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| Question | Answer |
| Three Ps of hyperglycemia are | 1. Polydipsia (increased thirst) 2. Polyphagia (increased hunger) 3. Polyurea (increased urination) |
| Tissue changes in response to DM | 1. protein function and turnover 2. cytokine activation 3. osmotic and oxidative stress 4. reduced motor and sensory nerve conduction velocity 5. increased GFR and renal plasma flow |
| List some common complications related to DM. | 1. peripheral and autonomic neuropathy 2. heart disease 3. hypertension 4. stroke 5. nephropathy 6. retinopathy |
| What is the measure of kidney function? | 1. spot urine albumin/creatintine ratio if >30mg/g, abnormal 2. serum creatinine 3. glomerular filtration rate |
| List the 3-tiered approach of DM | 1. initiate metformin therapy and lifestyle modification 2. initiate insulin therapy or additional oral agents 3. initiate or intensify insulin therapy |
| What is the GI? | Glycemic index (how a carb-containing food raise blood glucose level |
| High GI food is _______ Low GI food is _______. | high: >70 low: <55 |
| How can exercise improve DM? | 1. increase insulin sensitivity 2. move glucose out of blood system |
| Describe contraction-mediated pathway | 1. calcium flux --> glucose enter muscle INSULIN INDEPENDENT!!!!!! |
| What is a diagnostic test of DM? | Hgb A1C (average blood glucose level over 2-3 months |
| Normal A1C level | < 6.0% |
| Low risk A1C level | 6-8% |
| Key subjective questions with DM patients. | See slide 27 onwards. |
| Essential components for DM eval | 1. skin inspection 2. heel/toe/foot/shoe inspection 3. sensory/vibration test 4. pressure assessment with Semmes-Weinstein monofilament (5.07) 5. reflex 6. skin temp 7. ROM and MMT |
| Normal Semmes-weinstein monofilament test | normal = 3.61 neuropathy = 4.17 loss of protective sensation = 5.07 total loss of sensation = 6.10 |
| Hand involvement usually occurs when LE involved to ______. | Calf |
| Normal patient presentation in bed. | see slide 39 |
| Key impairment for DM | 1. decreased sensation 2. impaired wound healing 3. impaired cardiovascular fitness 4. impaired static and dynamic balance 5. decreased strength 6. decreased ROM 7. decreased proprioception 8. impaired gait pattern 9. decreased peripheral pulses 8. elevated HR/BP 9. pain 10.increased risk of infection |
| Activity and relationship with: BP HR ECG RR SpO2 Pain | See normal values stop or continue? MET level? |
| Sternal precautfull ion | 1. shoulder/scapular full pain-free ROM 2. both unilateral and bilateral are safe 3. allow UE for sit-to-stand 4. log roll for bed mobility 5. avoid lifting >10 bilaterally or >5 unilaterally 6. avoid curl-up from supine |
| Why might DM patient have blunted HR/BP resonse to activity? | Autonomic neuropathy |
| A common adaptive device for LE neuropathy | rocker shoe |
| Why rolling walker instead of FWW for patients after cardio surgery? | sternal precaution |
| Normal ABI | Double check |
| Normal great toe brachial index | 0.8 - 0.99 |
| Some patient education points | 1. control glucose 2. shoe fitting 3. callus and skin care |
| Normal fasting glucose level: | <100 mg/dl |
| fasting glucose level for diagnosis of DM | >126 mg/dl |
| wound healing impaired when fasting glucose is | >200 mg/dl |
| GOLD STANDARD for diabetes diagnosis | Hgb A1C > 6.5 % |
| If blood glucose level is <90mg/dl , exercise precaution: | eat light carbs before exercise |
| If blood glucose level is 90-150mg/dl , exercise precaution: | ok |
| If blood glucose level is 150 - 250mg/dl , exercise precaution: | exercise first, delay carb consumption until <150 |
| If blood glucose level is >250 , exercise precaution: | test for ketones (if high, no exercise). |
| If blood glucose level is >350 , exercise precaution: | 1. test ketone 2. conservative insulin tx 3. mild-to-moderate until glucose level decreased. |
| ____g of carbs should be taken before/after 1 hour of exercise. | 15g |
| Snack/insulin change should be done _______ before exercise. | 30- 60 MIN |
| How would you prescribe aerobic exercise for patients with DM? | Moderate to vigorous, 150min/week. HIIT is recommended also No more than 2 consecutive days w/o exercise |
| How would you prescribe resistance training for patients with DM? | 8-10 exercises with 1-3 sets of 10 -15 reps. |
| Other than aerobic and resistance training, what other exercise is important to patients with DM? | BALANCE! Flexibility! |
| Contraindication for exercise | 1. retinal hemorrhage/ laser therapy for retina 2. illness/infection 3. glucose >250mg/dl and ketones are present 4. blood glucose <70mg/dl (hypoglycemia) |
| Benefits of exercise in DM patients. | 1. possible blood glucose control 2. increased insulin sensitivity 3. reduced bodyfat 4. stress reduction 5. decrease risk of DM2 |
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