Diabetes mellitus (DM) Flashcards
main issue in diabetes is a problem with
the body’s production and/or utilization of the
hormone insulin
long-term complications of DM are severe including
cardiovascular, renal and retinal
disease
most common cause of peripheral neuropathy
DM characterized by
elevated levels of glucose in the blood (hyperglycemia) and in the urine
(glycosuria)
a wide range of medications used to treat DM by (3 methods)
o some replace insulin
o some increase insulin sensitivity
o some increase insulin secretion
generally _______ is more worrisome for the therapist than ________
- hypoglycemia
- hyperglycemia
Hypoglycemia (lead to insulin shock) symptoms include
Stomach pains Nervousness Hunger Sweating Weakness Continuing headaches Tachycardia Palpitations Confusion Moist and pale skin Convulsions
Hyperglycemia (lead to diabetic coma) symptoms include
Thirst Polyuria Fatigue, confusion, reduced levels of consciousness Headaches Blurred vision Nausea and vomiting Constipation Dehydration
Insulin is normally released from the
pancreatic beta cells
normal blood glucose level is
80-90 mg per 100 mL of blood
the aim of administering exogenous insulin is to
to normalize levels of blood glucose
many sources of insulin are derived from extraction from
the pancreas of the animal, (beef and pork insulin)
- widely used but can cause some allergic reactions
- synthetic form is also available
insulin would be broken down in the ______if taken orally, so ______ ______ is
preferred
GI tract
subcutaneous injection
common areas for injection include:
o abdominal wall (fastest onset of action)
o lateral arm
o around the waist and hips
o thigh
External Insulin Pumps are devices
that can be programmed to automatically release insulin
- they are worn externally and connected to the patient’s bloodstream via a catheter
- they are about the size of a deck of cards, weigh about 3 ounces and can be worn on a
belt or in a pocket
Insulin
Examples: Toronto,
NPH, lente, ultralente
- allows glucose to enter cells, which decreases blood sugar - occurs by insertion of glucose transporters (GLUT) into the cell membrane
Massage Therapy
Guidelines Insulin
- follow guidelines when working around injection sites or implanted devices. Working with old fibrous injection sites may be beneficial but likely consultation should be undertaken due to impaired tissue healing - peripheral neuropathy is common
oral hypoglycemic drugs are used to lower blood glucose levels
o sulfonylureas
o biguanides
othiazolidinediones
o alpha-glucosidases
Sulfonylureas
(Glipizide, glyburide) MoA
-increases insulin secretion by the pancreas (only effective for Type II) -
Sulfonylureas
(Glipizide, glyburide) Notable Adverse
effects
- hypoglycemia
- rarely: paresthesias
and skin rashes
Sulfonylureas
(Glipizide, glyburide) Massage Therapy
Guidelines
Hypoglycemia- as for insulin above. If patient is experiencing paresthesias, then care must be taken during stretching and deeper tissue work. =NSAIDs can increase the serum concentration of sulfonylureas, thus increasing likelihood of hypoglycemia
Biguanides
(Metformin) MoA
- decrease release of glucose by liver, decrease intestinal absorption of glucose, increase insulin sensitivity in peripheral tissues (only effective for Type II)
Biguanides
(Metformin) Notable Adverse
effects
fatigue and weakness - nausea and vomiting, bruising, flatulence, lactic acidosis (see HIV med section for definition)
Biguanides
(Metformin)
Massage Therapy
Guidelines
\: deep techniques may be a bad idea due to increased risk of bruising. Fatigue may necessitate shorter treatments. Diabetic neuropathy is common
Thiazolidinediones
(Rosiglitazone,
pioglitazone) MoA
increase sensitivity to insulin, beneficial cardiovascular lipid profiles (only effective for Type II)
Thiazolidinediones
(Rosiglitazone,
pioglitazone) Notable Adverse
effects
- edema
- headache
- anemia
- fatigue
Thiazolidinediones
(Rosiglitazone,
pioglitazone) Massage Therapy
Guidelines
\: peripheral edema may be poorly amenable to massage- if causing significant concerns, then may need medical review. Same for headache
Alpha-Glucosidase
Inhibitors
(Precose) MoA
- decreases absorption
of glucose by the
intestine
Alpha-Glucosidase
Inhibitors
(Precose) Notable Adverse
effects
Fluatulence
Alpha-Glucosidase
Inhibitors
(Precose) Massage Therapy
Guidelines
main concern is diarrhea, bloating, gas,
-encourage washroom before Tx
