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 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
