Other Systems (Diabetes and Pregnancy) Flashcards
What is the role of insulin
Insulin
- Released by the pancreas (IOL) which binds to insulin receptor which allows glucose transporter to open which allows glucose to enter cell
- This process is required in order break down glucose into usable energy units called ATP
What is hyperglycemia
When there is too much insulin in the bloodcell.
What is
Diabetes Mellitus Type I (-5 % of cases)
- chronic disorder characterized by hyperglycemia (high blood sugar) and disruption in metabolism of carbohydrates, fats, and proteins. It occurs because of little or no insulin being produced by the pancreas.
- Found in children and young adults, usually before the age of 30.
What is
Diabetes Mellitus Type II (90-95 % of cases)
a chronic condition that affects how the body metabolizes glucose. When you have type 2 diabetes, your fat, liver, and muscle cells do not respond correctly to insulin, known as insulin resistance.
•As a result, blood sugar does not get transported into these cells to be stored for energy and builds up in the bloodstream; this is known as hyperglycemia
Diabetes clinical presentation
Top 3 Signs and Symptoms
Increased Thirst
Polyuria
Lethargy
Prolonged Diabetes S&S
Neuropathies (retinal, peripheral)
Renal Failure
Cardiac Consequences
Have increased thirst because there is so much glucose that they want to dilute thebloodstream which results in thirst and then too much water = polyuria
If a person has a high level of sugar, it it toxic and can have neuropathies
Why are the kidneys failing with a patient with diabetes. They are working overtime and overtaxed.
A physical therapist is hosting an educational workshop for a group of people with type II diabetes mellitus. The therapist would like to provide accurate information about prognosis after being diagnosed with this condition. Which of the following is the MOST accurate regarding a DM Type II prognosis?
A. Excellent, proper diet and exercise has been found to reduce HgBA1c by 0.8% over a 12-week period
●
B. Good, life expectancy is 5 years less than the average, the patient is expected to be able to perform all ADL’s/IADL’s independently
C. Good, life expectancy is unaffected, the patient is expected to perform all ADL’s independently but lose ability to perform IADL’s after 10 years
D. Poor, the patient is expected to live 10 years less than the average, with progressive decline in IADL’s/ADL’s
Prognosis: What is the optimal outcome
Is it a curable condition. They are, they are able to reverse the condition.
Life expectancy is not affected
A: Absolutely
B: Life expectancy is not affected
C: Do not love ability to perform IADLs
D: More like ALS
Diabetes clinical presentation
HgbA1C and Ranges.
•HgbA1C
–indicates your average blood sugar level for the past two to three months by measuring the percentage of blood sugar attached to hemoglobin
•Ranges to know
–Normal: Less than 5.7%
–Pre-diabetes: 5.7% - 6.4%
–Diabetes: 6.5% or higher
Fasting Blood glucose levels
Fasting Blood Glucose
•indicates your current level of blood sugar when you have not eaten in the past 8 hours.
Ranges to know
- 70 -100 mg/dl is normal
- 101 – 125 mg/dl is pre-diabetes
- 126 or higher is diabetes
Semmes-Weinstein Monofilaments
- Sensory tools that we use to test for impairments in sensory function typically in the extremities
- Several sizes of these filaments but only need to worry about two
- 4.17 monofilament (1 g of force) – Normal Sensation
- 5.07 monofilament (10g of force) – Protective Sensation
A patient with a chronic history of diabetes type II and inability to detect the 5.07g monofilament is in need a proper shoe wear to prevent ulceration and support skin protection. Which of the following recommendations would BEST address the patient’s needs?
A.Cast Shoes
B.Extra-depth Shoes
C.Solid Ankle Foot Orthosis with added padding under the heel
D.TED hoses and regular sneakers
Intervention strategy
Health condition – DM2
Primary Impairment – loss of sensation
A: Shoe like a sandal with Velcro strap – normally used for after a surgery - no
B: Gives patient the compression so there’s not a lot of sheer and extra space in the toes space
C: No, used to restrict motion – not for patient – no indication
D: Uesd for EDEMA and risk of DVT – not for ulceration and skin breakdown
Exercise Principles
Safe Glucose Levels for Exercise
•100-250 mg/dl
•
Exercise Caution Zones
•70 – 100 mg/dl
•No exercise below 70 mg/dl
•If 70-100 and symptoms present, no exercise, give 15g absorbable snack and retest in 15 minutes
- Can exercise 70 -100 if symptoms are not present but retested every 15 minutes
- Exercise Caution Zones
–250 – 300 mg/dl
- Avoid exercise if above 250 and ketones present
- No exercise if above 300 and symptoms present (EMS Call)
- Peak Insulin Times
–Exercise during these times in contraindicated
•Post Exercise Hypoglycemia
–Avoid late night exercising
Pre-exercise considerations
- Always Monitor BG before exercise
- 100-250 mg/dl
- First course of Action
- Eat within 1 hour of Exercise
- Make sure that there is enough glucose in thet bloodstream
- Do Not Inject in “To Be” Exercised Muscles
- Faster release of insulin
Injected site exercise would cause faster action of insulin and cause HYPOGLYCEMIA
•Produces hypoglycemia
•
During and post exercise
Exercise Duration
- 40-60 minutes
- Eating a readable absorbable snack every 30 mins
- Monitor Blood Glucose Every 30 mins
- Increase caloric intake 12- 24 after exercise
A patient with a long history of uncontrolled type 2 diabetes mellitus is exercising in the PT gym. The patient forgot to take their insulin prior to starting exercise. Which of the following signs or symptoms is expected?
A. Stupor or comatose
B. Hyperhidrosis
C. Polydipsia
D. Polyphagia
At risk with Hyperglycemia
A: This would be with HYPOglycemia
B: Excessive sweating – Should be Hypo
C: EXECSSIVE THIRST
D: Excessive eating
HYPO VS HYPERGLYCEMIA SYMPTOMS
COLD AND CLAMMY, GET SOME CANDY
HOT AND DRY, YOU’RE SUGARS HIGH
DKA - Fruity smell
Medical emergency – automatic call – condition when they have DM. It can cause hyperglycemia – the sugar is out in the bloodstream but the body is not able to utilize it so it breaks down fat and creates ketones. Ketones are acidic and pH decreases. Body will shut down if body is too acidic.
PREGNANCY RELATED CHANGES
LOWER CROSS SYNDROME
- Major Changes
- Weight
- Distribution (COM)
- Postural Compensation
- Hormones
- Increased secretion of
- Relaxin – atlantoaxial instability – joint laxity – ankle sprains, etc.
- Progesterone
- Body Structure
Rib flare – makes room for pregnancy – affects breathing pattern
•Diaphragm positioning
Pregnancy is considered a restrictive lung condition – diaphragm can’t flatten down very well.
•Abdominal Traffic
Blood is not flowing well through the abdomen = dependent edema
A patient who is two weeks postpartum presents with a 2.5cm diastasis recti and complaints of lower back and pelvic pain. Which of the following interventions should be initiated FIRST?
A. Hook lying head lifts with abdominal approximation
B. Single leg raises
C. Abdominal crunches
D. Posterior pelvic tilting while slowly lowering an extremity into extension
Health Condition – Diastasis Recti
Impairment – LBP
A: Can – it’s gentle enough – not enough stress on linea alba – back pain will improve with stronger abs
B: A little too provacative
C: A first
D: A first
What is the Linea Alba
3 muscles that stabilize the lumbar spine (primary role)
How about pelvis – 3 muclse
How do you test?
Linea alba binds both sides of the abdominals together
Any separation > 2cm is significant
3 muscles that stabilize the lumbar spine (primary role
Multifidus, int/ext abd. And transverse abdominals; rectus abdominus
How about pelvis – 3 muclse
Transverse abdominus, pelvic floor muscles, rectus abdominus for pelvic stability.
Palpating gap near umbilicus whiel supine with head and scapular spine off floor.
- two finger widths or more is abnormal
Nerve Compression Syndromes
- Carpal Tunnel Syndrome (CTS)
- Fluid retention
•
- Thoracic Outlet Syndrome (TOS)
- Postural Changes
- Gentle Stretching
- Low Intensity Strengthening
- Circulatory Compromise (edema)
Carpel tunnel due to fluid retention, so no need for surgery
Dexamethasone and Iontophoresis – Don’t want to use it because it’s not an inflammatory condition. (which is what those are used for)
You would just want to put them in a splint. – a normal cockup splint
TOS, WHY?
Upper cross syndrome as well. – Forward head and scalenes are overworked.
Relaxin affect mm tissue as well
Diastasis Recti Tx
- How do we treat this
- Acute phase (>2cm separation) ONLY corrective exercises
- Head lift
- Head lift with pelvic tilt
- Subacute phase (2cm or less)
- Pelvic Tilts in varying positions
- Leg Slides w/ pelvic tilt
- Leg Fallouts
- Pelvic Clocks
- RTF (Return to function) phase (No DR noted)
- Trunk curl ups/downs
- Modified Bicycle
- Diagonal Training
A patient who is in her 3rd trimester is being educated on proper positioning at night to avoid stress on the baby and difficulty breathing. The therapist would like to prescribe the most effective and safe positioning. Which of the following is the MOST appropriate type of positioning?
A. Right side-lying with a pillow between the legs
B. Supine positioning with 2 pillows underneath the legs
C. Left side-lying with a pillow between the legs
D. Prone positioning with a small pillow underneath the abdomen
A: Always choose left, cardiopulmonary is the best
B: No more than 5 minutes
C: pressure off inferior vena cava
D: Definitely on stomach
Postural Considerations
•Prolonged standing or supine positions
–Compression of inferior vena cava by uterus
–Avoid > 5 minutes in supine at any one time (Post 1st trimester)
–Can place towel roll underneath right pelvic to rotate patient to the left
By laying in the left lateral recumbent position, the uterus is kept off the maternal inferior vena cava and the right iliac artery.
Standing position - posture
Veins are at risk, if they balloon out, a condition happens – venous insufficiency when veins aren’t working anymore and balloon out.
Bridges are not contraindicated, as long as they’re not in the position for longer than 5 minutes
Positional Contraindications
•Knee-chest position with buttocks elevated above heart
–Introduction of air embolism into circulatory system (air bubble –embolism)
•Prone Lying
–Compression of fetus, decreased respiration
By laying in the left lateral recumbent position, the uterus is kept off the maternal inferior vena cava and the right iliac artery.
YOGA pose – childs pose.
Exercises to avoid during pregnancy
DO NOT DO SINGLE LEG activities UP TO 6 weeks after pregnancy – weak abdominals - as long as not hip pelvis related exercise
- Bilateral SLR’s
- Fire-hydrant’s
- Quadruped Hip Extension
- Contact or High Impact Exercise
Single leg hops, etc.
Pregnancy EXERCISE CONTRAINDICATIONS
•Absolute Contraindications
–Pre-eclampsia (pregnancy induced hypertension)
Proteinuria
Rising blood pressure
BP over 140/90 on two occasions at least 4 hrs apart
Edema
–Placenta Previa
•Placenta is located in a position where it may detach before the baby is born
General exercise level
- Exercise Prescription
- Frequency
- 5x/week or more
- Intensity
- Mild to moderate level exercise (vigorous level should be avoided)
- RPE 12-14 (more appropriate method*)
- Type
- Strength
- Aerobic training
- Time
•15-30 min sessions
PREGNANCY AND MODALITIES
- Hyperbaric Oxygen Therapy – Absolute Contraindication
- Lack of O2
- Lumbar Traction – Absolute Contraindication
- Relaxin, jt laxity
- Diathermy - Absolute Contraindication
- Don’t know effects on pregnancy
- Electrical Stimulation (IFC/TENS/IONTO)
CAN, BUT….
•Not over Hip, pelvis, lower back, or abdomen
- Absolute contraindication in patients with previous miscarriage
- Ultrasound (Continuous & Pulsed)
- Not over lower back, or abdomen
- Biofeedback – Indicated
- Thermotherapy (Superficial) - Indicated
