Diabetes and Obesity Flashcards
What BMI correlates with being class 1 obese?
Class 2 Obese?
Class 3?
What is considered normal?
30-35
35-40
40 and above
18.5-25
What is the estimated annual medical cost of obesity in the U.S?
$147 billion
roughly 21% of annual medical spending in america
What are common complications associated with obesity
Cardiovascular disease Type 2 diabetes Cancers (breast, colon) Hypertension Stroke Increased Fall Risk liver disease Sleep Apnea and respiratory issues Osteoarthritis LBP
What are the two types of Fat?
White Fat: lipid storage and undergoes pathological expansion during obesity
Brown Fat: thermogenic, large amounts of mitochondria, produces a lot of heat during cold weather to protect body and may play a role in body weight regulation
What are the common areas of adipose tissue distribution? What health concerns are associated with each?
Visceral/Intra-abdominal- surrounds abdominal organs and produce more pro-inflammatory cytokines and tumor necrosis factor-alpha, strongly lined to CVD, DM2 and various other conditions
Subcutaneous- not necessarily hazardous to your health
Perivascular (PVAT)
True or False: Adipose tissue is not metabolic and only acts as a storage for excess energy
False, adipose tissue is active with autocrine, paracrine, and endocrine functions and produces adipokines and changes leptin sensitivity and signalling
True or False: Adipokines are all proinflammatory and pathogenic
False, some are pathogenic and induce atherogenesis, insulin resistance, inflammation and endothelial dysfunction but some are beneficial, specifically adiponectin
What are the two main endothelium-derived relaxing and contracting factors and what do they maintain?
Nitric Oxide and endothelin-1
maintain vascular homeostasis
What is the role of adiponectin as it pertains to nitric oxide?
increases NO bioavailability
adiponectin is released by healthy adipocytes
How does obesity effect adiponectin?
obese patients have lower levels of adiponectin and thus the NO bioavailability is low and the pro-inflammatory effects of TNF-a are greater
What is myosteatosis?
What is it’s effect?
What mechanisms are involved?
presence of intermuscular and intramuscular adipose tissue
induces pathological changes to skeletal muscle structure and insulin signaling pathways into the muscle
- build up of fat in muscles (intermuscular fat)
- build up of lipid within myofibers themselves (intramuscular myocellular lipid IMC)
- exacerbating normal ageing processes
- Injury and inflammatory changes; macrophages and T-cell accumulation
How does obesity effect muscles?
- reduces anabolic hormone levels and testosterone which effects ability to hypertrophy
- blunts any beneficial effect of increased loading from exercise or resistance training
- obesity results in an increased secretion and expression of myostatin
- effects insulin sensitivity
True or False: Obese individuals tend to have lesser absolute maximum strength compared to non-obese persons
False, they have greater absolute strength but are actually weaker when normalized to body weight
This is usually in LE more than UE
What is the obesity paradox?
What might causes this paradox?
although obesity is a cardiovascular risk factor in epidemiological studies, a paradox exists in which obese pts are associated with more favorable prognosis compared to lean pts among cohorts of cardiac pts
possibly due to the poor classifcation of ‘obese’ when only using BMI, using BF% or waist:hip ratio to determine obesity may have better accuracy
True or False: While purposeful weight loss in obese pts with CAD did not cause harm and led to marked improvements in coronary risk factors it only led to a small reduction in mortality that was NOT significant statistically.
True
True or False: patients that were high fitness all had roughly the same risk factors for all-cause and CVD mortality regardless of BMI classification
True
True or False: Low fitness individuals who are at a normal BMI have less CVD risk factors than obese high fitness patients
False
True or False: BMI is a good indicator of CVD risk
False, cardiorespiratory fitness is a much better predictive factor and BMI does not have good correlation with CVD risk
When is bariatric surgery indicated?
What is the rate of resolution or reduction of comorbidities after bariatric surgery?
when pt is over 40 on BMI scale
86% for diabetes
70% for hyperlipidemia
79% for hypertension
84% for sleep apnea
True or False: non-surgery therapy for weight loss is has been shown to be more effective at reducing metabolic syndrome than an adjustable gastric band
False, the LAP-band was more effective at reducing metabolic syndrome and improved pts quality of life
LAP-band also has been shown to have few cases of post-op complications (~4.5%)
What complications post-surgery would require readmission?
- GI tract diagnoses
- gastric revision
- wound infection
- ventral hernia repair
- small bowel obstruction
- hypovolemia
- liver disease
- abdominal pain/nausea/vomiting
True or False: Pre-discharge complications and prolonged hospital stays post surgery are strongly associated with post discharge complications
True
What are the most common pre discharge complication post surgery?
respiratory problems such as pneumonia or unplanned intubation
What is the PT role for obese pts who did or did not have bariatric surgery
educate pt on incorporation of diet and exercise to maximize healthy lifestyle and prescribe exercise
Also help promote social/community based programs and interventions to promote weight loss and healthy lifestyle
True or False: Obesity treatments that rely on dieting as the sole factor have high rates of long-term success
False, poor long term success if diet is only factor addressed and within 2 or 3 yrs most pts who only change diet gain all the weight back
you should also use exercise along with diet changes to maximize weight loss long term effects
What are the goals and intentions for exercise prescription for obese pts?
- weight loss/ negative energy balance
- improve cardiorespiratory fitness
- improving functional mobility
- improving body comp.
What is the ideal exercise mode for obese patients?
Combination of Aerobic and resistance training to get benefits of both methods
What are the benefits of interval training for obese pts?
May improve adherence to program
may also enhance weight loss
produces similar changes, possibly greater than continuous in cardiorespiratory fitness
What abnormalities can be caused by the hyperglycemic state of diabetes?
- atherosclerosis
- decreased endothelium-derived nitric oxide
- increased synthesis of vasoconstrictor prostanoids and endothelin-1
- increased activated platelets, increased coagulation factors and inhibited pathways for fibrinolysis
How does insulin regulate vascular homeostasis?
maintaing the balance of endothelial derived NO and ET-1
What is the normal function of insulin?
How does it change with insulin resistance?
released during feeding it normally acts as a vasodilator to help increase glucose uptake to skeletal muscle via activation of P13-K which increases NO
relationship becomes paradoxical and P13K is selectively reduced allowing ET-1 production to be unopposed (ET-1 has many adverse effects on vascular health including vasoconstriction)
What are advanced glycation end-products?
(also known as glycotoxins)
They are highly oxidant compounds with pathogenic significance in deabetes that are responsible for many of the pathological changes in DM including increaed arterial stiffness, impaired wound healing, increased diastolic pressure, retinopathy, and neuropathy
What is diabetes?
a metabolic disease in which the body’s inability to produce any or enough insulin causes elevated levels of glucose in the blood
defined with a fasting glycated hemoglobin/hemoglobin A1C above 6.5% or; plasma glucose more than or equal to 11.1 mmol/l
What is the recommended diagnostic test for Diabetes?
oral glucose tolerance test (OGTT) should be given to all pts with fasting plasma glucose of 6.1-6.9 mmol/l because fasting plasma glucose alone fails to diagnose approx. 30% of cases of previously undiagnosed diabetes
What are the signs and symptoms of Diabetes?
- frequent urination
- excessive thirst
- extreme fatigue
- vision changes
- feelings of hunger
- slow healing response to cuts/bruises
- weight loss (DM 2)
- polyneuropathy
How might sensory diabetic polyneuropathy present?
motor diabetic polyneuropathy?
autonomic?
sensory-usually insidious in onset and showing a stocking and glove distribution in the distal extremities
motor-distal, proximal, or ore focal weakness, sometimes occurring along with sensory neuropathy
autonomic0neuropathy that may involve the cardiovascular, GI, and genitourinary systems and the sweatr glands
What are the 5 criteria for metabolic syndrome? How many need to present for a diagnosis?
- large waist cirucmference/abdominal obesity
- elevated triglycerides
- low HDL
- Hypertension
- Elevated blood glucose level when fasting
3 out of 5
What is the primary risk factor for type 2 diabetes?
Metabolic syndrome
What does increased level of C-reactive protein increase?
risk of atherosclerosis and HTN
What conditions could diabetes be secondary to?
- any pancreas disease
- gestational diabetes can occur during pregnancy
- long term corticosteroid usage
- beta blockers
- rare diseases and hormonal disorders i.e cushing syndrome
What is the hallmark sign for type 1 diabetes?
beta cells fail to produce sufficient insulin
type 1 DM is an auto-immune disease that attacks beta cells
What is the hallmark sign for type 2 diabetes?
insulin resistance (chronic cases can cause beta cell burnout where beta cells stop producing insulin all together)
What are common complications with diabetes?
- heart disease
- eye complications
- kidney disease
- peripheral nerve damage
- autonomic dysfunction
- integumentary issues
What is hypoglycemia?
What are some early symptoms?
glucose levels under 70 mg/dl for DM
palpitations, fatigue, pale skin, shakiness, anxiety, sweating, hunger, irritability, weakness
What are the more severe symptoms of hypoglycemia?
confusion abnormal behavior inability to complete routine tasks visual disturbances seizures loss of consciousness
What is hyperglycemia?
What are early symptoms?
Often asymptomatic over 200 mg/dl
frequent urination increased thirst blurred vision fatigue headache
What are the more severe symptoms of hyperglycemia?
nausea and vomiting shortness of breath dry mouth weakness confusion coma abdominal pain sweet smelling breath presence of ketones
What is ketoacidosis?
What are early symptoms?
when body metabolizes fats and proteins instead of glucose due to inadequate amount of glucose (more common in DM1 than DM2)
increased thirst
dry mouth
frequent urination
glucose levels over 240 mg/dl
What are severe symptoms of ketoacidosis?
dry or flushed skin nausea, vomiting or abdominal pain difficulty breathing fruity breath confusion could cause coma
What is the benefit of exercise for diabetic patients?
exercise increases glucose uptake during AND after exercise and increases insulin sensitivity (lasts hours to days) and glucose uptake (1-3 hours) after exercise
When should you check blood glucose with exercise for type 1 diabetics? what is the criteria for the test?
How is this different for type 2 diabetic?
type 1-check glucose before EVERY exercise session and every 30 min during
criteria- generally between 100 and 240
Type 2-check blood glucose before and after exercise for first few weeks
criteria-generally between 100 and 240
What is the best mode for exercise for diabetics?
Combined aerobic and resistance training- better improvement together than either apart
interval training is an emerging area but needs more research to be done
