Diabetes Accross Physical Therapist Practice Patterns Flashcards
Coronary artery disease and stroke is ____ to ____ more common in older people with DM
2 to 4
_______ (fraction) of people with DM die from heart disease or stroke
2/3
DM accelerates macrovascular disease, which leads to which 3 diseases
Stroke, CAD, PAD
Microvascular disease leads to which 2 conditions
Retinopathy, nephropathy,
Type 1 DM, physiological mechanism underlying it
Autoimmune destruction of pancreatic beta cells, usually resulting in absolute deficiency in insulin secretion.
Latent autoimmune diabetes physiological mechanism of action
Acquired in adulthood, slowly progressive, a presence of some of the DM associated autoantibodies seen in DM1, but insulin is not required at time of diagnosis-distinguishes it from type 1. Eventually beta cells lose ability to produce insulin
Definition of impaired glucose tolerance
140-199 mg/dL on the 75 g oral glucose tolerance test
Definition of impaired fasting glucose
100-125 mg/dL in fasting individuals
Impaired glucose tolerance and impaired fasting glucose together define prediabetes
Definition of metabolic syndrome, 5 factors
Insulin resistance Dyslipidemia HTN Abdominal obesity Prothrombotic state Proinflammatory state
What is the dual defect of DM2?
Progressive beta cell failure against a background of insulin resistance
What did Fowler find in the landmark double blind study about preventing DM2
If lose 7% of weight and walk 30 minutes 5 days per week
It is now evident that high intensity exercise not necessary for reducing risk of chronic cardiovascular and metabolic disease, but is is evident that high intensity is more effective with these diseases:
DM2, depression, osteopenia, sarcopenia
It is important to keep systolic levels
180
SMART acronym for goals
Specific Measurable Attainable Realistic Time-frame specific
Sulfonylureas mode of action
“IDE” e.g. Glipizide
Stimulate beta cells to release insulin
Biguanide mode of action
E.g. Metformin
Decrease hepatic glucose production and decrease insulin resistance in periphery
Meglitinides mode of action
E.g. Repaglinide
Stimulate beta cells to release insulin, can cause hypoglycemia
Thiazolidinediones mode of action
Decrease insulin resistance in muscle and fat and reduce glucose production in the liver
D-phenylalnine derivatives mode of action
Stimulate insulin secretion for pancreas, extent of insulin is glucose dependent so less risk for hypoglycemia
DPP-4 inhibitors mode of action
Liptins
Increase insulin synthesis, indirectly increase glucose uptake, lowers glucose only when elevated
Glucagon-like peptide-1 analog mode of action
tides
E.g. Exenatide
Injection only, mechanism not quite understood, but enhances glucose dependent insulin secretion, suppresses appetite, suppresses high glucagon secretion
Dopamine agonist mode of action
E.g. Bromocriptine
Unknown but improves glycemic control
Alpha-glycosidase inhibitor mode of action
Acarbose
Miglitol
Lower glucose by blocking breakdown of carbs in the intestine
Rapid acting insulins
Onset
Peak
Duration
15 min
30-90 minutes
3-5 hours
Short acting insulin
Onset
Peak
Duration
30-60
2-4
5-8
Intermediate acting insulin
Onset
Peak
Duration
1-3
8
12-16
Long acting insulin
Onset
Peak
Duration
1 hour
Peakless
20-26 hours
Which drugs often preferred to treat HTN in people with DM due to protective effect to kidneys?
ACE inhibitors, but water soluble, so can be toxic especially in older people who tend to have decreased total water volume.
The 5 most prevalent acute syndromes associated with poly pharmacy
Confusion Falls Malnutrition Failure to thrive Urinary incontinence
Goals for glycemic control
A1C
Preprandial
Posprandial
<6.5-7
<100-130
<140-180 2 hours after meal
7 signs of stage 1 hypoglycemia (ANS response)
Tremor Palpitations Anxiety Pallor Hunger Diaphoresis Parasthesias
7 signs of stage 2, Neuroglycopenic hypoglycemia
Brain glucose deprivation response
Cognitive impairments Inappropriate behavioral changes Weakness and fatigue Hunger Focal neurologic deficits e.g. Hemiparesis,slurred speech Seizures Coma/death
Most common cause of diabetic coma and death, primary cause?
Hyperosmolar hyperglycemic state
Dehydration the most frequent cause, with infection such as pneumonia being a precipitating factor
More frequent in older adults
15% fatality rate
Main difference between DKA and HHS is that with HHS insulin present, DKA usually only occurs in people with DM1, HHS occurs almost exclusively in people with DM2
Types of drugs that may precipitate the development of HHS
Glucocorticoids, thiazide diuretics, phenytoin (Dilantin) and beta blockers
4 primary features of HHS
Sever hyperglycemia (>600mg/dL)
Absence of significant ketosis
Profound dehydration
Neurologic manifestations
What are Advanced Glycation End Products and their relation to DM?
AGEs for slowly throughout time, but much more quickly in people with DM because of more readily available glucose. As glucose becomes incorporated into proteins, AGEs are formed in an irreversible chemical reaction. Found in retinal vessels of people with DM, found in large and small vessels (micro and macrovascular disease) joint capsules and tendons (decreased ROM)
What is thought to be a major contributor to joint ROM loss in people with DM?
AGEs, chemical reaction between glucose and proteins that is irreversible and acts as molecular glue, decreasing soft-tissue extensibility and joint capsule mobility.
Hallux limitus
Hallux rigidus
Normal extension value of 1st IP joint
What do these conditions place person at risk for?
Limited ROM of 1st MP joints, 0-50 or 70 DF
Complete loss of ROM of 1st MP
10-15 degrees
Great toe ulceration
the most common neuropathies associated with DM
Chronic sensorimotor distal symmetric polyneuropathy
Autonomic neuropathy
Peripheral neuropathy affects _____% of people with DM
30
A meta analysis provides evidence that treatment with ______________ (drug) improves neuropathic symptoms
alpha-lipoic acid
According to the CDC _________ disease is the leading cause of morbidity and mortality in people with DM
Cardiovascular
People with DM are ____ to ____ times likely to have an MI
2-4
Cardiovascular impairment is present in _____% of people with DM
40
3 major associated cardiac syndromes to DM
Orthostatic hypotension
Cardiac enervation syndrome
Abnormal cardiovascular response to exercise
Definition of orthostatic hypotension
Drop >30 on SBP
or > 10 on DBP
Within 2 minutes of changing from supine to standing
Definition of cardiac denervation syndrome
Does not Change in response to stress or sleep, breathing etc
Often called or goes hand in hand with silent cardiac ischemia
