Quiz 5B Flashcards
This quiz starts NEW EXAM - Exam 2
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This quiz is on “The Endocrine and Metabolic Systems … continued”
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During your August clinical education experience, you will be participating with your clinical instructor in the examination of a patient who has had type 2 diabetes for 5 years. He asks you to review and be able to summarize key points you think would be important to include in the initial examination and patient education related to foot care:
Patients with diabetes are more prone to wounds, so in EVERY exam I would want to ask the patient about any wounds, and exam the foot.
People with diabetes may have reduced nerve functioning due to peripheral diabetic neuropathy. This means that the nerves that usually carry pain sensation to the brain from the feet do not function as well and it is possible for damage to occur to your foot without feeling it.
You are working with a high school cross country athlete with a ten year history of type 1 diabetes. She has been cleared to begin running again after an ankle injury. As you begin to work with her to increase her aerobic activity, you are concerned about possible hypoglycemia. What signs and symptoms would you look for?
If she has a LOW blood sugar level, she will obviously fatigue quickly and get lightheaded and fatigued.
A patient with type 2 diabetes has been referred to physical therapy to begin an exercise program. The patient asks you how exercise can help his diabetes. Respond to him.
Exercise can help burn excess sugar from the blood (and excess sugar stored in the liver and other areas). By lowering blood sugar levels, the pancreas can produce sufficient amounts of insulin to properly regulate blood sugar levels. This will help decrease weight, blood pressure, and diabetes.
It also reduces stress, stops the progression of atherosclerosis (which limits impact of developing a cardiovascular heart issue).
*** Exercise increases your cells receptivity to insulin (which unlocks the cell to allow the glucose in for energy - thus reducing blood sugar levels).
A patient has been referred to you by an endocrinologist to begin an exercise program. The patient tells you that he has been diagnosed with type 2 diabetes. He had a blood test and reports that his blood sugar level test result was a 9.2 (HbA1c); the doctor wants it under 7 and thinks exercise might help. He doesn’t understand what this lab value means. Explain it to him.
(See flashcard below) … but a HbA1c test will test blood sugar levels over 3 months. How it does this is if your insulin is NOT working (type I or type II diabetic), blood sugar will accumulate in your blood. It will bind to hemoglobin in your blood. But since you don’t have insulin, or receptors on cells can’t accept insulin, then the sugar will stay bound to the hemoglobin. The HbA1c tests to see how much blood sugar has bound itself to hemoglobin over a 3 month period.
A HbA1c level of 4-5.7 is normal. 5.7-6.4 is pre-diabetic. 6.5 or higher means you have diabetes.
1) What is the function of the pancreas:
2) What are endocrine glands:
3) Define an endocrine and exocrine gland:
4) Describe the endocrine and exocrine function of the pancreas:
4A) The cells in the pancreas are called islets of langerhans. The 3 cells and their function are:
(how to remember)
5) Another organ, besides the pancreas, that has both endocrine and exocrine function:
6) Review: what is the difference between the hormones of insulin and glucagon
7) Function of Insulin is:
1) The pancreas (organ in the abdomen) plays an essential role in maintaining blood sugar levels, and converting the food we eat into fuel for the body’s cells. A healthy pancreas produces the correct chemicals in the proper quantities, at the right times, to regulate blood sugar and digest the foods we eat. It has an EXocrine function, and an ENDOcrine function.
2) Glands that are specialized groups of cells or organs that secrete chemical substances (HORMONES) into the bloodstream for various functions and maintenance of homeostasis in the body.
3)
ENDOcrine: These are glands that secrete chemical substances called HORMONES. These hormones are released INTO THE BLOOD or tissues of the body to maintain homeostasis. Examples are all the endorcrine (hormone) glands: pituitary, adrenal, thyroid, etc.
EXOcrine: These glands release substances into ducts to be released to OUTSIDE of body (or even to other parts of body, but not in the blood, like the GI tract). Examples: sweat, salivary, mammary, mucous. Liver and Pancreas also have an exocrine function.
4)
ENDOcrine: Creates and releases important HORMONES directly into the BLOODSTREAM. Two of the main pancreatic hormones are:
- INSULIN, which acts to LOWER blood sugar by taking glucose OUT of blood to cells to metabolize.
- GLUCOGON, which acts to RAISE blood sugar levels.
Maintaining proper blood sugar levels is crucial to the functioning of key organs including the brain, liver, and kidneys.
EXocrine: The pancreas contains exocrine glands that produce ENZYMES important to DIGESTION (or METABOLISM). These enzymes include trypsin and chymotrypsin to DIGEST PROTEINS; amylase for the DIGEST CARBS; and lipase to BREAK DOWN FATS. When food enters the stomach, these pancreatic juices are released into a system of ducts that culminate in the main pancreatic duct. The pancreatic duct joins the common bile duct. The common bile duct originates in the liver and the gallbladder and produces another important digestive juice called bile. The pancreatic juices and bile are released into the duodenum help the body to digest fats, carbohydrates, and proteins.
4A)
- Alpha cells produce glucAgon
- Beta cells produce insulin (for DiaBetes)
- Delta cells produce somatostatin
(remember: alphabetical order)
5) Liver
6)
- The pancreas releases glucagon when the concentration of glucose in the bloodstream falls too LOW. Glucagon causes the LIVER to convert the STORED glycogen within it into glucose, which is released into the bloodstream to be taken to cells.
- High blood-glucose levels, on the other hand, stimulate the release of insulin from the pancreas, which takes glucose to cells (out of bloodstream) to metabolize for energy.
7) Remember that Insulin transports glucose out of blood and into cells for use as energy (and excess goes to the liver for storage as glycogen).
1) Define Diabetes Mellitus:
2) Explain difference between Type I diabetes, and Type II
3) Long term hyperglycemia leads to:
3A)
- Describe IGT and IFG’s
4) What are normal and high blood sugar levels from an IGT test?
5) What are normal and high ranges for a IFG test (so AFTER fasting):
6)
- Which type of diabetes would you typically find children having?
- Which for adults?
1) Diabetes is essentially when someone is unable to maintain proper blood sugar levels (typically a systemic disorder) characterized by hyperglycemia or high blood sugar levels. Those with diabetes also have a disruption to the metabolizing of carbs, fats, and proteins. Normally the pancreas produces insulin properly to combat high blood sugar levels, but a disorder (type 1 or type 2) means blood sugar isn’t being regulated properly.
2)
- Type I: Typically this is a GENETIC defect, seen in early age, and is NOT COMMON. It is when the body’s immune system attacks BETA cells that produce insulin in the pancreas, and so a person doesn’t have insulin to clear out blood sugar levels, so they need insulin injection for life.
- Type II: This is MUCH more common, and develops typically later in life as a result of an unhealthy diet, and so PANCREAS CAN’T KEEP INSULIN PRODUCTION UP for continued high blood sugar levels. You can control it through diet and exercise, but may need to take insulin.
TYPE I Diabetes: the immune system mistakenly attacks the insulin-producing pancreatic beta cells. These cells are destroyed, reducing the body’s ability to produce sufficient insulin and regulate blood glucose levels. The body does not produce insulin, so the person needs supplemental insulin from the time they are diagnosed. It often affects children and young adults, and it can start suddenly.
TYPE II Diabetes: This is when cells (insulin receptors on cell walls) become RESISTANT to the effects of insulin. In time, the body stops producing enough insulin, or insulin just can’t get into cells to distribute glucose. So, the body can no longer use glucose effectively and blood sugar levels spike. This means the cells cannot take up glucose, and glucose builds up in the blood. This is called insulin resistance. If blood glucose is always high, the cells will be overexposed to insulin. They become less responsive or unresponsive to insulin. Symptoms may take years to appear, and people can often use medications, diet, and exercise in the early stages to reduce the risk or slow the disease. People in the early stage of type 2 diabetes do not need supplemental insulin, but as the disease progresses, this may be necessary to control blood glucose control and to survive. Type 2 often results from obesity and lifestyle and dietary factors, as well as medications and other issues.
3) Long-term hyperglycemia is associated with diabetes obviously, but also damage and dysfunction of tissues and organs, esp. eyes, kidneys, nerves (neuropathies), heart and blood vessels. It also is commonly a result of poor diet, and so a person gets atherosclerosis, which leads to a host of cardiovascular issues (MI, CVA, CAD, CHF, etc.)
3A)
- Impaired glucose tolerance (IGT):
- Impaired fasting glucose (IFG)
- These tests are to measure blood glucose levels (and are both are related to prediabetes). A high IGT test result means glucose isn’t being removed from blood for some reasons (elevated levels). And a high IFG test means after fasting (which should clear out glucose from blood) you still have elevated blood glucose levels (not normal).
4)
IGT:
Normal
<139 mg/dl
Prediabetes
140-199 mg/dl
Diabetes
>200 mg/dl (lots of blood sugar)
5)
IFG:
Normal
<100 mg/dl
Prediabetes
100-125 mg/dl
Diabetes
>125 mg/dl
6)
- Children typically have Type I (genetic). But more and more kids are becoming overweight and getting Type II.
- But adults typically get Type II.
1) What is PRE-diabetes:
2) Prediabetes ranges for IGT and IFG tests:
3) What is metabolic syndrome
4) What is Dyslipidemia
5) Are carbs sugars?
1) Prediabetes is essentially a wake-up call that you’re on the path to diabetes (but it’s not too late to turn things around). It basically means the body is NOT utilizing glucose well (you blood sugar levels and HbA1c test levels are high) most likely as a result of poor diet/exercise. There is decreased insulin sensitivity. IGT test levels are high, but not in the diabetes ranges yet (see slide above).
“Prediabetes” is a term used to describe a condition of altered glucose metabolism which falls short of a formal definition of diabetes yet confers an increased risk of progression to diabetes and/or vascular disease.
2)
Prediabetes ranges:
IGT’s = 140-200
IFT’s = 100-125
3) Metabolic syndrome is not a disease in itself. Instead, it’s a group of risk factors – high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat. It comes as a result of poor diet and being overweight. The syndrome increases a person’s risk for heart attack and stroke. Thus, it is associated heavily with diabetes.
4) Abnormally elevated cholesterol or fats (lipids) in the blood.
5) Carbs themselves are a macronutrient found in many foods and are not sugar themselves. However, the body breaks down (metabolizes) these carbs to become glucose (a sugar) that can be taken from the blood into cells (by insulin) to create energy the body needs. So in short, carbs are not sugars technically but are broken down through digestion to become sugars.
1) Describe the incidence and prevalence of diabetes:
2) What are the stats of diabetes:
1) 14.6 million Americans diagnosed with DM (with 6.2 million undiagnosed). Becoming more prevalent (especially in children)
2)
- Leading cause of death from disease in US
- Black, Native, Hispanic and Asian Americans 1.5 – 2 TIMES > white Americans
- 1/2 > 60 years old; ¼ > 65 years have diabetes (for Type II)
- Most with Type I are younger children/adults
- Males = Females
- 90% Type 2: 10% Type 1
1) What are the RISK FACTORS for Type I Diabetes:
2) What are the RISK FACTORS for Type II Diabetes:
3) How might someone become diagnosed with diabetes?
1) Disease present in immediate family member (parent, sibling). It is genetic.
2) Family heritage, ethnic origin, obesity, age (greater than 45), HTN, weight, diet, inactivity
3) HbA1c, IFG or IGT glucose tests
1) Does autoimmune destruction of beta-cells producing insulin happen in Type I or Type II diabetes
2) Type of diabetes associated with genetic defect
3) Type of diabetes associated with obesity
1) Type I
2) Type I
3) Type II
1) What are the s/s (clinical manifestations) of Type I diabetes
2) What are the s/s (clinical manifestations) of Type II diabetes
1)
- HIGH counts of HbA1c, IFG or IGT glucose tests due to no insulin.
- Polyuria (peeing a lot)
- Polydipsia (very thirsty)
(how to remember: DIP my cup in to get water)
- ** Weight loss with Polyphagia (excessive hunger, but glucose doesn’t get to body tissues, so they starve)
(how to remember: phag like cell phagocytize)
- Blurred vision
- Weakness, fatigue and dizziness
- Ketonuria (peeing out lots of keytones)
2)
- Polyuria
- Polydipsia
- Blurred vision
- Weakness, fatigue and dizziness
- May be asymptomatic for years **
BOTH:
- Atherosclerosis
- Blindness (retinopathy)
Let’s discuss some of the complications that come from Diabetes:
1) Atherosclerosis is a complication that can come from diabetes. Explain:
2) Does smoking increase the risk of atheroscleroisis … and thus all the resulting cardio / vascular / pulmonary issues:
3) Other complications resulting from having diabetes:
1) If you have high levels of blood sugar, it will collect and build up within vessels (atherosclerosis), plaque up, and eventually lead to a clot, aneurysm, stenosis. This can lead to ischemia, MI, CAD, stroke (CVA), CVD, CHF, etc.
2) ABSOLUTELY
3)
- Impaired wound healing
- Increased risk for infection
- Increased glucose fosters bacterial growth ***
- Skin, urinary tract, vaginal, other - Impaired vision and peripheral neuropathy
- Retinopathy (retina disease = loss of vision)
- Nephropathy (kidney disease, kidneys harden so don’t filter properly)
- Musculoskeletal issues: Limited shoulder mobility, carpal tunnel and stiff hand syndrome, osteoporosis
- Neuropathy: Weakness, numbness, and pain from nerve damage, usually in the hands and especially in FEET where you can’t see/feel wound.
Describe the primary, secondary, and tertiary prevention strategies for type II diabetes.
PRIMARY:
- *** Exercise with proper nutrition
- 150 mins of moderate exercise weekly
- Education / informing
SECONDARY:
- Screening. Start doing tests at age 25. IGT’s and IFG’s, HbA1c exam, eye exams, foot exams daily / at each visit
TERTIARY:
- Exercise
- Diet
- Wound care (for ulcers to prevent amputation … debridement)
- Infection control
- Medications
- Possibly surgery or amputation
How is Diabetes diagnosed?
- Plasma glucose levels (HbA1c)
- Urine keytone levels
- IGT and IFG tests
These tests are then confirmed by symptoms of hyperglycemia like; polyuria, polydispia, unexplained weight loss (for Type I)
1) Explain medical treatment for Type I diabetes
2) Explain the medical treatment for Type II diabetes
1)
- Exogenous insulin (insulin taken into body via many forms / amounts dependent on pt needs)
- Controlled specific diet
- Not a ton of proof that exercise helps those with Type I (just be careful and not over due it).
2)
- Does not always require a continuous administration of insulin, but can
- Can be treated by diet and exercise alone (EXERCISE IS KEY KEY KEY because exercise decreases blood sugar levels and helps cell receptors be more open to receiving insulin).
- Low fat low calorie diet with consistent exercise typically reduces type II diabetes by 58% over 3 years.
- Hypoglycemic drugs
- LONG TERM: dialysis, kidney transplant
Explain Hypo and Hyperglycemia … and how you get each / what results from each:
Hypoglycemia = LOW blood glucose levels ( < 70 mg/dL)
- Overdose of insulin - Late/skipped meals - Overexertion in exercise
Hyperglycemia = HIGH blood glucose levels ( > 250 mg/DL)
- Diabetic ketoacidosis (DKA) - Hyperosmolar, Hyperglycemic State (HHS)
What is the prognosis for those with Diabetes:
- If properly managed and controlled, person could live long normal lives.
- But, if insulin isn’t injected regularly or properly, or exercise/diet isn’t implemented, then DM is going to increase risk of death by heart disease by 2-3 times. Also it could lead to blindness or renal failure.
1) What is the role of the PT with pt’s who have diabetes:
2) Why is exercise so crucial to managing diabetes (be specific about Type I and Type II):
1)
- EDUCATION
- DIET
- EXERCISE (to avoid surgery)
- Monitor vitals during exercise (and ensure they have their insulin and some sugar back up resource).
- Check skin and feet for wounds (from neuropathy on feet)
- Ensure they have insulin or sugary drink/food when exercising any time.
2)
FOR TYPE II:
- Exercising makes the body NEED more energy, so it has to metabolize more sugar to create energy needed. So, exercise helps rid body of excess glucose (broken down in metabolism to produce energy to exercise).
- It helps lower blood pressure and stress, reduces progression of atherosclerosis, which thus helps reduce various cardiovascular problems as a result.
*** Exercise increases your cells receptivity to insulin (which unlocks the cell to allow the glucose in for energy).
TYPE I:
- Typically these patients are not metabolizing well and losing weight, so exercise should be moderate primarily to help build strength, endurance, or helps one not fatigue as easily. But exercise for these patients does NOT really help regulate glucose levels in blood like it would for Type II pt’s.
1) What is insulin resistance syndrome:
2) What is best thing you can do to reverse this?
3) Is insulin resistance syndrome synonymous with metabolic syndrome?
1) Means you have high levels of insulin AND glucose in your bloodstream, but the insulin molecules can NOT bind to the insulin receptors on cells to allow glucose to enter cells to be used for energy. It explains why some people get HTN, obesity, dyslipidemia, atherosclerosis, etc. It is an indicator of someone getting prediabetes.
2) Change in lifestyle - diet and EXERCISE.
3) yes
**** Let’s review the differences between Type I and Type II diabetes:
1) Type I typical age (for those who have it)
2) Type II typical age
3) Prevelance of Type I vs. Type II
4) In Type I diabetes, how much insulin will be produced and secreted by the pancreas? For Type II, how much insulin will be produced and secreted by pancreas?
5) Are people obese in Type I or Type II?
6) Is Type I or Type II diabetes an autoimmune disease
7) Treatment (medical management) for Type I vs. Type II
1) Childhood
2) Adulthood (typically 45 or older, usually 60+, but kids can get it)
3) Type I is very UNcommon, Type II is very common (90% of those with diabetes have Type II)
4) Type I is complete failure where autoimmune disorder attacks beta cells that produce insulin, so insulin is not produced in Type I diabetes. Type II is where insulin is impaired. Either the pancreas can’t produce enough because of a high sugar diet, or insulin receptors on cells are damaged and won’t let insulin in.
5) Type I they are NOT obese (often lose weight), Type II they ARE obese.
6) Type I YES, Type II NO
7) Type I is external insulin injection (and diet and limited exercise), Type II is diet and exercise and medication and weight control.
Levels of blood sugar with Hyperglycemia =
** Two conditions associated with Hyperglycemia:
1) Describe what Diabetic Ketoacidosis (DKA) is:
2) Is DKA more common in people with Type I or Type II
3) How would you know if someone had DKA:
4) s/s of DKA
5) Medical treatment for DKA
Blood glucose level from a IGT: > 200 mg/DL
- Diabetic Ketoacidosis (DKA)
- Hyperosmolar, Hyperglycemic State (HHS)
1) Basically when your body isn’t producing enough insulin, the blood sugar levels rise. Insulin can’t take it to the cells, so the kidney filters it and urinates it out. Then body needs other sources to metabolize to get energy, so it takes the fat reserves from body and breaks down lipids. This releases acidic keytones into the bloodstream causing a chemical imbalance leading to diabetic ketonacidosis - which is LIFE THREATENING.
2) Type I (that is why people with Type I will lose weight, and can even lose weight with Polyphagia).
3) Do a blood or urine test … Characterized by hyperglycemia, acidosis, and ketosis
4) Nausea and leads to coma
5) This is an emergency situation, so pt needs fluids, insulin quickly injected into bloodstream.
1) HHS =
1AA) So what is main difference between DKA and HHS:
1A) What is osmolarity:
1B)
- What is a solute:
- What is a solvent:
- What is a solution:
2) s/s of HHS are:
3) Is this more common with Type I or Type II
4) Medical management of HHS
5) So, DKA is more common in Type __ diabetes. HHS is more common in Type __ diabetes.
1) Hyperosmolar Hyperglycemic State:
IT IS EXTREME HYPERGLYCEMIA, but not having keytone acidosis in blood.
Hyperosmolar hyperglycemic state (HHS) is one of two serious metabolic derangements that occurs in patients with diabetes mellitus (DM). It is a life-threatening emergency that, although less common than its counterpart, diabetic ketoacidosis (DKA), has a much higher mortality rate, reaching up to 5-10%
Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolarity WITHOUT significant ketoacidosis. So … IT IS EXTREME HYPERGLYCEMIA, but not having keytone acidosis in blood.
1AA)
DKA= Diabetic Ketoacidosis
-more common in individuals with type 1 DM
-ketosis process
-s/s: hyperventilation, acetone breath, etc.
HHS= Hyperglycemic Hyperosmolar State
- more common in individuals with type 2 DM (specifically older adults)
- osmotic process
- s/s: water dehydration, polyuria
1A) Osmotic concentration, formerly known as osmolarity, is the measure of solute concentration, defined as the number of osmoles (Osm) of solute per litre (L) of solution (osmol/L or Osm/L)
1B)
- Solute: is the substance being dissolved in the solvent
- Solvent: liquid solute being dissolved in (water)
(ALPHABETICAL … U before V, so drop U into V, as you drop Salt into water … solute is salt, water is solvent, and salt water is solution).
- Solution: combination of the solute and solvent, or solute dissolved in solvent. The mixture.
2) Symptoms include signs of dehydration, weakness, legs cramps, trouble seeing, and an altered level of consciousness (and obviously high levels of blood glucose).
3) TYPE II
4) This is an emergency situation, so pt needs fluids, insulin quickly injected into bloodstream.
5)
- DKA = Type I
- HHS = Type II
1) The biggest medical emergency related to diabetes is:
2) Why are having keytones in your blood so dangerous:
1) DKA (Diabetic Ketoacidosis)
2)
Ketones can make your blood ACIDIC. Acidic blood can cause DKA. The most serious effects of DKA include:
- Swelling in your brain
- A loss of consciousness
- Diabetic coma
- Death
This is why it’s important to have a plan of action in the event that your ketone levels become too high.
Review acidocis, alkalosis, pH levels:
When your body fluids contain too much acid, it’s known as acidosis. Acidosis occurs when your kidneys and lungs can’t keep your body’s pH in balance. Many of the body’s processes produce acid. Your lungs and kidneys can usually compensate for slight pH imbalances, but problems with these organs can lead to excess acid accumulating in your body.
The acidity of your blood is measured by determining its pH. A lower pH means that your blood is more acidic (thus more H+ ions), while a higher pH means that your blood is more basic (alkalotic or fewer H+ ions). The pH of your blood should be between 7.35 and 7.45. Acidosis is characterized by a pH of 7.35 or lower. Alkalosis is characterized by a pH level of 7.45 or higher. While seemingly slight, these numerical differences can be serious. Acidosis can lead to numerous health issues, and it can even be life-threatening.
1) Lets review the HbA1c test. What is it / what is it for?
2) What is hemoglobin and it’s function:
3) What are the normal and abnormal levels of the HbA1c test:
1) The hemoglobin A1c test tells you your average level of blood sugar over the past 2 to 3 months. It’s also called HbA1c, glycated hemoglobin test, and glycohemoglobin. ** The sugar in your blood is called glucose. When glucose builds up in your blood (diabetes), it binds to the hemoglobin in your red blood cells. The A1c test measures how much glucose is bound to Hb. Red blood cells live for about 3 months, so the test shows the average level of glucose in your blood for the past 3 months.
2) Hemoglobin is a protein found in red blood cells. It is what O2 binds to and is then taken to cells, and CO2 then binds to it to be taken back to the lungs. Blood sugar also binds to hemoglobin. Hb gives blood its red color, and it’s job is to carry oxygen throughout your body
3) For people without diabetes, the normal range for the hemoglobin A1c level is between 4% and 5.6% (below 5.7%). Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher change of getting of diabetes (prediabetes). Levels of 6.5% or higher mean you DO have diabetes.
T or F: Type I and Type II are very clear cut differentiations between each?
Normally that is true, but there is some overlap.
Is prevelance higher or lower with Type II
Type II is MUCH higher (more common)
How do you tell if someone has Type I diabetes
(regarding insulin):
What about Type II:
BETA cells (which produce insulin) of the pancreas do NOT work in Type I because it is an autoimmune disorder where your body attacks the beta cells that produce insulin. So insulin isn’t produced so there is no insulin in blood. You’d detect this with a HbA1c or IGT or IFT test … which would result in high levels suggesting hyperglycemia..
Type II: High levels of blood glucose (found through a HbA1c, IGT, or IFG test). Either pancreas can’t keep up to producing enough insulin based poor diet which produces high blood glucose levels. Or there is a resistance of cells to insulin, meaning receptor sites on cells for insulin malfunction (based on high amounts of insulin/sugar) and they no longer accept insulin any more. So it is impaired acceptance of insulin into the cell. Basically, patients with Type II diabetes are still producing insulin, but cells are not receptive to it.
Drug of choice with Type II
how to remember
METFORMIN
George “formin” is overweight from diabetes, he needs this drug
If insulin is not even being created, you have what type of Diabetes?
If insulin is not working properly by not taking blood glucose to cells, or cells aren’t receptive to the insulin, you have what type of diabetes?
Type I
Type II
1) Which type gets exogenous insulin injected?
1A) Why doesn’t the OTHER one (not mentioned in #1 above) need exogenous insulin injected?
2) Do Type I or Type II patients need to be very very very closely monitored for proper glucose and insulin levels?
1) Type I
1A) With type II, it may be that the pancreas can’t produce enough insulin and so the patient does in fact need external insulin injected. But, it also could be that the cell receptor sites don’t accept insulin, so it is not a matter of injecting MORE insulin in (the body already has the insulin).
1) Type I
Why is NOT exercising dangerous with Diabetic patients?
Of course it is good to exercise every day,
But specifically with diabetic patients, if you
Do NOT exercise, blood glucose will build
Up … but EXERCISE INCREASES YOUR CELLS
RECEPTIVITY TO INSULIN (which unlocks the cell
to allow the glucose in for energy).
This effect only lasts 24-72 hours. So if you do
NOT exercise on the 2nd day, you go 3 days without
Exercise, so blood glucose levels again spike (dangerous).
If exercise is non-existent, there are also many other impacts to heart related issues: CVD, CAD, atherosclerosis, MI, etc.
If you exercise, yes blood sugar
Will go down, but not immediately. It takes
A bit of time. If you don’t exercise, blood sugar will spike.
Anyone with diabetes should thus
Closely monitor themselves (their glucose
And insulin levels) at all times, but
Especially during exercise.
If a patient is taking insulin, you do NOT
Want to exercise at the PEAK time
Of taking insulin because at that time your
Blood glucose level is much lower.
Anyone exercising with diabetes should ALWAYS have some form of sugar, ID, and not exercise right after peak intake of insulin.
Carb counting is what:
Which of these is NOT a carb: banana, wheat bread, ice cream
T or F: A carb is a carb, the source does NOT matter
Counting how many carbs you eat, because carbs are broken down into sugars once in the body being digested.
THEY ALL ARE CARBS
TRUE. 15g of carb from ice cream, or from bread is the SAME effect on blood glucose levels.
Should a diabetic skip meals?
NEVER … you need consistent intake of carbs
1 choice of carbs =
What does this mean?
15g of carbs
I can do a choice of 1 bowl of ice cream that has 15g of carbs, or I can eat 5 fruits that have 15g of carbs. Either way, it is 15g of carbs = 1 choice of carbs.
How many choices of carbs in a meal of 75 g of carbs (if my I/C ratio is 1:15 … cause it can be different for diff. patients).
I/C ratio = 1:15
Current BG = 250
Target pre-meal BG = 150
CF = 1:50
Step 1 : 75 g ÷ 15 = 5 u (carb bolus)
Step 2: 250 – 150 = 100 ÷ 50 = 2u (correction bolus)
Step 3: Add 5 + 2 = 7u (meal bolus)
If you had a meal of 75g of carb, that is
5 choices of carbs.
One unit of insulin to 15g of carbs
Current Blood Glucose is 250, which is way
To high.
Correction factor is 1:50 (if you over eat you need to correct it … so the patient is
100g over, so they need 2 units of insulin
To correct). You could have a 1:100 or a 1:70 correction factor … it varies with each patient.
So they need to take 7units of insulin
T or F: Alcohol requires insulin to be metabolized?
What does alcohol do with regards to glucose? Why is this important to know?
FALSE. Alchohol is not converted to glucose … it is metabolized in the liver.
Alcohol inhibits the release of glucose from the liver. Because drinking too much shuts the liver down from releasing excess glucose, you become hypoglycemic which could cause someone to pass out / go into a coma.
Can you lower high blood glucose levels with a high-fiber diet?
YOU are in charge of managing your diabetes
You body needs carbohydrates for energy
Smoking increases the risk for other complications of diabetes
Blood glucose monitoring can help you manage your diabetes
Yes. In people with diabetes, fiber can slow the absorption of sugar and help improve blood sugar levels. A healthy diet that includes fiber may also reduce the risk of developing type 2 diabetes
Is the item below a s/s for HIGH or LOW blood glucose:
- Increased urination
- Thirst
- Hunger
- Weakness
- Seizure
- Fast heartbeat
- Anxiety
- Numbness or tingling around lips
- Not able to think clearly
- Lack of energy
- Irritable
- Dry skin and mouth
- Sweating
- Headache
- Cut or sore that won’t heal
- Feeling drowsy
- Shaky
- Confusion
- Blurred vision
- Increased urination (High) … polyuria
- Thirst (high) … polydispia
- Hunger (low)
- Weakness (low)
- Seizure (low)
- Fast heartbeat (low)
- Anxiety (low)
- Numbness or tingling around lips (low)
- Not able to think clearly (low)
- Lack of energy (high)
- Irritable (low)
- Dry skin and mouth (high)
- Sweating (low)
- Headache (low)
- Cut or sore that won’t heal (high)
- Feeling drowsy (low)
- Shaky (low)
- Confusion (low)
- Blurred vision (high)
Will the factors below cause blood sugar levels to go UP or DOWN?
- More physical activity than usual
- Being sick
- Taking more diabetes medicine than prescribed
- A late or skipped meal
- When taking diabetes medicine, drinking alcohol without eating
- Increased stress at work or at home
- Forgetting to take diabetes medicine
- Eating more carbs than usual
- Eating less carbs than usual
- Less activity than usual
- More physical activity than usual (down)
- Being sick (up)
a. Because of stress - Taking more diabetes medicine than prescribed (down)
- A late or skipped meal (down)
- When taking diabetes medicine, drinking alcohol without eating (down)
- Increased stress at work or at home (up)
- Forgetting to take diabetes medicine (up)
- Eating more carbs than usual (up)
- Eating less than usual (down)
- Less activity than usual (up)
FACT OR MYTH:
- You can lower high blood glucose with high-fiber foods.
- Diabetes is a fairly easy disease to manage.
- Smoking increases the risk of complications of diabetes.
- People with diabetes can’t eat sweets or chocolate.
- Insulin causes atherosclerosis (hardening of the arteries) and high blood pressure.
- Insulin causes weight gain, and because obesity is bad for you, one should avoid taking insulin.
- Blood glucose monitoring can help you manage your diabetes.
- The main problem in diabetes is blood glucose.
- Insulin causes diabetes to get worse.
- Insulin causes complications.
- If a person with diabetes feels okay, he or she is okay.
- Fruit is a healthy food. Therefore, it is okay to eat as much of it as you wish.
- You don’t need to change your diabetes treatment plan unless your A1C is greater than 8%.
- Eating too much sugar causes diabetes.
- An ultra low carb diet (like Atkins) is the best diet for people with diabetes.
- To lose as much weight as you want, you have to crash diet (reduce calories significantly).
- Your body needs carbohydrates for energy.
- If you have diabetes, you should only eat small amounts of starchy foods, such as bread, potatoes and pasta.
- Insulin is a cure for diabetes.
- People with diabetes are more likely to get colds and other illnesses.
- You can catch diabetes from someone else.
- The patient is in charge of managing his/her diabetes.
- You can lower high blood glucose with high-fiber foods.
a. Myth - Diabetes is a fairly easy disease to manage.
a. Fact - Smoking increases the risk of complications of diabetes.
a. Fact - People with diabetes can’t eat sweets or chocolate.
a. Myth - Insulin causes atherosclerosis (hardening of the arteries) and high blood pressure.
a. Myth - Insulin causes weight gain, and because obesity is bad for you, one should avoid taking insulin.
a. Myth - Blood glucose monitoring can help you manage your diabetes.
a. Fact - The main problem in diabetes is blood glucose.
a. Myth - Insulin causes diabetes to get worse.
a. Myth - Insulin causes complications.
a. Myth - If a person with diabetes feels okay, he or she is okay.
a. Myth - Fruit is a healthy food. Therefore, it is okay to eat as much of it as you wish.
a. Myth - You don’t need to change your diabetes treatment plan unless your A1C is greater than 8%.
a. Myth - Eating too much sugar causes diabetes.
a. Myth - An ultra low carb diet (like Atkins) is the best diet for people with diabetes.
a. Myth - To lose as much weight as you want, you have to crash diet (reduce calories significantly).
a. Myth - Your body needs carbohydrates for energy.
a. Fact - If you have diabetes, you should only eat small amounts of starchy foods, such as bread, potatoes and pasta.
a. Fact - Insulin is a cure for diabetes.
a. Myth - People with diabetes are more likely to get colds and other illnesses.
a. Fact - You can catch diabetes from someone else.
a. Myth - The patient is in charge of managing his/her diabetes.
a. Fact
Is DKA or HHS pH level below 7.35
Is Blood glucose level greater than 250 mg/dl in DKA or HHS?
Would you see Polyuria (and thus lead to dehydration) in DKA or HHS?
Would you see seizures in DKA or HHS?
*** Rapid deep breathing is seen in DKA or HHS? (REMEMBER the video)
Which one (DKA or HHS) would you have acetone breath?
DKA
Both
DKA
HHS
DKA
DKA (because you have acetones in breath from excess keytones in blood)
How many times a week should someone with diabetes exercise:
30 mins a day 5 days a week (150 mins)
Why are foot exams SO important for someone with diabetes
How often should someone check their feet with diabetes?
WHY?
How often should PT check patients feet?
How often should someone with diabetes get their eyes checked?
How often should a patient get a Hb1Ac?
These pts get peripheral neuropathies so they can’t feel (or see) bottom of feet, so it is important to check for wounds.
Once a day
Why: diabetes patients bruise and get wounds more easily (see above comment).
Every visit
Annually
Every 3-6 months
You should take 1 unit of insulin for every ________ of carbohydrate you eat.
15 grams
Does too much sugar and inactivity cause diabetes?
How can you delay the onset of Type II diabetes
NO
Diet and exercise. And go to Dr. to get HbA1c and IGT, iFT tests done regularly.
Patients are taught to know the ABC’s of diabetes. What are they:
A: HbA1c (aim for less than 7%)
B: Blood Pressure: Less than 130/80 ideally
C: Cholesterol: of LDL <100
Which type of diabetes comes about by a gradual onset around age 40
When patients actually have s/s of diabetes, they typically have had it for how long?
Type II
15 years
“Brittle” diabetic patients mean:
Patients are considered “brittle” diabetes if their highs and lows of blood surgar fluctuate and are very hard to predict.
Alpha cells are associated with:
Beta cells are associated with:
What IS a risk factor for BOTH type I and type II diabetes?
Classic s/s of diabetes include everything except:
Term used when blood glucose levels swing form high to low and back to high to low
Strong irregular pulse is s/s of:
BEST TIME FOR patients to exercise with Type I diabetes is:
If you have high blood glucose with NO keytones in blood it is:
Will drinking alcohol without eating make your blood glucose go up or down?
GLUCAGON
INSULIN
1st degree relative
UNEXPECTED WEIGHT GAIN
Brittle
DKA
In the MORNING
HHS
DOWN
A hormone that is needed to move glucose from the blood stream into cells to be used for energy.
This organ produces insulin and other hormones.
This organ has many jobs including making and storing glucose.
The amount of sugar in the blood.
Excess food and glucose is generally stored as this.
Insulin
Pancreas
Liver
Blood glucose level
Body fat
1) 3 legged stool for managing diabetes:
2) T or F: Carbohydrates = sugars
3) T or F: The total amount of carbs is more important than the source of carbs? Explain
4) The goal for exercise each week for any pt is:
1)
- Diet
- Exercise
- Medication
2) True
3) True. The total amount of carbs is more Important than the source. Meaning It is not the healthiness of the choice Of food, vs. the quantity (portion Control). Meaning you can eat a Ton of carbs in bread, and one bowl Of ice cream, but if sugar levels are Same from each, then is is equally As bad no matter what you eat.
4) 150 min/wk moderate activity (30 min a day 5x a week)
Explain what a FPG and OGTT are:
When HbA1c is higher than 6.5 =
FPG: Fasting plasma glucose
Is a test to measure glucose levels in blood after fasting. To be normal, it has to be less than 100 mg/dl
OGTT: Oral Glucose Tolerance Test
Where you drink a very sweet liquid and then have your blood tested to see how much blood sugar is in your blood. If there is a high amount, probably means diabetes because insulin isn’t working.
Diabetes
If someone is taking injected insulin, when should they exercise?
T or F: Diabetes patients have trouble with wound healing?
Related to the last point, what should PT’s monitor with diabetic pt’s
Are vegetables a source of high amounts of carbs?
If patient is taking insulin, you do NOT want to exercise at the PEAK time of taking insulin because at that time your
blood glucose levels are much lower. Exercise in the morning.
But, any time they exercise, they should closely monitor blood glucose levels and have something sweet with them in case, and insulin handy to inject if needed.
True
Soles of feet.
Not usually (they have low carb amounts)
T or F: Exercise helps spur the growth of RBC’s
Exercise DOES actually helps spur the growth of RBC’s
