Diabetes Management

Question 1

Insulin Dependenet Diabetes

Answer 1

Type 1

Question 2

Non Insulin Dependent Diabetes

Answer 2

Type II

Question 3

IDDM Type I vs NIDDM Type II

Onset Age

Answer 3

<20yr vs >40yr

Question 4

IDDM Type I vs NIDDM Type II

% of all cases

Answer 4

5-10% vs 90-95%

Question 5

IDDM Type I vs NIDDM Type II

Onset

Answer 5

Abrupt vs Gradual

Question 6

IDDM Type I vs NIDDM Type II

Etiology

Answer 6

Possible viral/autoimmune, destroys islet cells (pancreas)
vs
obesity associated insulin receptor resistance

Question 7

IDDM Type I vs NIDDM Type II

Insulin Antibodies

Answer 7

Yes vs No

Question 8

IDDM Type I vs NIDDM Type II

Insulin Production

Answer 8

Decreased vs Variable

Question 9

IDDM Type I vs NIDDM Type II

Ketoacidosis

Answer 9

May occur vs Rare

Question 10

IDDM Type I vs NIDDM Type II

Intervention

Answer 10

Diet & insulin vs Diet, exercise, oral hypoglycemics

Question 11

IDDM Type I vs NIDDM Type II

Reversible?

Answer 11

No vs Yes

Question 12

Prediabetes is a risk factor for:

Answer 12

CAD

Question 13

Risk for prediabetes

Answer 13

overweight
45 or older
Immediate family member with Type II
Gestational diabetes or birth to baby >9 lbs
African American, Hispanic, American Indian, Alaska Native, Asian American

Question 14

Glycosylated hemoglobin

Answer 14

HbA1C reflects mean blood glucose control over the past 2-3 months
the lower the better

Question 15

Type II Risk

Answer 15

Prediabetes risk factors
Physically active less than 3 times a week
HTN (≥130/80)
HDL cholesterol < 35 mg/dL
Triglyceride ≥250 mg/dl

Question 16

Type I Risk

Answer 16

Family history
More likely to develop in children, teens, young adults
Caucasian

Question 17

Insulin is secreted by

Answer 17

B cells,& transports blood glucose into cells

Question 18

Glucose function

Answer 18

used as energy
stored as glycogen
trigger increased secretion of insulin

Question 19

Without insulin

Answer 19

decreased use of glucose
increased fat mobilization
impaired protein utilization

Question 20

Cardinal Signs of DM

Answer 20

Polydipsia (1 & 2)
Polyuria (1 & 2)
Weakness, fatigue, dizziness (1 & 2)
Polyphagia (1)
Weight loss (1)
Ketonuria (1)
Asymptomatic (2)

Question 21

Complications of DM

Answer 21

Neuropathy
2 x risk of high BP
2-4 x risk of heart disease
2-4 x risk of stroke
Blindness
Kidney failure
LE amputation

Question 22

CKD

Answer 22

chronic kidney disease
staged 1-5

Question 23

Impaired Tissue Healing

Blood vessels

Answer 23

hyperglycemia correlates w/ stiff blood vessels, leading to reduced circulation and microvascular dysfunction resulting in reduced tissue oxygenation

Question 24

Impaired Tissue Healing

Wound healing

Answer 24

reduced leukocyte migration into a wound, which becomes more vulnerable to infection

Question 25

# Impaired Tissue Healing Muscle atrophy

Answer 25

Muscle atrophy is caused by an imbalance in contractile protein synthesis & degredation which can be triggered by various conditions including Type II

Question 26

# Musculoskeletal Complications Upper Extremity

Answer 26

Syndrome of limited joint mobility (more in type 2) Adhesive capsulitis Stiff hand syndrome Dupytren's contracture Carpal Tunnel

Question 27

# Musculoskeletal Complications Spine

Answer 27

Diffuse idiopathic skeletal hyperostosis (DISH)

Question 28

# Musculoskeletal Complications Other complications

Answer 28

Osteoperosis

Question 29

# Skin Disorders and DM Frequency

Answer 29

30-91.2% Sometimes first sign of DM is associated w/ the skin Increases with length of DM

Question 30

# Skin Disorders and DM Skin disorders are shown in increased frequency with:

Answer 30

retinopathy or neuropathy

Question 31

# Skin Disorders and DM What type of infection was found to be more prevelant in pts with neuropathy?

Answer 31

Fungal infection

Question 32

# Amputations as a result of DM Significant predictors of amputations

Answer 32

Peripheral neuropathy Peripheral arterial disease Microalbuminuria Retinopathy Male gender

Question 33

# Amputations as a result of DM Risk of amputation in females increases w/

Answer 33

Age

Question 34

# Amputations as a result of DM Risk of amputation in males increases if:

Answer 34

diagnosed at younger age

Question 35

Areas most susceptible to pressure ulcer

Answer 35

Areas that receive pressure MTP heads Great Toe Heel

Question 36

# Outcome Measures Pressure Ulcer Scale for Healing

Answer 36

PUSH used to assess change in pressure ulcer status over time, including, size, exudate amount and tissue type

Question 37

Medical Management

Answer 37

Self monitoring blood glucose Glycemic control for Type I & Type II Diet

Question 38

# Medical management Glycemic control for Type I DM:

Answer 38

insulin injections, rotate injection sites, insulin pump, immunotherapy, islet cell transplant

Question 39

# Medical Management Glycemic control for Type II DM:

Answer 39

Diet Exercise Oral hypoglycemics

Question 40

GLP-1 Agonist Mechanism

Answer 40

* trigger insulin release * blocks glucagon secretion * slows stomach emptying * increases satiety

Question 41

Metabolic Syndrome increases risk of:

Answer 41

Increases risk of CVD and Type II DM

Question 42

Metabolic syndrome diagnostic criteria

Answer 42

Elevated waist circumference (40 in males, ≥35in females) Elevated triglycerides (≥150 mg/dL) Reduced HDL (<40 mg/dL males, <50 mg/dL females) Elevated BP (≥130/85) Elevated fasting glucose (≥100 mg/DL) 3 of the above criteria = Metabolic syndrome

Question 43

Diabetes Prevention Program

Answer 43

minor lifestyle changes (losing 7-10% of BW, cutting back 100 kcal/day, increase exercise to 30 min/day or brisk walking 5x/week) decreased incidence greater than drugs

Question 44

# DM Exercise testing ECG stress test

Answer 44

may be indicated for pts with DM and for sedentary people who wanted to participate in vigorous intensity activities

Question 45

# DM Exercise testing CVD risk factor assessments

Answer 45

Annual CVD risk factor assessments should be conducted to detect silent ischemia

Question 46

# Exercise Considerations ADA & ACSM recommendations

Answer 46

150 min of aerobic exercise 4-7 days/week or every other day Be mindful of injection site/area

Question 47

Contraindications for exercise in persons w/ DM

Answer 47

hypoglycemia (<70 mg/dL) hyperglycemia w/ ketones (>300 mg/dL) Unevaluated or poorly controlled retinopathy, HTN, nephropathy, neuropathy Dehydration

Question 48

Resistance Exercise vs Aerobic Exercise in Type I DM

Answer 48

Resistive exercise should be performed prior to aerobic exercise to improve glycemic stability in pts w/ Type I DM

Question 49

Resistance Exercise vs Aerobic Exercise in Type II DM

Answer 49

Maintaining lean body mass is important for improving outcomes