Diabetes Mellitus Flashcards
What is Diabetes Mellitus?
- Diabetes mellitus is a chronic condition that results in problems with carbohydrate, protein and fat metabolism
The metabolism problems associated with diabetes mellitus result from an imbalance caused by the body’s inability to make or to use insulin
Normally, insulin is produced in the pancreas and helps to utilize sử dụng glucose which is the body’s main source of fuel
With diabetes, the body is unable to transport glucose into fat and muscle cells which results in very high levels of glucose in the blood (hyperglycemia tăng đường huyết) and ultimately, the starvation sự đói khát and increased breakdown of the fat and muscle cells
There are several types of diabetes, the most common being diabetes mellitus. The metabolic imbalances that are present with diabetes can affect almost all systems and tissues of the body
Insulin Production & Glucose Levels
Normally, insulin and blood glucose levels rise within minutes of a meal, peak đỉnh cao about 30 mins after eating and return to baseline with 3 hours
Some glucose is used by skeletal muscles or fat cells and large amounts are taken up by the liver for storage
Between meals, insulin levels are low
Sources of stored glucose and amino acids are mobilized to supply the energy needs of glucose-dependent tissue such as the brain
When insulin production is impaired, the glucose remains in the blood
Because the liver has taken in no new glucose, it release more into the circulation which further increases the blood sugar levels, resulting in hyperglycemia tăng đường huyết
Type I Diabetes Mellitus
- Type I Insulin Dependent Diabetes Mellitus:
IDDM or juvenile Q vị thành niên diabetes
Usually associated with a dysfunction in the pancreas resulting in an absolute deficiency of insulin
- Those at Risk of Having Type I:
It may occur at any age, but it mostly affects children or young adults
There is some suggestion that the cause may be viral
There is usually a family history of diabetes
Symptom Picture of Type I Diabetes Mellitus
The onset is often abrupt đột ngột with extreme symptoms including:
- Frequent urination (polyuria)
- Glucose and ketones in urine (glycosuria and ketonuria)
- Excessive thirst (polydipsia)
- Extreme hunger (polyphagia)
- Unusual weight loss with normal or increased eating
- Extreme fatigue
- Irritability Cáu gắt
- Sweet-smelling breath
- Nausea or vomiting ( the blood supply to the GI not enough)
- Blood sugar levels fluctuate dao động often and include very high levels and very low levels, either can have potentially serious medical consequences
Type II Diabetes Mellitus
- Type II Non- Insulin Dependent Diabetes Mellitus:
NIDDM
When the pancreas produces inadequate insulin or when the body is unable to utilize the insulin produced
This type of diabetes is often linked to poor diet
Those at Risk of Having Type II
Adults, usually after age 45
People who are overweight
People with a family history of diabetes mellitus
Physically inactive people
Certain racial chủng tộc origins
Those with a previous diagnosis of impaired glucose
Symptom Picture of Type II Diabetes Mellitus
This type of diabetes has a gradual onset so many people are asymptomatic. Symptoms that do manifest rõ ràng include:
Any symptoms of IDDM
Frequent infections
Slow-healing cuts and bruises
Tingling or numbness in the hands or feet
Recurring Định kỳ skin, gum or bladder infections
Blurred vision
Type II diabetes is fairly stable and easy to control
Other Types of Diabetes
- Impaired Glucose Tolerance Suy giảm dung nạp:
Another classification of diabetes that is considered a latent form of diabetes that may ultimately lead to diabetes mellitus
In this type, levels and utilization sự tận dụng of glucose are not quite that of a person with diabetes, yet not quite healthy
- Gestational Diabetes Mellitus (GDM) Bệnh tiểu đường thai kỳ :
A temporary diabetes with the onset during pregnancy
It affects one out of every 20 women and creates an increased risk for perinatal complications
While it resolves after delivery, 40% of those with GDM will develop Type II NIDDM in the following 5-10 years
Complication of Diabetes Mellitus
- Ketoacidosis (lot of fat less carb):
A complication of Type I IDDM and gestational diabetes which often occurs before a diagnosis of the diabetes has been made
It has a gradual onset and a prolonged recovery
It occurs when sodium, potassium and ketones are lost in the urine
It begins with a state of hyperglycemia tăng đường huyết which builds over a period of hours or a day which is often secondary to an emotional or physical stress, when the body’s requirement for insulin in high
Because the need of the body cannot be met, the blood sugar levels increase
Dehydration and electrolyte imbalance follow, fats are broken down to liberate giải phóng glucose and ketones are produced in the process
Ketones form in the blood rapidly resulting in the potentially serious condition of ketoacidosis
Symptoms include warm, dry skin, tachycardia, hypotension, fruity smell of ketones on breath. Depression of the CNS, lethargy hôn mê, vomiting, abdominal pain, stupor sững sờ and coma hôn mê
Hyperosmolar Nonketotic Coma
Hôn mê tăng thẩm thấu không nhiễm ceton
The onset is often insidious xảo quyệt, taking from one day to two weeks
An initial hyperglycemia tăng đường huyết episode occurs, brought on by a resistance to the effects of insulin and an excessive carbohydrate intake
The resulting blood serum is “hyperosmotic” siêu thẩm thấu or highly concentrated with glucose
It draws fluid from the interstitial tissue which is then lost through the kidneys with increased urination
As serious amounts of fluids are lost, the person becomes extremely thirsty, drinking copious dồi dào amounts
Initial symptoms include extreme thirst, excessive urination, severe dehydration, dry skin and lethargy progressing to coma and seizures
In the elderly, this type of coma may be mistaken for a stroke
Hypoglycemia Hạ đường huyết
An insulin reaction that usually occurs in insulin-dependent diabetes or may be an early sign of diabetes
Can cause CNS problems such as HA (headache), numbness of the lips and tongue, blurred vision, slurred speech, confusion, euphoria, difficulty problem solving and impaired motor function
Initially there is hypotension and feelings of hunger leading to emotional changes, nervousness and irritability, tachycardia, shaking, sweating and constriction of the peripheral vasculature causing cool, clammy skin
- Long Term Complications:
- Infection:
Over time, there is a decrease in the individual’s tissue health
There is poor healing time, decreased peripheral sensation due to nerve damage, infection and tissue breakdown leading to ulcers and gangrene
If the blood sugar levels are not controlled, those with diabetes have an increased risk of infection in the lower extremities
- Peripheral Neuropathy:
Affects about half of those with diabetes
The feet are often at risk
One hypothesis as to why distal peripheral and cranial nerves are affected by diabetes is that microcirculation in the nerves is affected as the axon travels increasingly distal from the cell body
The nutrition to the fibres is affected, resulting in increasing necrosis of fibres as the nerve travels distally
- Peripheral Neuropathy-Distal symmetrical neuropathy:
The most common form of neuropathy
With impaired circulation and sensory losses, an injury to the foot may be painless and then ulcerate loét
- Peripheral Neuropathy-Diabetic radiculopathy and polyradiculopathy (bệnh lý rễ thần kinh và bệnh đa rễ thần kinh):
Common in long-standing cases of diabetes mellitus
May be confused with a nerve root compression
Usually thoracic and lumbar roots are affected
Acute burning pain and supersensitivity of the skin occur unilaterally in the trunk
Minimal sensory loss and weakness are experienced
Pain reaches a maximum level within weeks of inset, persists for several months and then gradually resolves completely
- Peripheral Neuropathy-Plexopathy Bệnh thần kinh ngoại biên-bệnh đám rối:
Usually affects older people
Sets in rapidly over days to a few weeks
Pain is in the anterior thigh with minimal sensory loss
This is followed by reduced or absent knee flexion and buckling of the knee due to quadriceps weakness and atrophy
The maximum weakness is reached in a few weeks then stabilizes for weeks to years and improves over months to years
- Peripheral Neuropathy-Compression syndromes:
Carpal tunnel syndrome, ulnar neuropathy at the elbow and peroneal neuropathy at the fibular head are more common in those with diabetes
- Peripheral Neuropathy-Retinopathy Bệnh lý thần kinh-võng mạc:
Loss or impairment of vision due to damage of the microcirculation to the eyes
Medical Treatment of Diabetes
Treatment of the disease will often cause anxiety in the person because of the need for regular food monitoring, blood sugar testing and insulin injections
Many people experience depression
Contraindications
- If a client with diabetes arrives for a tx in a confused or lethargic hôn mê state or exhibits changes in mental function, massage is CI’d
- If a client has a hypoglycemic hạ đường huyết attack during tx, rapidly utilized carbohydrates are administered and the massage is discontinued
- Care must be taken when doing slow, deep diaphragmatic breathing with those who have IDDM and with anyone with diabetes who is susceptible to ketoacidosis. Diaphragmatic breathing may change insulin levels
- If the client has hypertension or cardiac complications, refer to the appropriate chapter
- If a peripheral nerve lesion or compression syndrome is present, see the appropriate chapter for contraindications
- If a decubitus ulcer or gangrene chứng hoại thư is present, local and distal massage is CI’d
- If deep cracks are observed on the heels of the feet, the therapist should avoid using oil in this area as it may provide an avenue for infection
- Tissue health throughout the body must be considered, with technique pressure modified accordingly
- Hydrotherapy extremes are CI’d in caution of the possibility of decreased tissue health and sensory losses
Health History Questions
- What is your general health?
- When was the diabetes diagnosed? What type is it?
- How is your diabetes controlled? If through insulin use, where are your old and current injection sites?
- Is your diabetes stable?
- Do you have a tendency to hypoglycemia? If so, what are your specific symptoms? How frequent are the episodes?
- Are blood sugar levels checked regularly?
- When was your most recent crisis?
- Do you have a stable diet and regular sleeping habits?
- Do you exercise and does that change your insulin requirements?
- Is there any indication of peripheral neuropathy?
- Is fainting or postural lightheadedness experienced that may be a concern for the client getting off the table
Massage
- It is appropriate and recommended that the client’s physician be consulted with the client’s permission if:
- The diabetes is long standing with cardiac and kidney complications
- If the client’s insulin levels are unstable (often with IDDM)
- If the client is not compliant tuân thủ with medication use or food and alcohol intake restrictions
- Positioning is according to client comfort
- Hydrotherapy is modified according to complications
- If the client’s insulin levels are stable, a relaxation massage is appropriate because stress can destabilize blood sugar levels
- The therapist must consider any complications and modify the treatment accordingly
- Unhealthy tissue and edema are addressed if present
Improving circulation and drainage to susceptible dễ bị tổn thương tissue is important
Self-Care
Relaxation strategies such as deep breathing, meditation and visualization hình dung are appropriate
Referral to the local diabetes association
Educate the client about tissue health and decubitus ulcer concern
