Metabolic Conditions and Related Clinical Assessments Flashcards
What is diabetes mellitus?
Chronic conditions of elevated blood glucose (hyperglycemia).
Monitor with glucose readings with daily glucose readings and HbA1C levels through lab blood work every 3-6 months.
Type 1 Diabetes
Autoimmune destruction of beta cells in pancreas that produce insulin.
Diagnosis of Type 1
> 6.5% HbA1C
11.1 mmol/L random blood glucose or OGTT
7 mmol/L fasting blood glucose
Often diagnosed in those <35 years old and lower BMI (<25kg/m2) due to lifestyle not being a factor in the condition.
Most likely childhood.
At the higher end of numbers.
Type 2 Diabetes
Lifestyle disease from elevated glucose levels from insulin resistance (from visceral fat accumulation).
Genetic factor as well = individuals with family who have type 2 diabetes are more likely to get it themselves.
Pre-diabetes can be managed with lifestyle changes.
-progresses to needing medication and insulin shots.
Diagnosis of Type 2 Diabetes
> 6.5% HbA1C
11.1 mmol/L random blood glucose or OGTT
7 mmol/L fasting blood glucose
Normally different from T1 due to lifestyle factors influencing the conditions (ie. BMI>25kg/m2).
No weight loss
No ketoacidosis, less marked hyperglycemia to start with compared to T1
Daily Glucose Readings
Blood glucose meters
-important to monitor blood glucose levels and ensure that patients are aware of what is going on.
Continuous glucose monitoring
-measuring glucose through interstitial fluid every few minutes by externally-worn glucose sensory on the upper arm
-give reading with a scanner
Management of Diabetes
Medications
Insulin Shots
Lifestyle
Medication Management of Diabetes
Insulin sensitizers (metformin)
Insulin secretors
Obesity medications (ozempic)
Insulin Shots in the Management of Diabetes
Needed when other medicators do not meet demand to manage hyperglycemia.
Brings glucose into tissues and out of the blood.
Required for type 1 diabetes (last progression for type 2 diabetes).
Lifestyle for the Management of Diabetes
Nutrition, stress management, weight management
Exercise = increases insulin sensitivity by increasing upregulation of insulin and responsiveness of receptors into tissues.
-single bout of exercise can increase insulin sensitivty for 24-72 hours.
-caution with hypoglycemia = monitor blood glucose before and after exercise.
-blood glucose level more than 11 or 12 mmol/L on test prior to exercise = contraindication to exercise.
Clinical Assessment of Diabetes
Fasting and Random blood glucose tests
What is dyslipidemia?
Defined as abnormal lipid levels in blood.
-High levels of low-density lipoprotein (LDL) cholesterol.
-Low levels of high-density lipoprotein (HDL) cholesterol.
-High total cholesterol.
-Elevated triglyceride levels.
Can be genetic or lifestyle.
Will most likely see this condition with another one as well.
Primary Dyslipidemia
inherited and caused by genetic mutations.
Secondary Dyslipidemia
Caused by lifestyle factors or other medical conditions.
Management of Dyslipidemia
Medications
Lifestyle
Medications for the Management of Dyslipidemia
Statins
Ezetimibe
PCSK inhibitors
Lifestyle for the Management fo Dyslipidemia
Healthy diet = reducing processed foods and unhealthy saturated or trans fats.
Maintaining healthy weight = reducing visceral fat.
Quit smoking and limit alcohol consumption.
Exercise regularly = can lower LDLs and triglycerides and increase HDLs
Clinical Assessment of Dyslipidemia
Lipid panel procedure
Lab blood work
Finger prick tests
-not very common in clinic, usually done in lab
-can be completed in clinic or at home
-can take cholesterol and triglycerides in single sample
-may need multiple if trying ti distinguish between LDL and HDL levels, depending on the brand of test
What is metabolic syndrome?
Cluster of risk factors that increase risk and onset of T2D, CVD, stroke, cancer, etc.
Defined as poor glycemic control (pre-diabetes), central obesity (increased waist circumference), dyslipidemia (specifically high cholesterol, but also high triglycerides), AND hypertension.
Management of Metabolic Syndrome
Medications
Lifestyle
Medications of the Management of Metabolic Syndrome
Diabetes medications (metformin, insulin, etc.)
Obesity medications
Cholesterol controlling medications (statin, etc.)
Lifestyle in the Management of Metabolic Syndrome
Healthier diets
No smoking and reduced alcohol consumption.
Regular exercise (ie. PA guidelines).
-lots of goal setting and behaviour change work with these types of clients.
Clinical Assessments for Metabolic Syndrome
Blood pressure
Waist circumference
-possible weight and BMI
Random or fasted blood glucose levels
Cholesterol and triglyceride blood levels.
Questionnaires for QOL, goal settings, quitting smoking, etc.
What is cancer?
Multiple forms from multiple causes/risk factors.
-Nutrition, exercise, radiation exposure, chemicals, hormones, immune system, genetic, aging, etc.
-caused by uncontrolled division of abnormal cells in certain tissues.
-can lead to malignancy (spreading to other tissues)
Breast cancer, prostate cancer, lung cancer, skin cancer, colorectal cancer are the most common.
Diagnosis of Cancer
Each type of cancer has its own diagnosis
Self examination
-early detection is possible and important
-breast and prostate/testicular cancer can be easiest to self detect
Imaging
Blood tests
Biopsies
Treatment for Cancer
Each type of cancer has its own treatment process depending on the stage of cancer, and patient factors/wishes
-surgery, radiotherapy, chemotherapy, hormone therapy, immunotherapy.
Combination of treatments are often used.
Symptoms of treatment includes nausea, fatigue, muscle atrophy, cardiovascular fitness decline, loss of appetite, anemic, skin sensitivity, decreased bone density, etc.
Exercise and Cancer
Exercise is beneficial before, during, and after cancer treatment.
Before = increase strength, muscle mass, and CV fitness prior to treatment.
During = offsets side effects of treatment, retains strength and CV fitness, lower fatigue and nausea, increases self-efficacy and coping mechanisms, increases bone density, improved immune function, circulated chemotherapy, improve overall physical and mental well being, improve QOL.
After = regain strength and fitness, improved QOL and body image, decreases likelihood of secondary cancer.
Clinical Assessments for Cancer
Subjective measures = pain VAS, fatigue scales, SOB, RPE scales, QOL questionnaires, cancer specific questionnaires.
Anthropometric measures = weight, BMI, BIA, waist circumference, bone imaging (DEXAs).
Vitals = should be monitored during exercise as well (blood pressure, SpO2, heart rate, ECGs).
Cardiovascular fitness = submaximal VO2 or GXTs.
Muscular and bone strengthening/endurance = 5-10 RM, functional strength tests, grip strength.
Balance and functional mobility tests.
