FINAL/CH8- Diabetes Flashcards
clinical name for diabetes
diabetes mellitus
diabetes mellitus
group of metabolic diseases characterized by inability to produce sufficient amounts of insulin OR inability to use it properly
result of diabetes
hyperglycemia (elevated blood glucose)
hyperglycemia
elevated blood glucose
scope of diabetes
-34 million in the US have diabetes
-88 million have prediabetes
-CDC considers diabetes epidemic in US
-7th leading cause of death in US
3 reasons for diabetes epidemic
-increasing overweight and obesity
-increasing sedentary lifestyle
-poor eating practices
where is insulin secreted from
cells in Islets of Langerhans (pancreas)
insulin does what
promotes tissue storage of glucose, amino acids, + fats
-helps us utilize carbohydrates as a substrate
type 1 diabetes
lack of insulin production
-NOT PREVENTABLE
type 2 diabetes
ineffective insulin (sometimes coupled with low insulin production)
-PREVENTABLE
which diabetes is preventable
type 2
which diabetes is not preventable
type 1
2 subcategories of type 1 diabetes
-immune-mediated (aka juvenile onset)
-idiopathic
immune-mediated type 1 diabetes (aka juvenile onset)
-cause: beta-cell destruction leading to insulin deficiency
-considered an autoimmune disease
-onset typically in childhood or adolescence
-requires exogenous insulin (injection or pump)
idiopathic type 1 diabetes
-cause: unknown
-can occur at any time during the lifespan
-much less common
idiopathic
what we call a condition that doesn’t fit the normal description of how it normally presents
-occurs within many different diagnosis
-example: someone gets diagnosed at later age in life with no explanation as to why
type 2 diabetes pathophysiology
-multifactoral cause, typically a combination of genetics + lifestyle
-insulin resistance + progressive loss in insulin secretion
-peripheral tissues become less sensitive to insulin
-declining beta cell function
type 2 diabetes was formally called what
adult-onset diabetes
-typical onset was 40+ years old but now seeing children with type 2
what is the most common form of diabetes
type 2
-90-95% of diabetes cases
gestational diabetes mellitus
diagnosed in 2nd or 3rd trimester of pregnancy via oral glucose challenge
-typically resolves following childbirth
-greater likelihood of developing type 2 later in life
what is used to diagnose gestational diabetes mellitus
oral glucose challenge
oral glucose challenge
-pt drinks a bottle of glucose drink + chugs as fast as possible
-after an hour from drinking, take a blood draw
-another hour after, take another blood draw
-we are looking for how well the body clears excess glucose over time after consuming very high sugar bolus
-also used to diagnose pts without signs/symptoms
what will a mother with gestational diabetes mellitus have to do throughout pregnancy after diagnosis
limit excess carbs, focus on complex carbs that won’t skyrocket blood glucose, etc.
-very uncommon to prescribe insulin to a pregnant woman, because this diagnosis can be monitored via change in behaviors alone
-also this diabetes goes away after childbirth
dangers of gestational diabetes mellitus
-baby is more likely to be preterm (one of the very last things to develop is lungs, so this is very dangerous to give birth preterm since lungs may not be developed yet)
-baby is likely to be chubby/excess weight (bigger baby is harder to push and more likely to have a c-section)
-if mom had this diabetes, she + THE BABY is at increased risk for type 2 diabetes later in life
other types of diabetes
-account for very small proportion of all diagnosed cases
-caused by reasons other than those for type 1/2 (ex: certain diseases, injuries, genetic syndromes)
-ex: someone is in a car accident with organ damage to pancreas where beta cells are ineffective + not secreting insulin)
primary issue of diabetes
hyperglycemia
signs/symptoms of uncontrolled diabetes (above pt’s glycemic goal)
-dehydration
-increased urine production
-headache
-weakness
-fatigue
how to controll uncontrolled diabetes
-hydrate with non-carb beverages (sugar free)
-regular monitoring of blood glucose
-medication
what 2 things can uncontrolled diabetes (above glycemic goal) lead to
-diabetic ketoacidosis
WHICH CAN LEAD TO…
-hyperosmolar nonketotic syndrome
WHICH CAN LEAD TO DEATH
why do we see dehydration/increased urine in uncontrolled diabetes
when you have chronically elevated glucose, kidneys try to filter as much as possible
-urine would have high levels of sugar
diabetic ketoacidosis
-poorly controlled diabetes with low/no effective insulin
-formation of ketones from ineffective fat metabolism
-fat metabolism is considered to be incomplete- body still can’t even use the fat as a proper source of energy + all together our body becomes more acidic
-pH goes down, enzymes can’t function properly, etc.
hyperosmolar nonketotic syndrome
-profound + prolonged hyperglycemia typically leads to illness, stress, or undiagnosed diabetes
-severe dehydration, decreased mentation, possible coma
-diabetic shock or diabetic coma
-start to see brain effects, due to brains use of carbs
other complications of diabetes
hypoglycemia
-too much insulin or selected antidiabetic oral agent
-too little carbohydrate intake
-missed meals
-excessive/poorly planned exercise
3 chronic complications of diabetes
-macrovascular
-microvascular
-neuropathy
chronic complications of diabetes- macrovascular
large-vessel disease of coronary arteries, cerebrum, + peripheries
-can result in PAD, intermittent claudication, exercise intolerance
chronic complications of diabetes- microvascular
small-vessel disease of eyes + kidneys
-can result in blindness + end-stage renal failure
chronic complications of diabetes- neuropathy
affecting both the peripheral + autonomic systems
peripheral neuropathy
burning, tingling, or loss of sensation in hands/feet
-“diabetic foot”- because diabetics have vascular issues, periphery is not getting adequate circulation, so when they scrape/cut their foot it won’t get adequate circulation, can get infected, + become gangrene
-common for diabetics to have amputations due to chronic vascular complications
autonomic neuropathy
nerve damage resulting in system dysfunction
-presents as abnormal HR, BP, etc.
signs + symptoms of diabetes
-polydispia
-polyuria
-unexplained weight loss
-infections/cuts that are slow to heal
-blurry vision
-fatigue
polydispia
excessive thirst
polyuria
frequent urination
does everyone with diabetes experience signs/symptoms
no
-25% with diabetes don’t even know it
diabetes- medical history review
-exercise participation + training status
-BW + BMI
-laboratory values for A1C, plasma glucose, lipids, + proteinuria
-other non-diabetes-related health issues
diabetes- physical exam
presence of chronic complications
-poor eyesight, neuropathy, etc.
A1c
the % of hemoglobin that has sugar attached to it
-ex: 5.7% would mean that 5.7% of hemoglobin has sugar attached to it
stepwise progression of diagnosing diabetes
fasting plasma glucose -> glucose bolus -> subsequent tests from there like A1c
-know there can be prediabetes before full blown diabetes
diabetes treatment
-exercise
-medical nutrition therapy (MNT)
-self-monitoring of blood glucose
-diabetes self-management education
-medication
medical nutrition therapy (MNT)
may ultimately focus on large weight loss from a complete meal replacement diet or bariatric surgery
diabetes self-management education
delivered by a certified diabetes educator (can also be a CEP who is certified)
is exercise testing necessary for diabetes?
-according to ACSM, yes BUT it may not be necessary for those with well-controlled diabetes who have no other major risk factors
-may be beneficial if exercise training intensity is planned to be vigorous (>60% of peak VO2)
-may be necessary to develop baseline measures used to inform ExRx
exercise testing for diabetes
-similar to standardized testing
-treadmill or ergometer recommended for mode
-adjust workload/intensity appropriately
-modify for physical limiations (amputations, neuropathy, etc.)
special considerations for GXT + ExRx- influence of chronic complications
-macrovascular disease (heart + peripheral vasculature)
-peripheral neuropathy
-autonomic neuropathy (reduced HR, BP, + blood flow redistribution control)
PRIOR to each exercise testing/training session the CEP may inquire about
-starting blood glucose level (self-monitored)
-timing, amount, + type of recent food intake
-medication use + timing
ExRx for diabetic pts
-start with a program that is doable for pt then progress
-at the absolute minimum program should include:
-CR
* 10 min per bout of exercise
* 2-3 days per week
-resistance training
* 2-3 days per week
-flexibility/balance
* as often as possible
physioloigcal adaptations + benefits of ACUTE exercise for diabetics
-improves blood glucose values
-sustains post-exercise blood glucose control
-increases skeletal muscle glucose utilization
physiological adaptations + benefits of CHRONIC exercise for diabetics
-improved overall metabolic control (blood glucose, insulin resistance)
-BP control + reduced hypertension risk
-blood lipid improvements
-reduced body fat + increased lean body mass
-weight loss + improved weight maintenance
-delay/prevention of type 2 diabetes in those at risk
-psycholoigcal benefits (reduced stress + depression, improved self-esteem)
effects of training
-improved glucose tolerance was seen in as little as 7 consecutive days of training in subjects with early type 2 diabetes
-BUT the effect of exercise on insulin action is lost within a few days, indicating consistent exericise participation is important
-epidemiological evidence supports the role of exercise in preventing type 2 diabetes
