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PHTH 536 - Body Systems > Endocrine - Diabetes & Obesity > Flashcards

Endocrine - Diabetes & Obesity Flashcards

1
Q

Type 1 - Diabetes

Type 1 accounts for what percentage of diabetes?

A

5-10%

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2
Q

Type 1 - Diabetes

What age does it usually start?

A

generally quick in ages 25 or younger

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3
Q

Type 1 - Diabetes

What is the mechanism of disease?

A

The autoimmune destructs beta cells in the pancreas = lack of insulin

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4
Q

Type 1 - Diabetes

What is the management?

A
  • Insuline injections
  • Diet
  • Exercise
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5
Q

Type 1 - Diabetes

What is it often called?

A

“Insulin dependent” or “juvenile diabetes”

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6
Q

Type 2 - Diabetes

Type 2 accounts for what percentages of diabetes?

A

Accounts for 90%+ of all cases

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7
Q

Type 2 - Diabetes

What age does it usually start?

A

Gradual onset over time
- around 45+ y/o when diagnosed

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8
Q

Type 2 - Diabetes

What is the mechanism of disease?

A

Characterized by insulin resistance = insulin deficiency
- leads to progressive decline in beta cell function over time

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9
Q

Type 2 - Diabetes

What is the management?

A
  • diet
  • exercise
  • weight loss
  • oral meds
  • in some cases insulin injections
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10
Q

Type 2 - Diabetes

What is it often called?

A

“non-insulin dependent” or “adult onset”

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11
Q

What is the prevalence in the U.S?

A

~ 37+ million people have diabetes (11%)
~ 8.5 milly are undiagnosed (3%)

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12
Q

What age is prevalence in the U.S?

A

29% of adults are over 65 y.o

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13
Q

Limb loss

What is the percentage of people with diabetes suffer from diabetic ulcer?

A

10-15% experience a diabetic ulcer at some point in time = increased risk

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14
Q

Limb loss

What is the percentage undergo re-amputation?

A

who undergo amputation - 60% will need re-amputation
- 26% within a year following initial surgery

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14
Q

Limb loss

What is the healing time?

A

3-20 months

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15
Q

What is the criteria to diagnose diabetes?

A
  • A1C (gold standard)
  • Fasting plasma glucose
  • Oral glucose tolerance test
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16
Q

A1C

What is normal?

A

< 5.7%

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17
Q

A1C

What is pre-diabetic?

A

5.7 - 6.4%

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18
Q

A1C

What is diabetic?

A

6.5% or >

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19
Q

Fasting plasma glucose

What is normal?

A

< 100 mg/dL

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20
Q

Fasting plasma glucose

What is pre-diabetic?

A

100-125 mg/dL

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21
Q

Fasting plasma glucose

What is diabetic?

A

126 mg/dL or >

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22
Q

Oral glucose tolerance test

What is normal?

A

< 140 mg/dL

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23
Q

This number is for Oral Glucose Tolerance Test

What is pre-diabetic?

A

140-199 mg/dL

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24
Q

This number is for Oral Glucose Tolerance test

A

200 mg/dL

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25
Q

What are the risk factors for diabetes?

A
  • smoking
  • 1st degree relative
  • hx of CV disease
  • hx of hypertension
  • hx of hyperlipidemia
  • physical inactivity
  • 45 y/o or older
  • women: polycystic ovarian syndrome or gestational diabetes
  • overweight and obese
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26
Q

Gestational Diabetes

What is the mechanism of disease?

A

Increased insuline resistance contributes to increase blood glucose levels

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27
Q

Gestational Diabetes

When is it diagnosed?

A

commonly later 1/2 of pregnancy

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28
Q

Gestational Diabetes

What is the prevalence?

A

8 out of 100 women will develop GDM

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29
Q

Gestational Diabetes

What increases the rate?

A

With higher BMI

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30
Q

Gestational Diabetes

If sx persist > 6-8 weeks, what happens?

A

medical management will continue and reclassify the dx has DMII

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31
Q

Gestational Diabetes

If the mom is diagnosed, what occurs with the baby?

A

Tend to be larger (macrosomia) = potentially affect delivery

32
Q

Gestational Diabetes

What is the post-delivery complications for the baby?

A
  • Respiratory issues
  • jaundice
  • hypoglycemia
33
Q

Obesity

What is the prevalence for children?

A

2-19 y/o
- 19% obesity prevalence

34
Q

Obesity

What is the prevalence for adults

A

20+ y/o
- 42% = obesity
- 9% = severe obesity
- 15% = DM

35
Q

Obesity

What is the percentage of race that is affected?

A

Black - 50%
Hispanic - 45%
White - 41%
Asian - 16%

36
Q

Obesity

What are the factors related to obesity?

A
  • dietary factors
  • physical activity level
  • reduced physical activity in occupation or recreationally
  • genetics
  • metabolic medical conditions (hypothyroidism, cushing syndrome, PCOS)
  • Poor sleep
  • prenatal and early postnatal environmental factors
  • medications
37
Q

Obesity

How does obesity affect the cardiovascular system?

A
  • HTN
  • CAD
  • high cholesterol
  • left ventricle dysfunction
  • cardiomyopathy
38
Q

Obesity

How does obesity affect the pulmonary system?

A
  • restrictive lung dysfunction
  • obstructive sleep apnea
39
Q

Obesity

How does obesity affect the gastrointestinal system?

A
  • GERD
  • gallstones
  • fatty liver disease
40
Q

Obesity

How does obesity affect the musculoskeletal system?

A
  • OA in WB joints
  • plantar fasciitis
  • altered biomechanics
41
Q

Obesity

How does obesity affect the cancer?

A

increased risk and incidence:
- breast
- prostate
- colon
- endometrial
- gall bladder
- thyroid

42
Q

Obesity

How does obesity affect type 2 diabetes?

A

Insulin resistance

43
Q

Obesity treatment

What is a stepped-care approach?

A

Level of intervention based on severity of obesity

44
Q

Obesity treatment

What is the goals?

A

Loss of adipose tissue while keeping fat-free mass to:
- improve physical function
- reduce CV risk
- improve cardiorespiratory fitness

45
Q

Obesity treatment

What is the % of weight to make an effect?

A

5-10% of baseline weight to make clinically significant effects
- diet modification while being consistent

46
Q

Obesity treatment

How does exercise affect with treatment?

A
  • Movement is key
  • effective toward improving health benefits
47
Q

Obesity treatment

What is the medical management?

A
  • bariatric surgery
  • pharmacologic options
48
Q

Metabolic syndrome

What are the 5 risk factors?

A
  • abdominal obesity
  • high triglyceride level
  • low HDL
  • elevated blood pressure
  • elevated fasting blood glucose

3 or more confirms diagnosis = increased risk for heart disease, diabetes and stroke

49
Q

Metabolic syndrome

How is abdominal obesity determined?

A
  • waist circumference (men > 40 in / female 35 in)
  • waist to hip ratio (men >.90 / women >.85 or lower / BMI >30kg/m2)
50
Q

Metabolic syndrome

What is indicated for high triglyceride level?

A

≥ 150 mg/dL

51
Q

Metabolic syndrome

What is the ratio for low HDL?

A

women = < 50 mg/dL
men = < 40 mg/dL

52
Q

Metabolic syndrome

What is indicated as elevated blood pressure?

A

Systolic BP ≥ 130 mmHg
Diastolic BP ≥ 85 mmHg

53
Q

Metabolic syndrome

What is the ratio for elevated fasting blood glucose?

A

> 100 mg/dL

54
Q

What is the medical management for diabetes?

A

lifestyle changes
nutrition management
exercise/physical activity
medications
blood sugar monitoring

55
Q

What are the signs and sx of diabetes?

A
  • polyuria
  • polydipsia
  • extreme hunger and fatigue
  • blurry vision
  • irritability
  • cuts/bruises that are slow to heal
  • frequent infections
  • unusual weight loss
  • tingling, pain, numbness in hands/feet
56
Q

What are the complications of diabetes?

A
  • integumentary system
  • eye complications
  • CVA
  • nephropathy
  • CV system
  • ketoacidosis
57
Q

Complications of DM

What are the sx seen in the integumentary system?

A

skin infections
changes in color
and/or wounds

58
Q

Complications of DM

What are the eye complications associated?

A

glaucoma
cataracts
retinopathy

59
Q

What is ketoacidosis?

A

When the body can’t produce enough insulin = ketones are made at a high level

This is a medical emergency that needs immediate medical attention

60
Q

What are the symptoms of ketoacidosis?

A

confusion
dehydration
dry mouth
frequent urination
abdominal pain
coma and potential death

61
Q

Neuropathy

How is neuropathy defined as?

A

defined as any disease of the nerves (can occur in any nerve but usually peripheral)
- most common in diabetes as “diabetic neuropathy”

62
Q

Neuropathy

What is the cause of neuropathy?

A

poor understanding - probably related to high glucose levels in the blood

63
Q

Neuropathy

What is the most common location?

A

In the distal LE/foot

64
Q

Neuropathy

How does neuropathy progress?

A

estimates are ~15% of people with DM will turn to ulcers
- people with DM are 40x more likely to have an amputation because of poor wound healing

65
Q

Neuropathy

Where do ulcers most commonly happens?

A

most often on WB surfaces over bony prominences with poor blood supply

66
Q

What are some diabetic neuropathy subjective scales?

A

Neuropathy symptom scale
modified NSS
Michigan neuropathy screening instrument
diabetic neuropathy symptom score (DNS)

67
Q

What are the DNS items?

A

Unsteadiness walking - 1 = present

numbness on legs or feet - 1= present

burning, aching or tenderness in feet or LEs - 1 = present

prickling pain sensation at legs or feet - 1 = present

68
Q

What should we look for with cardiovascular examination?

A
  • vitals
  • observation
  • edema measurement
  • circulation
69
Q

How is pain rated?

A

pain rating scale

resting pain, pain with activities and changes over time

claudication scale

walking impairment questionnaire - commonly used for claudication

70
Q

What test is the simplest and best for balance with diabetes?

A

unilateral single leg stance

71
Q

How many times should the SLS be repeated?

A

Repeat test 3 times on each limb and average times

72
Q

What is indicated for fall-risk for older adults?

A

High-fall risk when SLS is maintained < 6.5 seconds

Normative SLS by age group/time

73
Q

What is the predictive score of falls for 30 sec sit to stand?

A

≤ 14 reps

Normative values by age group/time

74
Q

What are the common gait deviations?

A
  • reduced gait speed
  • mobility
  • strength
  • shortened step length
  • shortened stride length
  • widened stance width
  • double limb support time is increased
75
Q

Gait deviation

How is mobility affected?

A

Reduced ankle mobility = hip circumduction and increased knee flexion

76
Q

Gait deviation

How is strength affected?

A

Decreased PF propulsion = compensatory recuitment and increase use of hip flexors to advance LE

77
Q

What is the plan of care?

A
  • Patient education
  • Manual therapy techniques
  • Balance, gait and resistive training
  • Modalities

PHTH 536 - Body Systems (28 decks)

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