Diabetes & Chronic pain & Fibromyalgia

Question 1

What does insulin do?

Answer 1

• regulates glucose levels

- promotes glucose uptake into the cells for storage (as glycogen) : muscle, liver, adipose tissue

Question 2

What are the features of Type I diabetes?

Answer 2

• juvenile onset
• require insulin
• immune mediated attach of islet cells in pancreas
• Decreased circulating insulin

Question 3

What is the clinical presentation of someone with type I diabetes

Answer 3

• Weight loss
• Increased urination
• Dehydration

Question 4

What are the features of type II Diabetes

Answer 4

• adult onset
• don’t need insulin b/c doesn’t respond to it - causes insulin resistance in peripheral tissues (don’t respond to insulin)

Question 5

What is the clinical presentation of someone with Type II Diabetes

Answer 5

• obese
• acanthosis nigricans (hyperpigmented skin in axilla, groin, back of neck)
• HTN

Question 6

Diabetes Rx

Answer 6

• Diet
• meds - to stimulate insuline secretion
• Exercise

Question 7

What is gestational diabetes

Answer 7

any degree of glucose intolerance first noted in pregnancy

Question 8

What are the symptoms of hypoglycemia

Answer 8

• dizzy, nausea, weak, sweating profusely (this rules out orthostatic hypotension)
• fatigue, irritability, confusion, fainting

Question 9

What are the acute symptoms of hyperglycemia

Answer 9

blurred vision, fatigue, thirst, frequent urination, weakness, abnormal breathing, acetone breath

Question 10

What are the longterm effects of hyperglycemia

Answer 10

• 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

Question 11

What are normal fasting glucose levels

Answer 11

5.6 mmol/L,

Question 12

What are the fasting glucose levels of a diabetic

Answer 12

> 7mmol/L

Question 13

What are the long-term consequences of diabetes

Answer 13

• 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

Question 14

Exercise considerations for diabetic

Answer 14

• 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

Question 15

What is the definition of chronic pain

Answer 15

Pain that persists part the normal time of healing (usually 3 months)

Question 16

Chronic pain is very prominent among SCI patients - What proportion of them experience chronic pain

Answer 16

2/3

Question 17

What types of pain is transmitted by A-delta fibers? Is this type of pain susceptible to meds?

Answer 17

high threshold, sharp prickling, localized, fast adapting

• meds work well

Question 18

What types of pain is transmitted by C fibers? Is this type of pain susceptible to meds?

Answer 18

low threshold, dull, aching, diffuse, slow adapting and persistent
• meds dont work

Question 19

What is the pathway for pain conduction

Answer 19

at spinal cord goes up lateral spinothalamic tract to thalamus and to the cortex

Question 20

Pain may be inhibited by what system in the brain

Answer 20

• periaqueductal grey: releases endorphins which inhibits subs Pain and glutamate release (therefore no pain)

Question 21

Are there any actual chemical changes which occur in Chronic pain?

Answer 21

Yes, in the tissue and the brain

Question 22

What are the chemical changes with occur in the tissue and brain in chronic pain

Answer 22

receptors become hypersensitive

- RESULT: allodynia or hyperalgesia, increased activity in pain pathways;

Question 23

Chronic pain Rx

Answer 23

• 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))

Question 24

Chronic fatigue syndrome Dx

Answer 24

• by exclusion
• persistent or relapsing fatigue for at least 6 months
• not resolved with bed rest
• reduces daily activity by at least 50%

Question 25

Chronic fatigue syndrome Rx

Answer 25

• Analgesics, anti-inflammatories, NSAIDS, nutrition, psych support
• PT RX : check ex tolerance

Question 26

What is the etiology of fibromyalgia

Answer 26

unknown

Question 27

Is fibromyalgia more common in men or women

Answer 27

women

Question 28

What is fibromyalgia

Answer 28

• chronic pain syndrome affecting mm + soft tissue (non-articular rheumatism)

Question 29

Fibromyalgia S&S

Answer 29

• 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

Question 30

Fibromyalgia Rx

Answer 30

• 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