Diabetes Mellitus

Question 1

Chronic metabolic disorder characterized by high blood glucose (hyperglycemia)

Answer 1

diabetes mellitus

Question 2

Describe Type 1 Diabetes

Answer 2

-B cell of pancreas that produces insulin are destroyed
-results in insulin dependence

commonly detected before 30 years old

Question 3

Describe Type 2 Diabetes

Answer 3

-blood glucose levels rise due to:
1. insufficient insulin action (insulin resistance) followed by
2. declining insulin production

commonly detected after 40 years of age
effects >90% of DM pop eventually leads to B cell failure

Question 4

What is normal fasting plasma glucose?

Answer 4

test that is cheap, fast
normal 70-100 mg/dl
pre-diabetic 100-125 mg/dl
diabetic >125 mg/dl

Question 5

What is normal Hb A1c

Answer 5

normal <5.7% of Hb

Question 6

what is the oral glucose tolerance test?

Answer 6

tested after 2 hours of glucose rich drink
140-199 mg/dl signals pre-diabetes
>200 mg/dl signals diabetes

Question 7

what is the diagnostic criteria for diabetes

Answer 7

fasting plasma glucose >125 mg/dl
OR
2 hour plasma glucose during OGTT >200mg/dl
OR
A1C >6.1%
OR
classic diabetic symptoms + random plasma glucose >200 mg/dl

Question 8

what are some complications of diabetes mellitus

Answer 8

cardiovascular disease
-CAD
-HTN
-peripheral vascular disease
-CVA
Retinopathy
Nephropathy
Neuropathy
Osteopathy
Immune dysfunction

Question 9

In patients with DM assume what?

Answer 9

they have heart disease until proven otherwise
-CAD/MI is major cause of death in both types of DM (70%)
-increased HTN, CHF, CVA risk
-increased incidence of dysrhytmias

Question 10

Explain the clinical manifestation of retinopathy in DM

Answer 10

early recognition of visual changes and treatment best option for preventing further damage
affect ~80% of patients with DM
-involves macular edema and formation of fragile blood vessels

Question 11

Explain the clinical manifestations of diabetic peripheral neuropathy

Answer 11

loss of protective sensation distal>proximal
decreased vibration and proprioception
diminished reflexes
neuropathic pain

blood vessels are damaged that are supplying blood to the nerves

Question 12

explain clinical manifestation of osteopathy

Answer 12

charcot disease- degeneration of a weight bearing joint
increased risk of skin breakdown
-varied pressure distribution
-if combined with DPN increased wound risk

Question 13

what are common MSK manifestations for individuals with DM

Answer 13

-frozen shoulder
-carpal tunnel syndrome
-flexor tenosynovitis (trigger finger)

-spine osteoporosis

Question 14

Do individual have and increased risk for infection

Answer 14

yes innate immunity is impaired
-decreased function of macrophages
-skin breakdown is common
-infections more rapidly enter body

hyperglycemia promotes bacterial growth and proliferation
-glucose feeds the infection

Question 15

What is the most common acute hyperglycemic emergency

Answer 15

diabetic ketoacidosis- more common in type 1>type 2
results from a shortage of insulin

Question 16

What happens in diabetic ketoacidosis

Answer 16

body switches to burning fatty acids and produces acidic ketone bodies

Question 17

what are signs and symptoms of diabetic ketoacidosis

Answer 17

N/V
abdominal pain
polydipsia
polyuria
dehydration

Question 18

what causes diabetic ketoacidosis

Answer 18

can be because of an infection, pneumonia, MI, CVA, drug abuse, poor DM management

Question 19

What are the three major components of treatment for DM

Answer 19

diet and exercise
oral hypoglycemic therapy
insulin therapy

Question 20

what should diet aim at in DM management

Answer 20

1.ensuring weight control
2.providing nutritional requirements
3.allowing good gycemic control with blood glucose levels as close to normal
4. correcting any associated blood lipid abnormalities

Question 21

how does exercise help in DM management

Answer 21

promotes weight reduction and improves insulin sensitivity
lowers blood glucose levels

people should be educated on potential risk of hypoglycemia- know blood sugar before and afer

Question 22

Does exercise have any impact on glucose control in type 1 diabetes?

Answer 22

no

Question 23

does exercise have any impact on glucose control in type 2 diabetes

Answer 23

yes improves insulin sensitivity
increases glucose transporter

Question 24

what do you need to do when exercising with a patient who has DM

Answer 24

monitor blood glucose before, during and after session
there is an increased risk of hypoglycemia

Question 25

what are some symptoms of hypoglycemia

Answer 25

-headache
-confusion
-fatigue
-hunger
-tachycardia
-sweating
-anxiety

Question 26

what is the 4 step treatment of hypoglycemia

Answer 26

1. have at least 15-20 grams of fast acting carbohydrate (sports drink, soda)
2. wait 15-20 min
3. if still low repeat treatment
4. eat regular meals and snacks as planned to keep blood glucose up

Question 27

What if a patients blood glucose is >250 mg/dl at the start of exercise

Answer 27

postpone exercise
-may lead to induced hyperglycemia
-glucagon release combined with hyperglycemia can result in ketone bodies and ketoacidosis

Question 28

If a patients blood sugar is less than 100 mg/dl prior to exercise

Answer 28

take a snack before beginning

Question 29

Other insulin considerations for exercise

Answer 29

increased absorption if insulin is injected into exercising region
faster onset of action: increasing risk of hypoglycemia
patients are often instructed to rotate injection sites

Question 30

Can lifestyle modifications change or prevent the onset of type2 diabetes in high risk adults?

Answer 30

yes