Diabetes

Question 1

The body’s preferred, primary energy source for cellular metabolism

Answer 1

Glucose

Question 2

What are the functions of the Pancreas

Answer 2

Exocrine and Endocrine function: Somatostatin - regulates release of insulin and glucagon

Question 3

What is the function of Insulin

Answer 3

Stimulates cellular absorption of glucose.

• transport glucose into cells
• turns glucose into fats
• promotes transport of glucose to liver

Question 4

What is the function of Glucagon

Answer 4

Released during Hypoglycemia

Promotes conversion of glycogen into glucose: Raises blood sugar level

Question 5

Type of DM that occurs when the immune system attacks the insulin-producing beta cells in the pancreas

Answer 5

Type 1 DM

Question 6

Insulin resistance even though insulin present
AND Altered response to glucose
Results
Hyperglycemia
Onset: Adult (seen in obese children)
Gradual increase of resistance to insulin

Answer 6

Type 2 DM

Question 7

What are the extrinsic risk factors of Type 2 DM?

Answer 7

obesity
sedentary lifestyle
diet

Question 8

What are the intrinsic risk factors of Type 2 DM

Answer 8

Ethnicity: African-American, Asian, Pacific Islander, Latin
Males >45yo
HTN, Hyperlipidemia
Family history of DM

Question 9

What are the treatments involved with Type 2 DM?

Answer 9

Medication: Oral and insulin injection
Nutritional Counseling
Stress management
Exercise

Question 10

What are the delivery devices for insulin?

Answer 10

Insulin syringe
Insulin pen
Insulin pump
Jet injector

Question 11

What are the effects of Stress Cortisol Release?

Answer 11

increases visceral obesity, low grade inflammation, leptin, and insulin resistance.

Question 12

What benefits does exercise have on Type 2 DM?

Answer 12

Increases
-beta-cell mass
-insulin
-insulin sensitivity
-glucose uptake
-glucose and fatty acid oxidation
Decreases
-glucagon
-blood glucose
-hemoglobin A1c
-fat mass
-hepatic glucose production

Question 13

What is Gestational Diabetes?

Answer 13

Developed during pregnancy
Causes
Weight gain
Genetic predisposition 
Resistance to insulin 2° hormone changes
Low HDL, elevated triglycerides
MAY be more likely to develop Type 2 DM later in life

Question 14

Where is glycogen stored?

Answer 14

The Liver

Question 15

T/F: During periods of hypoglycemia, glucagon is released by the pancreas.

Answer 15

True

Question 16

What are the Big 3 Signs and Symptoms of DM?

Answer 16

Polydipsia (thirst)
Polyuria (urination)
Polyphagia (hunger)
*also...
Hyperglycemia
Hyperglycosuria (high excretion of glucose in urine)
Weight loss
Increased appetite
Nausea
Blurred vision
Amenorrhea (absence of menstrual period)
ED

Question 17

Created by the liver when the body has decreased glucose levels for use by cells, and used as an energy source for cellular function

Answer 17

Ketones

Question 18

The effect of Ketones used as an energy source are?

Answer 18

Hyperglycemia
Hyperketonemia (ketones in blood)
Hyperketonuria (ketones in urine)
Ketoacidosis (lowers blood PH level acidic levels

Question 19

What are the symptoms of Ketoacidosis?

Answer 19

headache confusion
sleepiness, LOC
weakness
diarrhea
shortness of breath
arrythmia
increased HR
nausea
vomiting

Question 20

What are the Systemic Complications of DM?

Answer 20

• gradual destruction of small blood vessels and nerves throughout the body
• 2 degree sugar crystal formation during hyperglycemia
• Affects ALL systems
• PVD (LE blood flow)

Question 21

What are the Neurologic complications of DM?

Answer 21

Sensory neuropathy (Paresthesia, pain, sensation loss)
Motor neuropathy (Muscle atrophy)
Autonomic neuropathy (Sweat/oil production, digestion, stress etc.)
Diabetic Neuropathy
(LE and feet)

Question 22

Additional Systemic Complications of DM?

Answer 22

Integumentary
Visual
CNS
Cardiac
Digestive
Renal (uncontrolled HTN)
Dental
Urinary/Reproductive
Mental

Question 23

What are the lab values for FPG (fasting plasma glucose)?

Answer 23

Mg/dL: Milligram per Deciliter
Normal: <100mg/dL
Prediabetic: 100 to 125mg/dL
Diabetic: >125mg/dL

Question 24

What is the normal value for A1C Testing? *also known as hemoglobin A1C

Answer 24

Normal: 4 to 5.6%
At Risk: 5.7 to 6.4%
Diabetes: 6.5%

Question 25

What are the symptoms of Hyperglycemia?

Answer 25

``` >200 - 300mg/dL gradual onset extreme thirst dry skin hungry need to urinate often blurry vision drowsy slow-healing wounds flushed, dry ```

Question 26

What are the symptoms of Hypoglycemia?

Answer 26

``` >70mg/dL sudden onset extreme fatigue blurred vision sweating mood changes dizziness increased pulse shaky/trembling ```

Question 27

When is exercise contraindicated for hypoglycemia or hyperglycemia?

Answer 27

hypo: < 70mg/dL hyper: > 300mg/dL with ketones

Question 28

What are some exercise guidelines for a patient that is hyperglycemic and on oral meds?

Answer 28

Oral - 10 to 15 min of activity - BG rises, STOP. - BG drops, continue while rechecking BG every 10 to 15 min

Question 29

What are some exercise guidelines for a patient that is hyperglycemic and on insulin?

Answer 29

Should be checked for ketones* (via urine dip stick or glucose meter) If (+) ketones: avoid activity If (-) ketones: participate with close BG monitoring

Question 30

T/F? One cause of ketoacidosis is low blood glucose availability for tissues to use and is a medical emergency.

Answer 30

True

Question 31

What are the benefits of exercise with Type 2 DM?

Answer 31

- Improve mild to moderate HTN - Increased energy expenditure - Cardio conditioning - Increased strength and flexibility - Improve well-being and quality of life.

Question 32

What are Diabetic exercise risks?

Answer 32

hypoglycemia hyperglycemia onset/exacerbation of cardiovascular diseases Autonomic neuropathy

Question 33

Guidelines for Cardiovascular Training for DM patients.

Answer 33

- gradual increase of intensity - 40 to 60% of MHR - walking, aquatic, treadmill, bike, UBE, tai-chi - 3 to 5x weekly - build to 30 min - 1000-2000 kcal/week

Question 34

Guidelines for Resistance Training for DM patients.

Answer 34

- Gravity - Free weights - Elastic Bands - Exercise Machines - Aquatic Exercises (water as resistance) - Gym Ball 10 to 15 reps/set 2 sets per major muscle group 1 min rest minimum 2-3x weekly 30 minutes

Question 35

What should you educate the Diabetic patient on?

Answer 35

- foot care - energy conservation - reinforce functional activities of interest

Question 36

What are the foot hygiene practices you should teach your patient?

Answer 36

- Inspect feet daily for injury or pressure areas - Wash feet with mild soap - Dry between toes - Don’t go barefoot - Caution with cutting toenails * Need Podiatrist?

Question 37

What are the Ulcer Prevention methods?

Answer 37

``` Control diabetes Foot hygiene Proper socks Proper shoes Pressure relief Wound care Monofilament testing ```

Question 38

Complication of neuropathy resulting in a complex of sensory, motor, and autonomic changes that lead to structural and vascular changes

Answer 38

Charcot Foot

Question 39

What are characteristics of Charcot Foot?

Answer 39

- Multiple osteoarthropathy - joint dislocation - pathological fractures - osteopenia - deformities (convex bottom of foot) - gait pattern changes - different pressure points

Question 40

What are the important questions to ask a patient with DM prior to exercising?

Answer 40

How do you feel? Did you monitor your glucose level this morning? What was it? Did you take your diabetes med today? Last time you ate? Do you have a snack or glucose tablets with you? Do you have your glucose monitor with you?