quiz #3- diabetes
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quiz #3- diabetes
diabetes and exercise
What does diabetes stand for?
named for the sweet taste of urine
diabetes = flow through a siphon
mellitus = honeyed
What is diabetes?
a systemic disorder of carbohydrate, fat and protein metabolism
What are characterisitcs of Type I diabetes?
severe insulin deficiency due to beta cell destruction
diagnosed before age 30
What are characteristics of Type II diabetes?
NIDDM, adult onset
begins with reduced sensitivity to insulin
overtime inadequate secretion of insulin due to beta cell exhaustion
usually diagnosed after age 40
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
What are characterisitics of prediabetes?
decreased insulin sensitivity, increased insulin resistance
higher than normal levels of insulin required for glucose transport into body cells
What are characteristics of secondary diabetes?
cushings syndrome (hormonal disorder with high levels of cortisol which inhibits use of glucose as fuel and promotes storage of glucose)
myotonic dystrophy ( delayed relaxation of muscles after contraction)
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
What is the rate of type 2 diabetes in children?
What is the cost of medical care for people with diabetes?
3-4x higher than a healthy individual
Diabetes is the ___ leading cause of death in the US.
What does diabetes put you at a greater risk for?
2-4x greater risk of CV disesase, stroke, PVD, and kidney disease
What is the difference in effect of diabetes on small and large arteries?
: relate to sensory
: relate to CV disease
What are some complications of diabetes?
PAD (4x greater risk for LE amputation)
impaired wound healing
What do microangiopathy and macroangiopathy lead to?
: lead to "opathy"
: lead to CVD, CAD, PAD
What do diabetic retinopathy, nephropathy, and neuropathy cause?
: cause blindness
: end stage renal disease
: autonomic, sensory, or muscular
What are risk factors for type II diabetes?
obesity (BMI >27, BW 20% > normal)
family history (doubles likelihood)
AA, hispanics, & american indians have highest rates
How does glucose impact the body?
food --> glucose --> body cells for energy
What is glucose regulated by and where is it formed?
regulated by hormone insulin which is formed by beta cells in the pancreas
What does high glucose mean?
release more insulin to push glucose into cells
What does low glucose mean?
body signals you to eat and release glucose stores from liver
What tissues in the body require insulin?
What tissues in the body do not require insulin?
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
What is the difference between fat metabolism in healthy muscle and in insulin resistant muscle?
: FA uptake --> lipid intermediates --> FA oxidation
: FA uptake--> increase lipid intermediates --> FA oxidation
What does insulin do?
promotes uptake and storage of amino acids resulting in protein synthesis in the muscle and liver
What are the 3 P's of diabetes and what do they mean?
: excessive thirst
: excessive urine
: excessive hunger
What are sysmptoms of diabetes?
the 3 P's (polydipsia, polyuria, polyphagia)
weight in people with type I
numbness in hands or feet
sweet smelling breath
What are normal BG levels?
< 180 after meals
lowest BG levels around 2 am
BG fluctuates throughout day but within normal range
What is a fasting glucose test?
measures glucose after 12 hour fast (usually more accurate)
>126=diabetes, 100-126= prediabetes, <100=normal
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
How can you diagnose diabetes?
glycated hemoglobin- HbA1c <6.5-7%
symptoms plus + fasting glucose test or + oral glucose test
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
What characteristics are associated with increased risk for CVD and type 2?
elevated fasting BG
(3 of 5)
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
What are signs/symptoms of hyperglycemia?
nausea and vomitting
loss of appettie
dry skin and mouth
decreased BP and increased HR
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
What are signs/symptoms of hypoglycemia?
increased tiredness and hunger
dizzy or fainting spells
nervous and increased HR
confusion and lack of coordination
changes in behavior/irritable
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)
When are adverse effects of insulin usually a problem?
waiting too long to take meds
your BG is already low when you take it
taking too much insulin
exercising when sugar is low
What are some of the different medications and how can they effect exercise?
: increase risk for hypoglycemia so avoid vigorous exercise during peak times
: increased risk of hypoglycemia
: increased risk of lactic acidosis so want to avoid high intensity anaerobic training
: control BP by blocking vasodialation so may cause dizziness
DON'T GIVE GRAPEFRUIT JUICE IF TAKING STATINS
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
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
What are resistance exercises for diabetics?
2-3 days/wk, all major muscle groups (8-20 exercises)
progress from 1 to 3 sets, rest 30 seconds between
What do diabetics want to avoid when exercising?
skipping exercise for more than 2 days
What are flexibility exercises for diabetics?
all major muscle groups
hold 15-30 seconds
repeat 4-6 times
What are balance exercises for diabetics?
static and dynamic balance
What do you do if BG is <70?
give 15 gm CHO snack, recheck in 15 min
if >70 proceed with exercise
What do you do if BG is 70-100?
give 15 gm CHO snack per hour of moderate intensity of exercise
What do you do if BG is 100-300
proceed with exercise
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
What do you do if BG is >300 & on insulin?
check for ketones
if + then NO exercise
if - then proceed and monitor BG
What happens when BG and ketones aren't ocntrolled during exercise?
ketone bodies increase because not enough sugar and trying to break down fat
Which is exercise more important for Type I or Type II?
more important in Type I to prevent CVD
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
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
What are some complications with peripheral neuropathies with exercise?
What are some complications with nephropatheis with exercise?
maintain SBP <180
avoid high intensity aerobic or resistance training and valsalva
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
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
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
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