Diabetes Accross Physical Therapist Practice Patterns

Question 1

Coronary artery disease and stroke is ____ to ____ more common in older people with DM

Answer 1

2 to 4

Question 2

_______ (fraction) of people with DM die from heart disease or stroke

Answer 2

2/3

Question 3

DM accelerates macrovascular disease, which leads to which 3 diseases

Answer 3

Stroke, CAD, PAD

Question 4

Microvascular disease leads to which 2 conditions

Answer 4

Retinopathy, nephropathy,

Question 5

Type 1 DM, physiological mechanism underlying it

Answer 5

Autoimmune destruction of pancreatic beta cells, usually resulting in absolute deficiency in insulin secretion.

Question 6

Latent autoimmune diabetes physiological mechanism of action

Answer 6

Acquired in adulthood, slowly progressive, a presence of some of the DM associated autoantibodies seen in DM1, but insulin is not required at time of diagnosis-distinguishes it from type 1. Eventually beta cells lose ability to produce insulin

Question 7

Definition of impaired glucose tolerance

Answer 7

140-199 mg/dL on the 75 g oral glucose tolerance test

Question 8

Definition of impaired fasting glucose

Answer 8

100-125 mg/dL in fasting individuals

Impaired glucose tolerance and impaired fasting glucose together define prediabetes

Question 9

Definition of metabolic syndrome, 5 factors

Answer 9

Insulin resistance
Dyslipidemia
HTN
Abdominal obesity
Prothrombotic state
Proinflammatory state

Question 10

What is the dual defect of DM2?

Answer 10

Progressive beta cell failure against a background of insulin resistance

Question 11

What did Fowler find in the landmark double blind study about preventing DM2

Answer 11

If lose 7% of weight and walk 30 minutes 5 days per week

Question 12

It is now evident that high intensity exercise not necessary for reducing risk of chronic cardiovascular and metabolic disease, but is is evident that high intensity is more effective with these diseases:

Answer 12

DM2, depression, osteopenia, sarcopenia

Question 13

It is important to keep systolic levels

Answer 13

180

Question 14

SMART acronym for goals

Answer 14

Specific
Measurable
Attainable
Realistic 
Time-frame specific

Question 15

Sulfonylureas mode of action

“IDE” e.g. Glipizide

Answer 15

Stimulate beta cells to release insulin

Question 16

Biguanide mode of action

E.g. Metformin

Answer 16

Decrease hepatic glucose production and decrease insulin resistance in periphery

Question 17

Meglitinides mode of action

E.g. Repaglinide

Answer 17

Stimulate beta cells to release insulin, can cause hypoglycemia

Question 18

Thiazolidinediones mode of action

Answer 18

Decrease insulin resistance in muscle and fat and reduce glucose production in the liver

Question 19

D-phenylalnine derivatives mode of action

Answer 19

Stimulate insulin secretion for pancreas, extent of insulin is glucose dependent so less risk for hypoglycemia

Question 20

DPP-4 inhibitors mode of action

Liptins

Answer 20

Increase insulin synthesis, indirectly increase glucose uptake, lowers glucose only when elevated

Question 21

Glucagon-like peptide-1 analog mode of action
tides
E.g. Exenatide

Answer 21

Injection only, mechanism not quite understood, but enhances glucose dependent insulin secretion, suppresses appetite, suppresses high glucagon secretion

Question 22

Dopamine agonist mode of action

E.g. Bromocriptine

Answer 22

Unknown but improves glycemic control

Question 23

Alpha-glycosidase inhibitor mode of action

Acarbose
Miglitol

Answer 23

Lower glucose by blocking breakdown of carbs in the intestine

Question 24

Rapid acting insulins
Onset
Peak
Duration

Answer 24

15 min
30-90 minutes
3-5 hours

Question 25

Short acting insulin Onset Peak Duration

Answer 25

30-60 2-4 5-8

Question 26

Intermediate acting insulin Onset Peak Duration

Answer 26

1-3 8 12-16

Question 27

Long acting insulin Onset Peak Duration

Answer 27

1 hour Peakless 20-26 hours

Question 28

Which drugs often preferred to treat HTN in people with DM due to protective effect to kidneys?

Answer 28

ACE inhibitors, but water soluble, so can be toxic especially in older people who tend to have decreased total water volume.

Question 29

The 5 most prevalent acute syndromes associated with poly pharmacy

Answer 29

``` Confusion Falls Malnutrition Failure to thrive Urinary incontinence ```

Question 30

Goals for glycemic control A1C Preprandial Posprandial

Answer 30

<6.5-7 <100-130 <140-180 2 hours after meal

Question 31

7 signs of stage 1 hypoglycemia (ANS response)

Answer 31

``` Tremor Palpitations Anxiety Pallor Hunger Diaphoresis Parasthesias ```

Question 32

7 signs of stage 2, Neuroglycopenic hypoglycemia | Brain glucose deprivation response

Answer 32

``` Cognitive impairments Inappropriate behavioral changes Weakness and fatigue Hunger Focal neurologic deficits e.g. Hemiparesis,slurred speech Seizures Coma/death ```

Question 33

Most common cause of diabetic coma and death, primary cause?

Answer 33

Hyperosmolar hyperglycemic state Dehydration the most frequent cause, with infection such as pneumonia being a precipitating factor More frequent in older adults 15% fatality rate Main difference between DKA and HHS is that with HHS insulin present, DKA usually only occurs in people with DM1, HHS occurs almost exclusively in people with DM2

Question 34

Types of drugs that may precipitate the development of HHS

Answer 34

Glucocorticoids, thiazide diuretics, phenytoin (Dilantin) and beta blockers

Question 35

4 primary features of HHS

Answer 35

Sever hyperglycemia (>600mg/dL) Absence of significant ketosis Profound dehydration Neurologic manifestations

Question 36

What are Advanced Glycation End Products and their relation to DM?

Answer 36

AGEs for slowly throughout time, but much more quickly in people with DM because of more readily available glucose. As glucose becomes incorporated into proteins, AGEs are formed in an irreversible chemical reaction. Found in retinal vessels of people with DM, found in large and small vessels (micro and macrovascular disease) joint capsules and tendons (decreased ROM)

Question 37

What is thought to be a major contributor to joint ROM loss in people with DM?

Answer 37

AGEs, chemical reaction between glucose and proteins that is irreversible and acts as molecular glue, decreasing soft-tissue extensibility and joint capsule mobility.

Question 38

Hallux limitus Hallux rigidus Normal extension value of 1st IP joint What do these conditions place person at risk for?

Answer 38

Limited ROM of 1st MP joints, 0-50 or 70 DF Complete loss of ROM of 1st MP 10-15 degrees Great toe ulceration

Question 39

the most common neuropathies associated with DM

Answer 39

Chronic sensorimotor distal symmetric polyneuropathy | Autonomic neuropathy

Question 40

Peripheral neuropathy affects _____% of people with DM

Answer 40

30

Question 41

A meta analysis provides evidence that treatment with ______________ (drug) improves neuropathic symptoms

Answer 41

alpha-lipoic acid

Question 42

According to the CDC _________ disease is the leading cause of morbidity and mortality in people with DM

Answer 42

Cardiovascular

Question 43

People with DM are ____ to ____ times likely to have an MI

Answer 43

2-4

Question 44

Cardiovascular impairment is present in _____% of people with DM

Answer 44

40

Question 45

3 major associated cardiac syndromes to DM

Answer 45

Orthostatic hypotension Cardiac enervation syndrome Abnormal cardiovascular response to exercise

Question 46

Definition of orthostatic hypotension

Answer 46

Drop >30 on SBP or > 10 on DBP Within 2 minutes of changing from supine to standing

Question 47

Definition of cardiac denervation syndrome

Answer 47

Does not Change in response to stress or sleep, breathing etc Often called or goes hand in hand with silent cardiac ischemia