Diabetes Lecture Flashcards
what are some risks of exercise in individuals with diabetes?
- hypoglycemia
-possible ketoacidosis if poor BG control before exercise especially with HIE - hypertensive BP response during exercise
-orthostatic hypotension post exercise
-MI, arrythmia, sudden death - aggravation of retinopathy or nephropathy
- MSK injury with neuropathy
what are benefits of exercise for individuals with diabetes?
- improved glycemia control
- increased insulin sensitivity
- increased exercise tolerance
- reduced risk of developing microvascular disease such as retinopathy, nephropathy, and neuropathy
what is a major concern during and after exercise?
hypoglycemia up to 24 hours after
what are common symptoms of hypoglycemia?
what are severe symptoms of hypoglycemia?
Common: shakiness, weakness, abnormal sweating, nervousness, anxiety, tingling of mouth and fingers, and hunger, pale skin, clumsy, behavior changes
Severe: headache, visual disturbance, mental dullness, confusion, amnesia, seizures, coma
when do episodes of hypoglycemia occur?
during, immediately following, and up to 12 hours post exercise
what are absolute contraindications to exercise and what are the symptoms to look out for?
- hypoglycemia (<70mg/dL): shakiness, weakness, abnormal sweating, nervousness, anxiety, tingling of mouth and fingers, and hunger, pale skin, clumsy, behavior changes
- hyperglycemia (>300mg/dL + ketones) (ketones with one or more of the following symptoms is an emergency!): SOB, fruity breath, nausea and vomiting, very dry mouth
what are relative contraindications to exercise that require close BG monitoring?
- 70 to 100mg/dL= SNACK (15g every hour for mod intensity, 20-50g for vig intensity)
- 100 to 300mg/dL= PROCEED (if exercise is >2hours you need increased carbohydrate intake)
->300mg/dL and oral meds= TRIAL 10-15mins and recheck BG (BG rises= STOP) (BG drops= recheck every 10-15 mins) - > 300mg/dL and insulin= CHECK ketones (+ ketones AVOID ACTIVITY) (- ketones CHECK frequently)
what are some considerations for exercise?
- is their vision affected?
- is the sensory system affected?
- what is their shoe wear?
- what do they do post exercise?
what are the stages of charcot foot?
- stage 0: inflammatory period with onset of warmth, swelling, and pain
- stage 1: destruction period, weak ligaments, joint subluxation or dislocation
-stage 2: formation of bone callus, consolidation of fractures
-stage 3: fixed deformity and instability
what is the common presentation of charcot foot?
-occurs with severe peripheral neuropathy and repeated trauma
- loss of protective sensation results in abnormal response to repeated injury and severe destruction of the foot architecture
- observed unilaterally and typically red, hot, swollen, and flat
what is LEAP?
- a comprehensive program that can aid in reducing risk factors that contribute to amputation in individuals with loss of protective sensation
1. annual foot screening
2. patient education
3. daily foot inspection
4. footwear selection
5. management of foot problems
what is diabetes?
- a syndrome or impaired metabolism caused by either lack of insulin production by pancreas or decreased sensitivity of the tissues to insulin
what is type 1 DM?
- accounts for 5-10% of DM
- onset is quick and typically 25 years or younger
-autoimmune destructs beta cells in the pancreas resulting in the lack of insulin
-managed with insulin injection, diet, and exercise
-insulin dependent
what is type 2 DM
- accounts for 90% of DM
- gradual onset with dx 45 years or older
- insulin resistance, insulin deficiency, progressive decline in beta cell function over time
- managed with diet, exercise, weight loss, oral meds
-noninsulin dependent
what is the criteria for dx of DM?
- A1C
- fasting plasma glucose
- oral glucose tolerance test
what is considered normal, prediabetes, and diabetes for A1C levels?
normal: <5.7%
pre-diabetes: 5.7-6.4%
Diabetes: 6.5% or greater
what is considered normal, prediabetes, and diabetes for fasting plasma glucose levels?
normal: <100mg/dL
prediabetes: 100-125mg/dL
diabetes: 126 mg/dL or greater
what is considered normal, prediabetes, and diabetes for oral glucose tolerance test levels?
normal: <140mg/dL
prediabetes: 140-199mg/dL
diabetes: 200mg/dL or greater
what are risk factors for diabetes?
- smoking, 1st degree relative, hx cardiovascular disease, hx of hypertension, hx of hyperlipedemia, physical inactivity, 45 years or older, PCOS, gestational DM, weight
what are possible complication for the baby if the mother has GDM
respiratory issues, jaundice, hypoglycemia
what is the aerobic ACSM recommendation for exercise in obese individuals?
F: >5days/week
I:moderate and progress to vigorous
T: 30 mins per day, 150 mins per week, increase to 60 mins per day and 250-300 mins per week
T: prolonged rhythmic activity using large muscle groups
what is the resistance ACSM recommendation for exercise in obese individuals?
F: 2-3 days per week
I: 60-70% 1RM and gradually increase
T: 2-4 sets and 8-12 reps
T: resistance machines or free weights
what is the flexibility ACSM recommendation for exercise in obese individuals?
F: 2-3 days per week
I: stretch to point of discomfort
T: 10-30 hold 2-4 reps
T: static, dynamic, PNF
what are the 5 risk factor for metabolic syndrome?
3 or more confirm diagnosis
1. abdominal obesity (M >40, W 35) (M>90inch, W>85inch)
2. high triglyceride( >150)
3. low HDL(W<50, M<40)
4. Elevated BP(Systolic >130, diastolic >85)
5. Elevated fasting BG(>100)
what are signs and symptoms of DM?
- polyuria (frequent urination)
- polydipsia (thirst)
- extreme hunger
- extreme fatigue
- blurry vision
- irritability
- cuts and bruises that are slow to heal
- frequent infection
- unusual weight loss
- tingling, pain and numbness in hands or feet
what are complications of DM
-skin infections, changes in color, wounds
- glaucoma, cataracts, retinopathy
- complication of the foot
-CVA
- nephropathy
- HTN
-ketoacidosis (body not producing enough insulin)
what are symptoms of ketoacidosis?
- confusion, dehydration, dry mouth, frequent urination, abdominal pain, coma, potentially death
what is the wagner ulcer classification scale?
Grade 0: intact skin, bony deformity or heated ulcer
Grade 1: superficial ulcer (no subcutaneous tissue)
Grade 2: deep ulcer (subcutaneous tissue involved, tendon or bone exposure)
Grade 3: deep infected ulcer (abcess, osteomyelitis)
Grade 4: partial foot gangrene (only digits)
Grade 5: full foot gangrene
what are normal grades of ROM for foot and ankle
PF: 30-50
DF: 20
Inv: 20
Ev: 10
Great toe flex-ext: 45-70
what are common foot deformities?
- claw toe: hyperextension of MTP joint with flexion of the PIP and DIP
- hammer toe: hyperextension of MTP joint and flexion of PIP joint, extension of DIP joint
- pes cavus: high longitudinal arch
-pes planus: flat foot and loss of arch support - prior amputations
what is monofilament testing for? what is the technique?
- measures for loss of protective sensation
- test each site for 5-10 times on each foot
- patient should be able to correctly identify stimulus 80% of the time to be considered normal
what are the levels of sensation?
- 4.17 (1g) normal sensation
- 5.07 (10g) protective sensation
- 6.10 (75g) loss of protective sensation
- no perception of 75g= insensate
what is the SLS test and what is considered high fall risk?
single leg stance test
<6.5 second hold is considered high fall risk
what is the 30STS test used for?
- assess LE strength in community dwelling older adults
- predictive of falls if <14 reps
what are common gait deviations noted in individuals with DM
- reduced gait speed, reduced ankle mobility, hip circumduction, increased knee flexion, decreased PF propulsion, increased use of hip flexors to advance LE, short step and stride, widened stance, double limb support increased
