Endocrine - Diabetes & Obesity Flashcards
(78 cards)
1
Q
Type 1 - Diabetes
Type 1 accounts for what percentage of diabetes?
A
5-10%
2
Q
Type 1 - Diabetes
What age does it usually start?
A
generally quick in ages 25 or younger
3
Q
Type 1 - Diabetes
What is the mechanism of disease?
A
The autoimmune destructs beta cells in the pancreas = lack of insulin
4
Q
Type 1 - Diabetes
What is the management?
A
- Insuline injections
- Diet
- Exercise
5
Q
Type 1 - Diabetes
What is it often called?
A
“Insulin dependent” or “juvenile diabetes”
6
Q
Type 2 - Diabetes
Type 2 accounts for what percentages of diabetes?
A
Accounts for 90%+ of all cases
7
Q
Type 2 - Diabetes
What age does it usually start?
A
Gradual onset over time
- around 45+ y/o when diagnosed
8
Q
Type 2 - Diabetes
What is the mechanism of disease?
A
Characterized by insulin resistance = insulin deficiency
- leads to progressive decline in beta cell function over time
9
Q
Type 2 - Diabetes
What is the management?
A
- diet
- exercise
- weight loss
- oral meds
- in some cases insulin injections
10
Q
Type 2 - Diabetes
What is it often called?
A
“non-insulin dependent” or “adult onset”
11
Q
What is the prevalence in the U.S?
A
~ 37+ million people have diabetes (11%)
~ 8.5 milly are undiagnosed (3%)
12
Q
What age is prevalence in the U.S?
A
29% of adults are over 65 y.o
13
Q
Limb loss
What is the percentage of people with diabetes suffer from diabetic ulcer?
A
10-15% experience a diabetic ulcer at some point in time = increased risk
14
Q
Limb loss
What is the percentage undergo re-amputation?
A
who undergo amputation - 60% will need re-amputation
- 26% within a year following initial surgery
14
Q
Limb loss
What is the healing time?
A
3-20 months
15
Q
What is the criteria to diagnose diabetes?
A
- A1C (gold standard)
- Fasting plasma glucose
- Oral glucose tolerance test
16
Q
A1C
What is normal?
A
< 5.7%
17
Q
A1C
What is pre-diabetic?
A
5.7 - 6.4%
18
Q
A1C
What is diabetic?
A
6.5% or >
19
Q
Fasting plasma glucose
What is normal?
A
< 100 mg/dL
20
Q
Fasting plasma glucose
What is pre-diabetic?
A
100-125 mg/dL
21
Q
Fasting plasma glucose
What is diabetic?
A
126 mg/dL or >
22
Q
Oral glucose tolerance test
What is normal?
A
< 140 mg/dL
23
Q
This number is for Oral Glucose Tolerance Test
What is pre-diabetic?
A
140-199 mg/dL
24
This number is for Oral Glucose Tolerance test
200 mg/dL
25
What are the risk factors for diabetes?
* smoking
* 1st degree relative
* hx of CV disease
* hx of hypertension
* hx of hyperlipidemia
* physical inactivity
* 45 y/o or older
* women: polycystic ovarian syndrome or gestational diabetes
* overweight and obese
26
# Gestational Diabetes
What is the mechanism of disease?
Increased insuline resistance contributes to increase blood glucose levels
27
# Gestational Diabetes
When is it diagnosed?
commonly later 1/2 of pregnancy
28
# Gestational Diabetes
What is the prevalence?
8 out of 100 women will develop GDM
29
# Gestational Diabetes
What increases the rate?
With higher BMI
30
# Gestational Diabetes
If sx persist > 6-8 weeks, what happens?
medical management will continue and reclassify the dx has DMII
31
# Gestational Diabetes
If the mom is diagnosed, what occurs with the baby?
Tend to be larger (macrosomia) = potentially affect delivery
32
# Gestational Diabetes
What is the post-delivery complications for the baby?
* Respiratory issues
* jaundice
* hypoglycemia
33
# Obesity
What is the prevalence for children?
2-19 y/o
- 19% obesity prevalence
34
# Obesity
What is the prevalence for adults
20+ y/o
- 42% = obesity
- 9% = severe obesity
- 15% = DM
35
# Obesity
What is the percentage of race that is affected?
Black - 50%
Hispanic - 45%
White - 41%
Asian - 16%
36
# Obesity
What are the factors related to obesity?
- dietary factors
- physical activity level
- reduced physical activity in occupation or recreationally
- genetics
- metabolic medical conditions (hypothyroidism, cushing syndrome, PCOS)
- Poor sleep
- prenatal and early postnatal environmental factors
- medications
37
# Obesity
How does obesity affect the cardiovascular system?
* HTN
* CAD
* high cholesterol
* left ventricle dysfunction
* cardiomyopathy
38
# Obesity
How does obesity affect the pulmonary system?
* restrictive lung dysfunction
* obstructive sleep apnea
39
# Obesity
How does obesity affect the gastrointestinal system?
- GERD
- gallstones
- fatty liver disease
40
# Obesity
How does obesity affect the musculoskeletal system?
* OA in WB joints
* plantar fasciitis
* altered biomechanics
41
# Obesity
How does obesity affect the cancer?
increased risk and incidence:
- breast
- prostate
- colon
- endometrial
- gall bladder
- thyroid
42
# Obesity
How does obesity affect type 2 diabetes?
Insulin resistance
43
# Obesity treatment
What is a stepped-care approach?
Level of intervention based on severity of obesity
44
# Obesity treatment
What is the goals?
Loss of adipose tissue while keeping fat-free mass to:
- improve physical function
- reduce CV risk
- improve cardiorespiratory fitness
45
# Obesity treatment
What is the % of weight to make an effect?
5-10% of baseline weight to make clinically significant effects
- diet modification while being consistent
46
# Obesity treatment
How does exercise affect with treatment?
* Movement is key
* effective toward improving health benefits
47
# Obesity treatment
What is the medical management?
- bariatric surgery
- pharmacologic options
48
# Metabolic syndrome
What are the 5 risk factors?
- abdominal obesity
- high triglyceride level
- low HDL
- elevated blood pressure
- elevated fasting blood glucose
## Footnote
3 or more confirms diagnosis = increased risk for heart disease, diabetes and stroke
49
# Metabolic syndrome
How is abdominal obesity determined?
* waist circumference (men > 40 in / female 35 in)
* waist to hip ratio (men >.90 / women >.85 or lower / BMI >30kg/m2)
50
# Metabolic syndrome
What is indicated for high triglyceride level?
≥ 150 mg/dL
51
# Metabolic syndrome
What is the ratio for low HDL?
women = < 50 mg/dL
men = < 40 mg/dL
52
# Metabolic syndrome
What is indicated as elevated blood pressure?
Systolic BP ≥ 130 mmHg
Diastolic BP ≥ 85 mmHg
53
# Metabolic syndrome
What is the ratio for elevated fasting blood glucose?
> 100 mg/dL
54
What is the medical management for diabetes?
lifestyle changes
nutrition management
exercise/physical activity
medications
blood sugar monitoring
55
What are the signs and sx of diabetes?
- polyuria
- polydipsia
- extreme hunger and fatigue
- blurry vision
- irritability
- cuts/bruises that are slow to heal
- frequent infections
- unusual weight loss
- tingling, pain, numbness in hands/feet
56
What are the complications of diabetes?
* integumentary system
* eye complications
* CVA
* nephropathy
* CV system
* ketoacidosis
57
# Complications of DM
What are the sx seen in the integumentary system?
skin infections
changes in color
and/or wounds
58
# Complications of DM
What are the eye complications associated?
glaucoma
cataracts
retinopathy
59
What is ketoacidosis?
When the body can't produce enough insulin = ketones are made at a high level
**This is a medical emergency that needs immediate medical attention**
60
What are the symptoms of ketoacidosis?
confusion
dehydration
dry mouth
frequent urination
abdominal pain
coma and potential death
61
# Neuropathy
How is neuropathy defined as?
defined as any disease of the nerves (can occur in any nerve but usually peripheral)
- most common in diabetes as "diabetic neuropathy"
62
# Neuropathy
What is the cause of neuropathy?
poor understanding - probably related to high glucose levels in the blood
63
# Neuropathy
What is the most common location?
In the distal LE/foot
64
# Neuropathy
How does neuropathy progress?
estimates are ~15% of people with DM will turn to ulcers
- people with DM are 40x more likely to have an amputation because of poor wound healing
65
# Neuropathy
Where do ulcers most commonly happens?
most often on WB surfaces over bony prominences with poor blood supply
66
What are some diabetic neuropathy subjective scales?
Neuropathy symptom scale
modified NSS
Michigan neuropathy screening instrument
diabetic neuropathy symptom score (DNS)
67
What are the DNS items?
Unsteadiness walking - 1 = present
numbness on legs or feet - 1= present
burning, aching or tenderness in feet or LEs - 1 = present
prickling pain sensation at legs or feet - 1 = present
68
What should we look for with cardiovascular examination?
- vitals
- observation
- edema measurement
- circulation
69
How is pain rated?
pain rating scale
resting pain, pain with activities and changes over time
claudication scale
walking impairment questionnaire - commonly used for claudication
70
What test is the simplest and best for balance with diabetes?
unilateral single leg stance
71
How many times should the SLS be repeated?
Repeat test 3 times on each limb and average times
72
What is indicated for fall-risk for older adults?
High-fall risk when SLS is maintained < 6.5 seconds
Normative SLS by age group/time
73
What is the predictive score of falls for 30 sec sit to stand?
≤ 14 reps
Normative values by age group/time
74
What are the common gait deviations?
- reduced gait speed
- mobility
- strength
- shortened step length
- shortened stride length
- widened stance width
- double limb support time is increased
75
# Gait deviation
How is mobility affected?
Reduced ankle mobility = hip circumduction and increased knee flexion
76
# Gait deviation
How is strength affected?
Decreased PF propulsion = compensatory recuitment and increase use of hip flexors to advance LE
77
What is the plan of care?
* Patient education
* Manual therapy techniques
* Balance, gait and resistive training
* Modalities
