

diffuse idiopathic skeletal hyperostosis DISH

Question 38

painful peripheral neuropathy and muscle wasting. usually proximal as opposed to distal. Can recover with resistance training and proper treatment

Answer 38

diabetic amyotrophy

Question 39

Destruction of mid foot structure

Answer 39

charcot jt.

Question 40

extrinsic factors in foot ulceration with diabetes

Answer 40

poorly fitting shoes, trauma

Question 41

main reason ppl with DM go to hospital and leading cause of non-traumatic amputations

Answer 41

foot ulcers

Question 42

risk factors for LE amputation in diabetic foot

Answer 42

limited jt ROM, obesity, impaired vision, poor glucose control, poor footwear, ulcer

Question 43

T/F exercise can influence the pathology of DM

Answer 43

T

Question 44

Width of shoe. Height of shoe. Heels. Back of shoe

Answer 44

at met heads, should be a 1/4 inch in on each side. Raise their great toe 1/2 inch before it hits the top. Less than an inch tall. Less than 1/4 inch in between heel and shoe

Question 45

If patients have protective sensation, it is indicate to have them walk barefoot.

Answer 45

T

Question 46

If patients do not have protective sensation, they should always have some sort of footwear protection.

Answer 46

T

Question 47

best way to offload

Answer 47

total contact casting

Question 48

Why do you get excess albumin in the urine when you exercise.

Answer 48

breaking down muscle from working out too hard. Avoid by working at less than 70% 1RM, and watch for increased blood pressure.

Question 49

Fitness needed for successful ambulation in elderly amputees

Answer 49

sustain more than 50 percent of VO2max

Question 50

capsaicin

Answer 50

pain cream that blocks substance P

Question 51

T/F antidepressants and anticonvulsants work for peripheral neuropathy

Answer 51

T

Question 52

rapid acting inulin

Answer 52

begins in 15 min (to see BGlucose drop)

Question 53

Regular/Short Acting

Answer 53

acts in 30 min

Question 54

intermediate acting

Answer 54

acts in 2-4 hours (most commonly used)

Question 55

long acting

Answer 55

acts in 3-4 hours and continues over 2-4 hours