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Geriatric Clinical Specialist > Diabetes Accross Physical Therapist Practice Patterns > Flashcards

Diabetes Accross Physical Therapist Practice Patterns Flashcards

1
Q

Coronary artery disease and stroke is ____ to ____ more common in older people with DM

A

2 to 4

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2
Q

_______ (fraction) of people with DM die from heart disease or stroke

A

2/3

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3
Q

DM accelerates macrovascular disease, which leads to which 3 diseases

A

Stroke, CAD, PAD

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4
Q

Microvascular disease leads to which 2 conditions

A

Retinopathy, nephropathy,

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5
Q

Type 1 DM, physiological mechanism underlying it

A

Autoimmune destruction of pancreatic beta cells, usually resulting in absolute deficiency in insulin secretion.

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6
Q

Latent autoimmune diabetes physiological mechanism of action

A

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

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7
Q

Definition of impaired glucose tolerance

A

140-199 mg/dL on the 75 g oral glucose tolerance test

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8
Q

Definition of impaired fasting glucose

A

100-125 mg/dL in fasting individuals

Impaired glucose tolerance and impaired fasting glucose together define prediabetes

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9
Q

Definition of metabolic syndrome, 5 factors

A 
Insulin resistance
Dyslipidemia
HTN
Abdominal obesity
Prothrombotic state
Proinflammatory state
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10
Q

What is the dual defect of DM2?

A

Progressive beta cell failure against a background of insulin resistance

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11
Q

What did Fowler find in the landmark double blind study about preventing DM2

A

If lose 7% of weight and walk 30 minutes 5 days per week

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12
Q

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:

A

DM2, depression, osteopenia, sarcopenia

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13
Q

It is important to keep systolic levels

A

180

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14
Q

SMART acronym for goals

A 
Specific
Measurable
Attainable
Realistic 
Time-frame specific
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15
Q

Sulfonylureas mode of action

“IDE” e.g. Glipizide

A

Stimulate beta cells to release insulin

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16
Q

Biguanide mode of action

E.g. Metformin

A

Decrease hepatic glucose production and decrease insulin resistance in periphery

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17
Q

Meglitinides mode of action

E.g. Repaglinide

A

Stimulate beta cells to release insulin, can cause hypoglycemia

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18
Q

Thiazolidinediones mode of action

A

Decrease insulin resistance in muscle and fat and reduce glucose production in the liver

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19
Q

D-phenylalnine derivatives mode of action

A

Stimulate insulin secretion for pancreas, extent of insulin is glucose dependent so less risk for hypoglycemia

20
Q

DPP-4 inhibitors mode of action

Liptins

A

Increase insulin synthesis, indirectly increase glucose uptake, lowers glucose only when elevated

21
Q

Glucagon-like peptide-1 analog mode of action
tides
E.g. Exenatide

A

Injection only, mechanism not quite understood, but enhances glucose dependent insulin secretion, suppresses appetite, suppresses high glucagon secretion

22
Q

Dopamine agonist mode of action

E.g. Bromocriptine

A

Unknown but improves glycemic control

23
Q

Alpha-glycosidase inhibitor mode of action

Acarbose
Miglitol

A

Lower glucose by blocking breakdown of carbs in the intestine

24
Q

Rapid acting insulins
Onset
Peak
Duration

A

15 min
30-90 minutes
3-5 hours

25
Q

Short acting insulin
Onset
Peak
Duration

A

30-60
2-4
5-8

26
Q

Intermediate acting insulin
Onset
Peak
Duration

A

1-3
8
12-16

27
Q

Long acting insulin
Onset
Peak
Duration

A

1 hour
Peakless
20-26 hours

28
Q

Which drugs often preferred to treat HTN in people with DM due to protective effect to kidneys?

A

ACE inhibitors, but water soluble, so can be toxic especially in older people who tend to have decreased total water volume.

29
Q

The 5 most prevalent acute syndromes associated with poly pharmacy

A 
Confusion
Falls
Malnutrition
Failure to thrive
Urinary incontinence
30
Q

Goals for glycemic control
A1C
Preprandial
Posprandial

A

<6.5-7
<100-130
<140-180 2 hours after meal

31
Q

7 signs of stage 1 hypoglycemia (ANS response)

A 
Tremor
Palpitations
Anxiety
Pallor
Hunger
Diaphoresis
Parasthesias
32
Q

7 signs of stage 2, Neuroglycopenic hypoglycemia

Brain glucose deprivation response

A 
Cognitive impairments
Inappropriate behavioral changes
Weakness and fatigue
Hunger
Focal neurologic deficits e.g. Hemiparesis,slurred speech
Seizures
Coma/death
33
Q

Most common cause of diabetic coma and death, primary cause?

A

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

34
Q

Types of drugs that may precipitate the development of HHS

A

Glucocorticoids, thiazide diuretics, phenytoin (Dilantin) and beta blockers

35
Q

4 primary features of HHS

A

Sever hyperglycemia (>600mg/dL)
Absence of significant ketosis
Profound dehydration
Neurologic manifestations

36
Q

What are Advanced Glycation End Products and their relation to DM?

A

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)

37
Q

What is thought to be a major contributor to joint ROM loss in people with DM?

A

AGEs, chemical reaction between glucose and proteins that is irreversible and acts as molecular glue, decreasing soft-tissue extensibility and joint capsule mobility.

38
Q

Hallux limitus
Hallux rigidus
Normal extension value of 1st IP joint
What do these conditions place person at risk for?

A

Limited ROM of 1st MP joints, 0-50 or 70 DF
Complete loss of ROM of 1st MP
10-15 degrees
Great toe ulceration

39
Q

the most common neuropathies associated with DM

A

Chronic sensorimotor distal symmetric polyneuropathy

Autonomic neuropathy

40
Q

Peripheral neuropathy affects _____% of people with DM

A

30

41
Q

A meta analysis provides evidence that treatment with ______________ (drug) improves neuropathic symptoms

A

alpha-lipoic acid

42
Q

According to the CDC _________ disease is the leading cause of morbidity and mortality in people with DM

A

Cardiovascular

43
Q

People with DM are ____ to ____ times likely to have an MI

A

2-4

44
Q

Cardiovascular impairment is present in _____% of people with DM

A

40

45
Q

3 major associated cardiac syndromes to DM

A

Orthostatic hypotension
Cardiac enervation syndrome
Abnormal cardiovascular response to exercise

46
Q

Definition of orthostatic hypotension

A

Drop >30 on SBP
or > 10 on DBP
Within 2 minutes of changing from supine to standing

47
Q

Definition of cardiac denervation syndrome

A

Does not Change in response to stress or sleep, breathing etc
Often called or goes hand in hand with silent cardiac ischemia

Geriatric Clinical Specialist (8 decks)

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