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Integ > Diabetes > Flashcards

Diabetes Flashcards

1
Q

The risk for death among people w/diabetes is about ____ that of people of
similar age without diabetes.

A

twice

- may be underreported only ~35-40% of people w/diabetes

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2
Q

What are the risk factors for type 2 diabetes development?

A
  1. Obesity – >80% are overweight
  2. > 30 yo
  3. Family Hx
  4. Hx of gestational diabetes; Delivering a baby weighing > 9lbs
  5. Stress of an injury, or illness
  6. Steroid therapy
  7. Native American, Hispanic, Asian or African American Decent
  8. UNEXPECTED RISK FACTOR: SLEEP!
    - both short (5-6hrs) and long (8-9hrs); difficulty initiating and maintaining
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3
Q

Characterized by elevated blood glucose levels due to metabolic defects in insulin
production, insulin action or both

A

diabetes

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4
Q

What’s the difference between type 1 and 2 diabetes?

A 
1 = insulin deficient; AI destruction of insulin producing cells in the pancreas
2 = insulin resistant; reduced amount of insulin and cells don't use available insulin efficiently
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5
Q

What are the symptoms of diabetes?

A
  1. Polydipsia
  2. Polyuria
  3. Weight loss
  4. Nocturia
  5. Fatigue
  6. Blurred Vision
  7. Recurrent fungal infections
  8. Poor wound healing
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6
Q

Insulin exerts an [stimulatory/ inhibitory] effect on hepatic glucose production. Glucagon [stimulates/ inhibits] hepatic glucose production.

A

inhibitory; stimulates

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7
Q

How is diabetes diagnosed?

A
  1. Symptoms + FPG >126mg/dl or RPG >200
  2. Asymptomatic: 2 FPG >126 …….or RPG >200 (subsequent days) or 2 hr OGTT >200
  3. v A1c**:
    - 6.5% or higher = diabetes
    - 5.7% - 6.4% = pre-diabetes
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8
Q

What is the average blood glucose at the A1c 6-13%?

A 
6% = 126
7% = 154
8% = 183
9% = 212
10% = 240
11% = 269
12% = 298
13% = 326
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9
Q

How does diabetes cause atherosclerosis?

A
  1. Endothelial cell dysfunction → atherosclerosis - glucose can pass freely through the endothelial cell membrane resulting in intracellular hyperglycemia and vascular damage that leads to microvascular complications
  2. Glycosylation of proteins → inflammatory changes in arterial cell walls → atherosclerosis
  3. Glycosylation of LDL → oxidation → formation of foam cells → atherosclerosis
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10
Q

What are the macrovascular complications of diabetes?

A
  1. MI
  2. Stroke
  3. Peripheral Arterial Disease
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11
Q

What are the microvascular complications of stroke?

A
  1. Retina (diabetic retinopathy) = #1 cause of blindness; also early cataracts
  2. Glomerulus (diabetic nephropathy) = #1 cause of ESRD; dialysis
  3. Nerves (diabetic neuropathy) = #1 cause of lower extremity amputations; diminished sensation, pain, amputations
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12
Q

What are lifestyle modifications can be made that will prevent or delay onset of diabetes?

A
  1. diet modifications - reduce carb intake; reduce calorie intake by 250-500
  2. activity and exercise - modest weight lost (5-10% BW); modest physical activity (30 mins 5-7 days/week) is most important
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13
Q

What is the primary management component athletes is important for sustained improvement in glycemic control?

A

exercise

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14
Q

Why does exercise balance out glucose?

A

exercise increases glucose uptake

  • decrease in exercise can lead to hyperglycemia
  • suppressed insulin levels lead to hypoglycemia`
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15
Q

What are the potential risks of exercise for people with diabetes?

A
  1. Hypoglycemia
  2. Hyperglycemia
  3. Ketosis
  4. Cardiovascular Event
  5. Musculoskeletal Injury
  6. Vitreous Hemorrhage or 7. Retinal Detachment
  7. Foot Ulcers
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16
Q

What are the benefits of exercise?

A
  1. Reduction in Plasma Glucose
  2. Improved Functioning of CV System
  3. Improved Strength and Endurance
  4. Reduction in Cholesterol, LDL and Triglycerides
  5. Increase in HDL
  6. Increased Insulin Sensitivity
  7. Improved Quality of Life and Self-Esteem
  8. Reduced Psychological Stress
17
Q

Prior to exercise, what complications do you need to determine a pt may have from diabetes?

A
  1. Autonomic Neuropathy
  2. Peripheral Neuropathy
  3. Retinopathy
  4. Nephropathy or Microalbuminuria
  5. Heart Disease
  6. Hypertension
  7. PVD
18
Q

What practices are encouraged for diabetes pts in terms of nutrition and exercise?

A
  1. Eat a meal 1-3 hours prior to exercise
  2. Check blood glucose before exercise
  3. Check BG every 30-60 min during exercise
  4. Check BG immediately after exercise and 2-4 hours following.
19
Q

What carb intake/ other action is recommended for a pre-exercise BG level < 90 mg/dL?

A

15-30 grams of fast-acting carbohydrate prior to start of exercise
- May require additional carbohydrate for prolonged activities

20
Q

What carb intake/ other action is recommended for a pre-exercise BG level 90-150 mg/dL?

A

Start consuming carbohydrate at onset of most exercise (depending on type of exercise and amount of active insulin

21
Q

What carb intake/ other action is recommended for a pre-exercise BG level 150-250 mg/dL?

A

Initiate exercise and delay consumption of carbohydrate until blood glucose levels are < 150mg/dL

22
Q

What carb intake/ other action is recommended for a pre-exercise BG level 250-350 mg/dL?

A

Test for ketones. Do not perform exercise if moderate-to-large ketones are present
Initiate mild-to-moderate intensity exercise.
- Intense exercise should be delayed until glucose is < 250mg/dL

23
Q

What carb intake/ other action is recommended for a pre-exercise BG level >350 mg/dL?

A

Test for ketones. Do not perform any exercise if moderate-to-large ketones are present

  • If ketones are negative (or trace), consider corrective insulin before exercise
  • Initiate mild-to-moderate exercise and avoid intense exercise until glucose levels decrease
24
Q

What are acceptable activities in pts with CVD complications from diabetes? discouraged activities?

A

Acceptable: any

Discouraged: Limitations on intensity should be dictated by cardiac status

25
Q

What are acceptable activities in pts with retinopathy complications from diabetes? discouraged activities?

A

Acceptable: low impact (walking, step exercises, yoga, swimming, biking)

Discouraged: vigorous exercises that involve jarring, pounding, or valsalva maneuvers (boxing, heavy weights diving, etc)

26
Q

What are acceptable activities in pts with peripheral neuropathy complications from diabetes? discouraged activities?

A

Acceptable: NWB activities (swimming, water aerobics, biking, etc.)

Discouraged: Activities with repetitive stepping

27
Q

What are acceptable activities in pts with autonomic neuropathy complications from diabetes?

A

need cardiac eval prior to and supervision during exercise due to CVD risk of ex-induced injury from postural hypotension, arrhythmias, hypoglycemia unawareness, impaired thermoregulation, anhidrosis/dry skin, gastroparesis

28
Q

What are acceptable activities in pts with microalbuminuria or nephropathy complications from diabetes? discouraged activities?

A

Acceptable: any

Discouraged: no specific restrictions

29
Q

What are exercise recommendations for Type 2 diabetes?

A
  1. Daily exercise, or at least not allowing more than 2 days to elapse between exercise sessions, is recommended to enhance insulin action.
  2. ideally perform both aerobic and resistance exercise training for optimal glycemic and health outcomes
  3. Children and adolescents w/type 2 diabetes should be encouraged to meet the same physical activity goals set for youth in general
  4. Structured lifestyle interventions that include at least 150 min/week of physical activity and dietary changes resulting in weight loss of 5%–7% are recommended to prevent or delay the onset of type 2 diabetes in populations at high risk and w/ prediabetes
30
Q

What are exercise recommendations for Type 1 diabetes?

A
  1. can benefit from being physically active, and activity should be recommended to all
  2. Blood glucose responses to physical activity in all people w/type 1 diabetes are highly variable based on activity type/timing and require different adjustments
  3. Additional carbohydrate intake and/or insulin reductions are typically required to maintain glycemic balance during and after physical activity. Frequent blood glucose checks are required to implement carbohydrate intake and insulin dose adjustment strategies
  4. Insulin users can exercise using either basal-bolus injection regimens or insulin pumps, but there are advantages and disadvantages to both insulin delivery methods.
  5. Continuous glucose monitoring during physical activity can be used to detect hypoglycemia when used as an adjunct rather than in place of capillary glucose tests
31
Q

What is the target blood glucosee range before exercise?

A

90-250 mg/dL

32
Q

Hormone secreted by pancreatic beta cells; Essential in normal metabolism and utilization of carbohydrate, protein and fat; Lowers blood glucose by facilitating cellular transport, allowing glucose to pass from the bloodstream to the cells where it is used for fuel

A

Insulin

  • needed by all Type 1 pt’s
  • needed by Type 2 pts not controlled with diet, ex, oral agents, or incretis
  • OR pregnancy, surgery, MI, ICU, Steroid therapy, stress, enable to utilize oral agents due to renal hepatic or cardiac abnormalities
33
Q

What should the insulin action be analyzed for prior to PT?

A

Onset:
How soon the insulin starts to lower the blood glucose after injection.

Peak:
The time the insulin is working the hardest to lower blood glucose.

Duration:
How long the insulin lasts - the length of time it continues to lower blood glucose

34
Q

What are the ABC’s of diabetes care?

A
  1. A1c - measured every 3 months, goal of <6.5%
  2. Blood Pressure/ Microalbum
  3. Cholesterol/Aspirin
  4. Diabetes Education
  5. Eye Exams
  6. Foot Exams
  7. Glucose Monitoring
  8. Health Maintenance/ Vaccinations
35
Q

What are sings of diabetic sensory neuropathy?

A
  1. Strongly related to poor glucose control
  2. Leads to impaired ability to feel pain, temperature or touch
  3. Loss of “protective” sensation
  4. Accompanied by burning/tingling sensations, pain, cramps (especially at night)
36
Q

What are sings of diabetic motor neuropathy?

A
  1. Wasting or loss (atrophy) of muscle tissue
  2. Deformities such as “claw” or “hammer” toes
  3. Pressure changes – causing callus formation - ulceration

Integ (11 decks)

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