Endocrine, Metabolic, and Nutritional Disorders

Question 1

Diabetes Mellitus (DM)

Answer 1

Is an autoimmune condition. The body destroys its own pancreatic beta cells, which produce insulin.

T1DM: idiopathic.
T2DM: most common, unknown etiology but genetic factors, pt’s have a resistance to insulin and an altered response to glucose, causing hyperglycemia.

Hypoglycemia: blood sugar <70mg/dL
Hyperglycemia: blood sugar >130mg/dL

Question 2

Diabetes Mellitus: Si and Sy

Answer 2

Similar in T1 and T2, however, T1 symptoms tend to occur suddenly and can be severe, whereas T2 symptoms develop gradually over months or years.

Complications:
> Diabetic neuropathy.
> Diabetic amyotrophy.
> Eye problems: glaucoma, retinopathy, cataracts.
> Renal disease.
> Cardiac and vascular diseases.
> Bone disease: OP

Question 3

Diabetes Mellitus: PT intervention

Answer 3

> Exercise program consisting of low to moderate resistive ex’s and aerobic ex’s 3-5 times/week.
PT specialize in orthotics and work with the podiatrist.
Ambulation.
Most of PT is for associated problems that develop secondary to DM.

Question 4

Diabetes Mellitus: PT advice for the DM pt

Answer 4

1. Exercise regularly, particularly aerobic exercise (walking).
2. Wear shoes with plenty of room for toes. Shouldn’t be tight.
3. Do NOT wear socks that are tight around the lower leg or knee.
4. Check feet daily. Any signs of redness, rubbing, or other skin irritation should be reported.
5. Visit a podiatrist regularly.
6. Eat a balanced diet and try to control weight.
7. Test blood sugar levels regularly.
8. Follow all medical advice.
9. Dry feet well after bathing to prevent skin irritation and breakdown.
10. Use a bed cradle at night to keep weight of bedclothes off feet.
11. Use light-weight bed clothes that are not tucked in.
12. Use an assistive device to walk when balance is poor.
13. Exercise more in the morning than the afternoon to prevent hyperglycemic episodes during the night.
14. Do NOT exercise alone.
15. Do NOT place your feet close to a source of heat.
16. When taking a bath, check the temp with your elbow. Water should be warm, not hot.
17. Do NOT walk around without shoes.
18. Do NOT exercise in very high or low temp’s.

Question 5

Diabetes Mellitus: precautions for the PT

Answer 5

1. Do NOT fatigue the pt with overexertion.
2. Monitor vital signs before, during, and after exercise sessions.
3. Check dorsalis pedis pulse before each treatment session.
4. Monitor pt’s for signs of hypoglycemia and hyperglycemia.
5. Beware of extreme thirst as it could be a precursor to a hyperglycemic episode.
6. When applying thermal agents, use extra insulating layers and test skin carefully.
7. When using aquatherapy, ensure pt’s have taken required insulin and have eaten correctly.
8. Keep whirlpool temp’s below body temp.
9. Warn pt’s to check glucose levels hours after their exercise session.
10. If you think a pt is hypoglycemic, administer some fruit juice as long as they are conscious. If it’s actually hypoglycemic could prevent a coma. If it’s hyperglycemic it won’t make it worse.

Question 6

Obesity: BMI

Answer 6

Normal BMI: 18.5-24.9 kg/m2
Overweight: 25-29.9 kg/m2
Class I obesity: 30-34.9 kg/m2
Class II obesity: 35-39.9 kg/m2
Class III obesity: >40 kg/m2

Question 7

Obesity: PT intervention

Answer 7

PT can play a major role in behaviour modification to increase daily exercise and activity via education.

Recommendations are start to walk for ±10’/day x 3/week and build up to 20-30’/day x 5/week.

12-minute walk/run (Cooper) test offers accurate date in obese populations.