quiz #3- diabetes

  1. What does diabetes stand for?
    • named for the sweet taste of urine
    • diabetes = flow through a siphon
    • mellitus = honeyed
  2. What is diabetes?
    a systemic disorder of carbohydrate, fat and protein metabolism
  3. What are characterisitcs of Type I diabetes?
    • IDDM, juvenile
    • 10-15%
    • severe insulin deficiency due to beta cell destruction
    • diagnosed before age 30
  4. What are characteristics of Type II diabetes?
    • NIDDM, adult onset
    • 85-90%
    • begins with reduced sensitivity to insulin
    • overtime inadequate secretion of insulin due to beta cell exhaustion
    • usually diagnosed after age 40
  5. WHat are characteristics of Gestational diabetes?
    • develops during pregnancy (4%)
    • higher prevalence in overweight moms
    • babies > 9lbs
    • if BG remains high >6 wks after delivery then type II
  6. What are characterisitics of prediabetes?
    • decreased insulin sensitivity, increased insulin resistance
    • higher than normal levels of insulin required for glucose transport into body cells
  7. What are characteristics of secondary diabetes?
    • chronic pancreatic
    • cushings syndrome (hormonal disorder with high levels of cortisol which inhibits use of glucose as fuel and promotes storage of glucose)
    • prednisone
    • myotonic dystrophy ( delayed relaxation of muscles after contraction)
    • denervation
    • prolonged immobilization
  8. What is the prevelance of diabetes?
    • 40% of adults have diabetes or prediabetes
    • 23.5 million= diabetes
    • 41 million= prediabetes
    • 80% of PT pts have diabetes, prediabetes, or risk factors for diabetes
  9. What is the rate of type 2 diabetes in children?
  10. What is the cost of medical care for people with diabetes?
    3-4x higher than a healthy individual
  11. Diabetes is the ___ leading cause of death in the US.
  12. What does diabetes put you at a greater risk for?
    2-4x greater risk of CV disesase, stroke, PVD, and kidney disease
  13. What is the difference in effect of diabetes on small and large arteries?
    • small arteries: relate to sensory
    • large arteries: relate to CV disease
  14. What are some complications of diabetes?
    • impaired metabolism
    • CVD
    • diabetic retinopathy
    • diabetic nephropathy
    • diabetic neuropathy
    • PAD (4x greater risk for LE amputation)
    • impaired wound healing
    • joint stiffness
    • microangiopathy
    • macroangiopathy
  15. What do microangiopathy and macroangiopathy lead to?
    • microangiopathy: lead to "opathy"
    • macroangiopathy: lead to CVD, CAD, PAD
  16. What do diabetic retinopathy, nephropathy, and neuropathy cause?
    • retinopathy: cause blindness
    • nephropathy: end stage renal disease
    • neuropathy: autonomic, sensory, or muscular
  17. What are risk factors for type II diabetes?
    • obesity (BMI >27, BW 20% > normal)
    • family history (doubles likelihood)
    • sedentary lifestyle
    • aging
    • AA, hispanics, & american indians have highest rates
  18. How does glucose impact the body?
    food --> glucose --> body cells for energy
  19. What is glucose regulated by and where is it formed?
    regulated by hormone insulin which is formed by beta cells in the pancreas
  20. What does high glucose mean?
    release more insulin to push glucose into cells
  21. What does low glucose mean?
    body signals you to eat and release glucose stores from liver
  22. What tissues in the body require insulin?
    • muscle cells
    • fat cells
    • WBC
  23. What tissues in the body do not require insulin?
    • nerve cells
    • CNS
    • lens/retina
    • RBC
    • blood vessels
    • kidney
  24. In people with diabetes lack of or ineffective action of insulin leads to what?
    • inability to use carbohydrates as fuel source
    • for energy metabolism of fat as a fuel source is increased above normal
    • decreased uptake of triglycerides by cells which leads to elevated blood triglyceride levels by 5x's, and excess formation of ketones and increased CHO levels
  25. What is the difference between fat metabolism in healthy muscle and in insulin resistant muscle?
    • healthy: FA uptake --> lipid intermediates --> FA oxidation
    • insulin resistant: FA uptake--> increase lipid intermediates --> FA oxidation
  26. What does insulin do?
    promotes uptake and storage of amino acids resulting in protein synthesis in the muscle and liver
  27. What are the 3 P's of diabetes and what do they mean?
    • polydipsia: excessive thirst
    • polyuria: excessive urine
    • polyphagia: excessive hunger
  28. What are sysmptoms of diabetes?
    • the 3 P's (polydipsia, polyuria, polyphagia)
    • increased fatigue
    • weight in people with type I
    • dry mouth
    • blurred vision
    • labored breathing
    • numbness in hands or feet
    • impotence
    • sweet smelling breath
  29. What are normal BG levels?
    • 80-120
    • < 180 after meals
    • lowest BG levels around 2 am
    • BG fluctuates throughout day but within normal range
  30. What is a fasting glucose test?
    • measures glucose after 12 hour fast (usually more accurate)
    • >126=diabetes, 100-126= prediabetes, <100=normal
  31. What is a oral glucose tolerance test?
    • measures glucose 2 hours after drinking concentrated glucose solution
    • delayed removal of glucose indicates diabetes
    • >200=diabetes, 140-200=prediabetes, <140=normal
  32. How can you diagnose diabetes?
    • glycated hemoglobin- HbA1c <6.5-7%
    • symptoms plus + fasting glucose test or + oral glucose test
  33. Who do you test for diabetes and when?
    • adults >45 repeat every 3 years
    • adults <45 with one of the following- BMI >27, triglycerides >250, family hx, hx of gestational diabetes, member of risk ethnic group, on previous testing had IFG or IGT
    • children >10 who are overweight plus two of the following- family hx, member of risk race, signs of insulin resistance- administer fasting glucose every 2 years
  34. What characteristics are associated with increased risk for CVD and type 2?
    • waist circumference
    • triglycerides
    • HDL <40/50
    • HTN
    • elevated fasting BG
    • (3 of 5)
  35. How do you treat hyperglycemia (>220) and ketosis?
    • have too little insulin- in a diabetic coma so give insulin
    • if still over 250 call MD
  36. What are signs/symptoms of hyperglycemia?
    • thirsty
    • frequent urination
    • general weakness
    • nausea and vomitting
    • loss of appettie
    • confusion
    • ill appearance
    • dry skin and mouth
    • decreased BP and increased HR
  37. How do you treat hypoglycemia (<60)
    • they are in insulin shock and have too much insulin so give them sugar, OJ, cola, (15 gram snack)
    • check it again in 15 min and give another if necessary
    • if still low call MD
  38. What are signs/symptoms of hypoglycemia?
    • increased tiredness and hunger
    • trembling
    • excessive sweating
    • dizzy or fainting spells
    • nervous and increased HR
    • confusion and lack of coordination
    • changes in behavior/irritable
    • headache
    • convulsions
    • blurred vision
    • paleness
    • slurred speech
  39. What are the different types of insulin and when are they effective?
    • ultra short acting- before meal --> 3.5 hours after (1 hr pk)
    • regular- 30 min before meal --> 6-8 hr after (2 hr peak)
    • intermediate- 1-4 hr before -->14-24 hours (6-12 hr peak)
    • long- 4-6 hr before --> 36 hours after (8-20 hr peak)
  40. When are adverse effects of insulin usually a problem?
    • waiting too long to take meds
    • your BG is already low when you take it
    • missed meals
    • taking too much insulin
    • exercising when sugar is low
  41. What are some of the different medications and how can they effect exercise?
    • insulin: increase risk for hypoglycemia so avoid vigorous exercise during peak times
    • sulfonylureas: increased risk of hypoglycemia
    • metformin: increased risk of lactic acidosis so want to avoid high intensity anaerobic training
    • ACE inhibitors: control BP by blocking vasodialation so may cause dizziness
  42. Exercise with ECG is recommended when?
    • prior to vigorous exercise
    • type II DM > 10yrs
    • type I DM > 15 yrs
    • presence of additional CAD risk factors
    • presence of retinopathy or nephropathy
    • PVD
    • autonomic neuropathy
  43. What are aerobic exercise guidelines for diabetics?
    • 3-5 days/wk (150 min/wk)
    • moderate intensity, PRE 10-12
    • increase duration before intensity
    • nonWB may be more appropriate if have peripheral neuropathy
  44. What are resistance exercises for diabetics?
    • 2-3 days/wk, all major muscle groups (8-20 exercises)
    • 8-12 RM
    • progress from 1 to 3 sets, rest 30 seconds between
  45. What do diabetics want to avoid when exercising?
    skipping exercise for more than 2 days
  46. What are flexibility exercises for diabetics?
    • all major muscle groups
    • hold 15-30 seconds
    • repeat 4-6 times
  47. What are balance exercises for diabetics?
    static and dynamic balance
  48. What do you do if BG is <70?
    • give 15 gm CHO snack, recheck in 15 min
    • if >70 proceed with exercise
  49. What do you do if BG is 70-100?
    give 15 gm CHO snack per hour of moderate intensity of exercise
  50. What do you do if BG is 100-300
    proceed with exercise
  51. What do you do if BG is >300 & on oral meds?
    • do 10-15 min exercises and check sugar
    • if rises then stop
    • if drops then proceed
  52. What do you do if BG is >300 & on insulin?
    • check for ketones
    • if + then NO exercise
    • if - then proceed and monitor BG
  53. What happens when BG and ketones aren't ocntrolled during exercise?
    ketone bodies increase because not enough sugar and trying to break down fat
  54. Which is exercise more important for Type I or Type II?
    • Type II
    • more important in Type I to prevent CVD
  55. What are some complications with retinopathy with exercise?
    • contraindicated if have retinal hemorrhage or recent surgical procedure
    • avoid valsalva, head jarring activities, and head below waist
    • SBP should not rise >20-30 RBP
  56. What are some complications with autonomic neuropathies with exercise?
    • may not develop warning signs of hypoglycemia until it is severe, monitor BG
    • may have blunted HR and BP responses to exercise
    • monitor signs for silent ischema
  57. What are some complications with peripheral neuropathies with exercise?
    impaired balance
  58. What are some complications with nephropatheis with exercise?
    • maintain SBP <180
    • avoid high intensity aerobic or resistance training and valsalva
  59. What are absolute contraindications to exercise for diabetetics?
    • ingesting alcohol 3 hours prior
    • hypoglycemia symptoms (shakiness, dizziness, sweating, hunger, headache, pale skin, behavior changes, clumsy, seizure, tingling sensation)
    • hyperglycemia symptoms (ketones with 1 or more of these symptoms- SOA, fruity breath smell, N/V, dry mouth
  60. What is the role of PT in prolonged bedrest?
    • IRS evident within 3 days
    • decrements in BG tolerance decrease in pts that are active in bed
  61. What is the role of PT in immobilization?
    one wk of immobilization reduces glucose uptake in the immobilized limb, isometric exercises minimize the reduction in glucose transport to the limb
  62. How do you avoid hypoglycemia and hyperglycemia when exercising?
    • check BG levels prior to exercise
    • don't exercise at time of peak insulin action (generally take 1 hr prior to exercise)
    • exercise after meals helps improve glycemic control
    • late in the evening may increase risk of nocturnal hypoglycemia
Card Set
quiz #3- diabetes
diabetes and exercise