Diabetes & Chronic pain & Fibromyalgia Flashcards
What does insulin do?
- regulates glucose levels
- promotes glucose uptake into the cells for storage (as glycogen) : muscle, liver, adipose tissue
What are the features of Type I diabetes?
- juvenile onset
- require insulin
- immune mediated attach of islet cells in pancreas
- Decreased circulating insulin
What is the clinical presentation of someone with type I diabetes
- Weight loss
- Increased urination
- Dehydration
What are the features of type II Diabetes
- adult onset
- don’t need insulin b/c doesn’t respond to it - causes insulin resistance in peripheral tissues (don’t respond to insulin)
What is the clinical presentation of someone with Type II Diabetes
- obese
- acanthosis nigricans (hyperpigmented skin in axilla, groin, back of neck)
- HTN
Diabetes Rx
- Diet
- meds - to stimulate insuline secretion
- Exercise
What is gestational diabetes
any degree of glucose intolerance first noted in pregnancy
What are the symptoms of hypoglycemia
- dizzy, nausea, weak, sweating profusely (this rules out orthostatic hypotension)
- fatigue, irritability, confusion, fainting
What are the acute symptoms of hyperglycemia
blurred vision, fatigue, thirst, frequent urination, weakness, abnormal breathing, acetone breath
What are the longterm effects of hyperglycemia
- damage to small blood vessels (retinopathy and diabetic nephropathy)
- damage to large blood vessels: abnormal glucose metabolism causes increased cholesterol levels - vessel wall damage resulting in atherosclerosis and myocardial infarction, stroke, gangrene
- damage to peripheral nerves: diabetic neuropathy
What are normal fasting glucose levels
5.6 mmol/L,
What are the fasting glucose levels of a diabetic
> 7mmol/L
What are the long-term consequences of diabetes
- peripheral (diabetic neuropathy—ulcers—amputation)
- kidney failure (diabetic nephropathy—congestive heart failure – swelling – HTN—protein urea)
- diabetic retinopathy (blindness)
- heart disease (heart attack, stroke, atherosclerosis)
- infection
Exercise considerations for diabetic
- regular exercise = very important
- Talk to MD about insulin levels for exercise
- have snack before (have raisins/juice available to boost sugar levels if necessary)
- monitor blood sugar levels pre, during, and post exercise
- avoid exercise at night - person may go to sleep and slip into a hypoglycemic coma and die
- PT always monitor patient for s&s hyper or hypoglycemia
What is the definition of chronic pain
Pain that persists part the normal time of healing (usually 3 months)
Chronic pain is very prominent among SCI patients - What proportion of them experience chronic pain
2/3
What types of pain is transmitted by A-delta fibers? Is this type of pain susceptible to meds?
high threshold, sharp prickling, localized, fast adapting
• meds work well
What types of pain is transmitted by C fibers? Is this type of pain susceptible to meds?
low threshold, dull, aching, diffuse, slow adapting and persistent
• meds dont work
What is the pathway for pain conduction
at spinal cord goes up lateral spinothalamic tract to thalamus and to the cortex
Pain may be inhibited by what system in the brain
- periaqueductal grey: releases endorphins which inhibits subs Pain and glutamate release (therefore no pain)
Are there any actual chemical changes which occur in Chronic pain?
Yes, in the tissue and the brain
What are the chemical changes with occur in the tissue and brain in chronic pain
receptors become hypersensitive
- RESULT: allodynia or hyperalgesia, increased activity in pain pathways;
Chronic pain Rx
- have to desensitize the area
- educate them that it’s not in their head
- restore normal function to the area
- variety of techniques: chemical (medications), physical (electrotherapy), cryotherapy, thermotherapy, exercises/stretch (reduce pain caused by muscle spasm))
Chronic fatigue syndrome Dx
- by exclusion
- persistent or relapsing fatigue for at least 6 months
- not resolved with bed rest
- reduces daily activity by at least 50%
Chronic fatigue syndrome Rx
- Analgesics, anti-inflammatories, NSAIDS, nutrition, psych support
- PT RX : check ex tolerance
What is the etiology of fibromyalgia
unknown
Is fibromyalgia more common in men or women
women
What is fibromyalgia
• chronic pain syndrome affecting mm + soft tissue (non-articular rheumatism)
Fibromyalgia S&S
- headaches, sensitivity to stimuli, fatigue, myalgia (mm pain), generalized aching, sleep disturbances, anxiety/depression
- 11 of 18 points: Occiput, low cervical (C5-C7), Traps (mid-point of upper border), Supraspinatus (at origin), Second rib, lateral epicondyle, gluteal, greater trochanter, knee
Fibromyalgia Rx
- anti-inflammatories, mm relaxants, pain meds, psychological support, nutrition, can respond well to dry needling (this is from my own (Erika) personal experience), they like heat and not ice
- PT RX: energy conservation, aquatic therapy
