Diabetes Lecture Notes PDF

**Lecture 11 Part 2: Diabetes** **Type I Diabetes Mellitus: T1DM** 1. Pathology a. Autoimmune disorder: the body attacks the insulin producing cells in the pancreas 2. Risk factors b. Infection with a virus (polio related) may trigger an autoimmune response c....

**Lecture 11 Part 2: Diabetes** **Type I Diabetes Mellitus: T1DM** 1. Pathology a. Autoimmune disorder: the body attacks the insulin producing cells in the pancreas 2. Risk factors b. Infection with a virus (polio related) may trigger an autoimmune response c. Hereditary factors i. Siblings of affected persons have 10 times the risk of developing type I DM over the general population 3. Onset usually before age of 30 4. Body build is usually lean (but not always) 5. Associated with ketosis **Type II Diabetes Mellitus: T2DM** 1. Pathology a. Disorder of insulin reception by peripheral target cells b. Decreased production of insulin by beta cells in the pancreas 2. Risk factors c. Increasing age: onset usually after age 40; however, significant increase in younger adult and adolescent pre-diabetic and type II diabetes in the past 10-20 years d. Obesity i. Fat distribution: increased abdominal fat associated with increased incidence of diabetes mellitus e. Hypertension f. Decreased physical activity g. Poor nutrition h. Smoking i. Genetic predisposition j. Race: increased rates in African Americans and Native Americans **Conditions associated with Diabetes** 1. Pancreatic disease 2. Genetic syndromes 3. Endocrine disease 4. Prolonged physiologic or emotional stress **Insulin Resistance -- impaired glucose tolerance** 1. Present when individuals have a plasma glucose level of 140-199 mg/dL two hours after oral load of 75 g of glucose **Insulin Deficiency** 1. In absence of insulin or its receptor sites, glucose cannot be utilized by skeletal muscle, cardiac muscle and adipose tissue; brain and red blood cells are unaffected 2. Increased utilization of fats as energy source 3. Protein depletion in the tissues secondary to increased protein catabolism **[Complications:]** - Pathophysiology - Hyperglycemia damages the Schwann cells that produce and maintain the myelin sheaths around the axons of the peripheral nervous system - Small vessel disease results in hypoxia to peripheral nerves - Affects sensory and motor nerves, and autonomic nervous system - S&S - Depression/loss of deep tendon reflexes at the ankle - Loss of vibratory, touch, pain and temperature sensation in stocking/glove distribution - Distal, symmetrical motor weakness and atrophy - Abnormal heart rate - Loss of protective sensation indicated by inability to detect 5.07 level monofilament any place on plantar aspect of foot - Shortening and thickening of connective tissue structures due to a variety of reasons - Result is painful, limited motion in variety of joints - Retinopathy - Most significant factor is poor control of blood sugar - Inner wall of capillaries thickens - Increased inflammatory cell adhesion to vessel walls - Weakening of vessel walls leading to aneurysm formation - S&S: total or partial vision loss; central vision loss - Thickening of basement membrane in kidney - Sclerosis of kidney - Chronic kidney disease - S&S - Abnormal glomerular filtration rate - High blood creatinine level - High blood urea nitrogen level (BUN) - Low red blood cell count - Peripheral edema - Shortness of breath - Fatigue - Muscle twitches and cramps - Treatment - Blood sugar regulation - Dialysis - Hemodialysis - Blood is pumped out of the body and filtered through a machine that acts like the kidneys and then pumped back into the body - Peritoneal dialysis - The inside lining of the stomach acts as the filter so the waste particles in blood are filtered out by cycles moving through the stomach wall - Kidney transplant - Have to be diagnosed with end stage renal disease or kidney failure - Also takes into consideration age, how long patient has been on dialysis, any previous organ donations, co morbidities such as diabetes, and availability of caregivers after surgery - Results in peripheral arterial disease, cardiac disease and CVA - A life-threatening complication of diabetes that occurs when the body produces too many ketones - When the body doesn\'t have enough insulin, it can\'t use blood sugar for energy. Instead, the liver breaks down fat for fuel, which produces ketones. If too many ketones are produced too quickly, they can build up to dangerous levels in the body. This can cause the blood to become acidic. - Ketone bodies are acidic compounds which are byproducts of fat metabolism - Symptoms: - Nausea - Vomiting - Abdominal pain - Air hunger with rapid respirations - Dry, flushed skin - Intense thirst - Smell of acetone on breath - Diabetic coma and death if untreated - Onset is gradual over a number of days or sudden - Symptoms resolve in 6-12 hours after treatment with insulin, fluids, and electrolytes - Low circulating blood glucose level which may result from insufficient food intake or excessive insulin - Blood glucose level \< 70 mg/dL - Rapid drop in blood glucose (400 to 200) - Quick onset of symptoms - Moist, pale skin - Weakness or shakiness - Normal or shallow respiration - Tachycardia - Headache - Confusion - Slurred speech - Blurred vision - Hunger - Convulsion or coma - Symptoms resolve quickly following carbohydrate administration (often orange juice) or glucagon injection **[Physical Therapy Management:]** - **Exercise:** - Increases ability of skeletal muscle to take glucose from blood stream and use it for fuel - Decreases insulin resistance - Reduces risk for atherosclerosis - Psychological and social enhancement - Risks - Exercise induced hypoglycemia can occur if exercising with circulating insulin at high levels - Ketoacidosis if exercising with insulin at very low levels - Precautions - Avoid extreme temperatures - Design exercise to minimize risks due to neuropathy, retinopathy, and LE ulcers - Avoid exercise at peak insulin times - Avoid exercise at insulin injection spots - Insure adequate diet supplement before exercise - Contraindication - Do not exercise if blood sugar level is greater than 240 mg/dL or lower than 70mg/dL (normal should be 80-120mg/dL)