Diabetes Mellitus Flashcards
Diabetes Mellitus
Defintion
A group of metabolic disorders characterized by hyperglycemia due to defective insulin action &/or secretion
Insulin helps regulate blood glucose levels by promoting glucose uptake into the liver, adipose cells, & skeletal mm for storage as glycogen
Type 1 DM
Def & Epi & Eti
Condition in which the pancreas fails to produce sufficient (or any) insulin
- Approx 5-10% of DM cases
Epi:
- Typical onset in childhood - juvenile diabetes
Etiology:
- Auto-immune abnormality that damages the islet cells of the pancreas
Type 2 DM
Def & Epi & Eti (RF)
Condition in which the pancreas fails to produce sufficient insulin as well as resistance to insulin action (inadequate utilization of insulin)
- Approx: 90-95% of cases
Epi
- Typical onset is adulthood
- More common in developed countries
Etiology (RF):
1. Secondary to many dysfunctions
2. Obesity (BMI >30) - MAIN FACTOR
3. High abdominal fat (high waist to hip ratio) - independent of obesity
4. Poor diet - excessive consumption of sugars & unhealthy fats
5. Sedentary lifestyle
Hypoglycemia
Drop in glucose <3.9 mmol/L
Commonly caused by medication that increases insulin secretion, not eating on time, restrictive caloric diets and increase PA
PA - INC insulin sensitivity -> hypoglycemia ** can even drop 17 hr after exercise
Hypoglycemia: Autonomic effects
S/S
(7)
- Sweating
- Nausea
- Tremors
- Warmth
- Anxiety
- Palpitations
- Hunger
Hypoglycemia: Neuroglycopenia effects
S/S
(8)
Decrease in blood glucose to the brain = AFFECTING the brain
- Headache
- Blurred vision
- Confusion
- Weakness
- Fatigue
- Difficulty speaking
- Seizures
- Coma
How to reduce risk of hypoglycemia w/ exercise
(7)
- Educate patient on self-monitoring S/S & how to self-manage symptoms
- Insulin injections hsould be take > 1 hr before exercise
- Avoid injecting into an exercising area (use abdominal injection site to reduce risk of hypo associated with exercise)
INC BF to exercised body part = INC risk of hypo w/ exercise - Check blood glucose levels before & after exercise
- Exercise at consistant times of the day
Preferably after a meal = INC blood glucose lvls < exercise will help uptake that glucose
Avoid exercise at night = could slip into a hypoglycemia coma - not aware of S/S while they are asleep - Keep glucose-rich snacks or drinks close by
- If <5.5 mmol/L inject 15-30g of carbohydrate
** 15:15 rule - ingest 15g of carbs, wait 15 minutes, and re-test
Hyperglycemia
Blood glucose > 11 mmol/L
Commonly caused by a lack of insulin present
Regular exercise, proper diet, and medication can prevent hypoglycemia
Hyperglycemia: S/S
(6)
- Polydipsia (increased thirst)
- Polydysphagia (frequent hunger)
- Polyuria (increased volume of urination)
- Fatigue - ** same for both (hyper & hypo)
- Blurred vision
- Delayed healing
What glucose levels are a contraindication for exercise?
> 16.7 mmol/L
The body will be using fatty acids (amino acids) / metabolizing for energy > can go into a state of Ketoacidosis
= life-threatening condition
HALLMARK sign = “fruity” breath smell
Diabetic Complications: CVD
(5)
- INC risk of CVD
- INC risk of CAD & MI (when controlling for comorbidities)
- INC risk of PVD - intermittent claudification d/t poor blood flow in L/E
- INC atherosclerotic plaque > narrowing of blood vessels (HTN) > impaired BF > ischemia of tissues & organs
Possible to have silent ischema = no S/S - **Leading cause of death in individuals w/ DM
Diabetic Complications: Peripheral Neuropathy
(7)
- Impaired function of peripheral nerves
- Insidious onset
- Affects sensory & motor neuron - often referred to as “diabetic neuropathy”
Damage to small vessels that supply the nerves - not getting adequate blood - “Glove & stocking” distribution of sensory loss or abnormal senstion - SYMMETRICAL
- May have poor balance d/t sensorimotor disturbances
- May lead to Charcot foot (also known as neuropathic arthropathy)
Bones are weak & can # - b/c of poor neuropathy they cannot feel the pain > continue to walk on it & the foot starts to become deformed - High risk of ulcers & infection may lead to amputation - insenitive foot
Diabetic Complications: Autonomic Neuropathy
(6)
- Impaired function of the peripheral nerves of the ANS
- Blunted HR & BP response to activity
- High resting HR
- Impaired peripheral vasodilation > impaired sweating > poor thermoregulation
Can overheat when they are exercising - AVOID hot & humid environments - INC incidence of orthostatic hypotension
- INC risk of post-exercise hypotension
** Very important to incorporate a longer cool-down
Diabetic Complications: Diabetic Retinopathy
(3+4)
- Damage to the retina caused by damage to the small blood vessels supplying the retina
- ** A leading cause of blindness**
- Patients must avoid activity which causes sudden increase in BP:
- Valsalva manuever
- Heavy lifting
- Strenuous U/E exercises - more pronounced sympathetic INC & vagal DEC
- Head down postures
Diabetic Complications: Nephropathy
(4)
- Kidney damage leading to loss of kidney function
- High protein concentrations in urine (protein loss)
- May lead to chronic kidney disease & kidney failure
- May require dialysis or kidney transplant
