Endocrine - Therapeutic Interventions Flashcards
Patient education
Daily foot inspection
Need for the heels to toes and in between
- use a mirror or family member for assistance
Patient education
Screening sensation
screen monthly at home using LEAP protocol
Patient education
Checking the feet
- checking shoes daily
- wash feet daily in warm water while making sure to dry completely and apply moisturizer to feet
- cut the toenails while asking the podiatrists or foot care specialists
Patient education
What is recommended to wear?
- white cotton or synthetic, soft moisture wicking socks
- wear properly constructed shoes (allowing 1/2 between toes and front of shoe)
Patient education
What do we suggest to avoid?
- walking barefoot
- use of hot water or heating pads on feet that can cause burns
What is the lower extremity amputation prevention (LEAP)?
A comprehensive program that can aide to decrease risk factors to prevent amputation in people with loss of protective sensation
What are the components of LEAP?
- Annual foot screening
- Patient education
- daily foot inspection
- footwear selection
- management of simple foot problems
What is the primary goal to help in wound healing?
Pressure offloading to relieve abnormal pressures that is applied to an ulcer
What is the total contact casting?
Molded plaster cast = helps pressure to be equally distributed to the entire LE
What is suggested to off-load the pressure over the surface of the ulcer?
Modified shoes and application of dressing
When does charcot foot occur?
With severe peripheral neuropathy and repeated trauma
What is the sx of charcot foot?
- loss of protective sensation = abnormal response to repeated injury and severe destruction
- unilateral observation = red, hot, swollen, flat and profound deformity
Charcot Foot - Stages of Development
Stage 0
inflammatory period
- onset of warmth, swelling, pain
Charcot Foot - Stages of Development
Stage 1
destruction period
- ligaments are weak
- joints sublux and/or dislocation
Charcot Foot - Stages of Development
Stage 2
Formation of bone callus
consolidation of fractures
Charcot Foot - Stages of Development
Stage 3
fixed deformity adn instability
What are the benefits of exercise?
- improve glycemic control
- improve body composition and weight reduction
- decrease hyperlipidemia and HTN
- slows down CVD development
- reduced stress
- improve well-being and QOL
What are the considerations for exercise?
- consider any comorbidities and physical changes
- consider baseline exercise abilities and progress if needed
ACSM guidelines
How is the frequency changed in different exercise types?
aerobic
- no more than 2 days consecutive w/o activity
resistance
- preferred 3 days/wks
- min 2 non-consecutive days
flexibility and balance
- > 2-3 days/wk
- for both
ACSM guidelines
How is intensity changed in different exercise types?
Aerobic
- mod to vigorous based on subjective
resistance
- mod (50-68% of 1RM) to vigorous (70-85% of 1RM)
flexible and balance
- stretch to point of tightness or slight discomfort
- balance exercise light-mod intensity
ACSM guidelines
How is time changed in different exercise types?
Aerobic
- T1DM and T2DM 150 min/wk
- at mod-vigorous intensity
resistance
- 8-10 exercises @ 1-3 sets
- 10-15 reps to near fatigue per set
flexibility and balance
- static stretch holds for 10-30 sec and 2-4 reps per stretch
- balance = any duration
ACSM guidelines
How is type changed in different exercise types?
aerobic
- prolonged
- rhythmic activities using large muscle groups
resistance
- resistance machines and/or free weights
*flexibility and balance *
- static
- dynamic
- other stretching
- yoga
Relative contraindications
What to do with blood glucose levels with 70-100 mg/dL
Get a snack
- 15g carbs every hour for mild-mod intensity
- 25-50g with mod-vigorous intensity
- hydration
Relative contraindications
What to do with blood glucose levels with 100-300 mg/dL
Proceed to exercise
- strenuous activity or long-duration (>1-2hrs) needs increased carb intake
- hydration
Relative contraindications
What to do with blood glucose levels with >300 mg/dL and on oral meds
Trial of 10-15 min of activity then recheck blood glucose
- if BG rises = stop
- if BG drops = continue and check every 10-15 mins
Relative contraindications
What to do with blood glucose levels with >300 mg/dL and on insulin
Check for ketones
- (+) = stop activity
- (-) = activity with close BG monitor every 10-15 min
Absolute contractindications
What is the value of hypoglycemia that is a contraindication?
< 70 mg/dL
Absolute contraindications
What is the sx of hypoglycemia?
- shakiness
- dizziness
- sweating
- hunger
- headache
- pale skin
- behavior changes
- clumsy/jerky movements
- seizure
- tingling sensation around the mouth
Absolute contraindications
What is the value of hyperglycemia that is a contraindication?
over 300 mg/dL with ketones
Absolute contraindications
What is the sx of hyperglycemia?
SOB
breath smells fruity
nausea and vomiting
very dry mouth
What is the most common acute concern for exercise?
hypoglycemia
What is the more severe sx of hypoglycemia?
- headache
- visual disturbances
- mental dullness
- confusion
- amnesia
- seizures
- coma
When do episodes occur during exercise for hypoglycemia?
most commonly during and right after exercise but can go up to 12+ hours post exercise
people need to monitor properly to eat or medications to manage sx
With people with diabetes, what do they need to be aware of?
Hypoglycemia - during, right after or up to at least 24 hours after
What is “balancing act” for diabetes and exercise?
To balance between insulin adminstration, food intake and exercise
What are the benefits of exercise for diabetes?
plays a central role in management of disease
- effects on glycemic control and weight loss
