SYS - 4 Diabetes PDF

SYS Diabetes - Diabetes — A chronic condition that results in problems with carbohydrate, protein, and fat metabolism into glucose (blood sugar) Characteristics - Small + large vessel vascular problems causing: - Atherosclerosis - Hypertension. - Poor tissue health - Gangrene - Impotence - Probl...

SYS Diabetes - Diabetes — A chronic condition that results in problems with carbohydrate, protein, and fat metabolism into glucose (blood sugar) Characteristics - Small + large vessel vascular problems causing: - Atherosclerosis - Hypertension. - Poor tissue health - Gangrene - Impotence - Problems in pregnancy - Kidney disease. - Eye disease that can lead to blindness. - Peripheral neuropathies that frequently decrease sensations in the hands and feet Type 2 - TYPE 1 DIABETES MELLITUS (Insulin Dependent Diabetes, Juvenile Diabetes). Associated with a dysfunction of the pancreas resulting in an absolute de ciency of insulin. - TYPE 2 DIABETES MELLITUS (Non-insulin-dependent, Adult-onset Diabetes). The body produces inadequate insulin, or the body is unable to utilize the insulin produced Risk factors - TYPE 1 Any age, ~ mostly children or young adults (before 25). Family history Black, Aboriginal, Latin American people. Possibly viral or autoimmune. - TYPE 2 Over age 45 Overweight Family history. fi  Sedentary life-style. Black, Aboriginal, and Latin American people. Previous diagnoses of impaired glucose tolerance. Symptoms Type 1 - Insulin dependent - Can be sudden onset. Frequent urination. - Glucose + Ketones in urine. - Ketones = compound produced durian oxidation of fatty acids Excessive thirst (Polydipsia) Extreme hunger (Polyphagia) - Unusual weight loss with normal or↑eating - Extreme fatigue - Irritability - Sweet-smelling breath. - Nausea or vomiting. - Fluctuating blood sugar levels Symptoms Type 2 - Non-insulin dependent - Adult onset - Similar to Type 1, but may be gradual onset. - Frequent infections. - Slow healing cuts and bruises. - Tingling or numbness in hands or feet. - Recurring skin, gum or bladder infections. - Blurred vision. - Can be easily controlled. - Tx = weight ↓/ exercise / diet If those fail —> take oral meds to boost insulin production & ↓ speed that glucose enters blood Complications - Ketoacidosis — build up of ketone acids (end product of fat metabolism) in blood Causes: symptoms that lead to coma - Hyperosmolar Nonketotic coma — hyperglycemea episode from resistance to insulin & excessive intake of carbs (not watching diet) Causes: dehydration, coma or seizure - Hypoglycemia — low blood sugar levels (usually Type 1) ~ could be early sign of diabetes Caused by: error of insulin dose / failure to eat /↑exercise - Hyperglycemia — Thirst fatigue nausea - Hypoglycaemia — sweat shake confusion Long term Complications - Complications↑with the severity of the hyperglycemia, and the duration of the disease. - INFECTION In the lower extremities, mouth, gums, urinary tract, cuts and incisions. due to poor healing time,↓peripheral sensation from nerve damage, ulcers, gangrene. - PERIPHERAL NEUROPATHY - likely due to impaired microcirculation to the nerves. Distal Symmetrical Neuropathy — in extremities causing parasthesia, sensory loss, and weakness. Diabetic Radiculopathy + Polyradiculopathy — acute burning pain and super sensitivity of the skin occurring unilaterally in the trunk Plexopathy — Occurs in older patients with pain in the anterior thigh and reduced knee exion with quadriceps atrophy leading to buckling of the knees. Compression Syndromes — - Carpal Tunnel. - Ulnar Neuropathy. - Peronial Neuropathy Retinopathy — loss or impaired vision due to damage of microcirculation to the eyes. - VASCULAR DAMAGE Cardiac Problems — Hypertension, heart disease, stroke, kidney disease Hyalinization — the callusing of capillary walls resulting from acidic irritation of the blood. Microangiopathy — Degeneration of capillaries and arteries fl  Atherosclerosis Hand sti ness. Re ex Sympathetic Dystrophy (Complex Regional Ⓟ Syndrome) — Shoulder pain, sti ness, swelling and pain in the hand Contraindications - Pt confused, lethargic, or in altered state (MD ref) - If pt has a hypoglycemic attack Administer rapidly utilized carbohydrates + discontinue treatment Massage, like exercise, can cause the patient to become hypoglycemic. Blood sugar levels should be monitored before the massage and be in good condition. Carbohydrates should be kept on hand during a massage. - *Diaphragmatic Breathing (according to Rattray) if not the patient's normal pattern may change insulin levels. - CIs for Hypertension + Heart Disease - Local or distal massage ~ if Decubitus ulcers or Gangrene are present - Massage around deep cracks in feet May bleed, oils carry bacteria, and may lead to infection. - Deep or aggressive techniques with sensory loss/poor tissue health - Hydro extremes Do not apply local hydrotherapy or manual techniques over recent insulin injection sites as this can alter the insulin pharmacokinetics - Caution w/ nerve lesions + compression syndromes - Injection sites History Questions - General health? - When diagnosed? - What type? - How is disease controlled? Insulin injections? Injection sites? - Does pt become easily Hypoglycemic? - What are their usual symptoms or precipitating factors? - Do they carry carbohydrates? fl ff ff - How often are their blood sugar levels checked? - When was the last time blood sugar levels were checked? - How often is there a crisis? - When was the last crisis? - Diet? - Alcohol? - Sleep? - Exercise? - How does exercise e ect insulin levels? - Tissue health? - Gangrene – present or past? - Peripheral Neuropathies? - Motor problems or weakness? - Autonomic abnormalities such as sweating, dry skin, cracked skin? - Fainting or light-headedness when getting up from bed? - Has pt recently eaten, exercised, or experienced high stress - General stress /Emotional Wellbeing? (Consider implications of living with long term illness) Special tests - Extremity circulation - Extremity nerve health Tx + modi cations - Consult Physician with pt consent when: Disease presents with cardiac or kidney concerns. Insulin levels are unstable. Self-care of pt is poor (diet, alcohol, meds.) - Blood pressure: When a concern take before + after tx. - Massage can lead to↑metabolic activity, —> leading to hypoglycemia. - Treatment for: Hypertension. Heart Disease. fi ff  Compression Syndromes. Other complications when applicable. - Position for comfort, or to manage other concerns (heart diseases, edema, etc) - Hydrotherapy: - modi ed according to presenting concerns Cardiovascular. Peripheral neuropathies. Could lead to hypoglycemia. Don’t apply over recent injection sites - Relaxation can stabilize blood sugar levels (caution with diaphragmatic breathing) - Tissue Health is a big concern: Improvement of circulation + drainage especially in distal limbs. Edema can be addressed with MLD when appropriate. - Injection Sites: Avoid recent sites. Work old sites CI = Avoid injection sites CI - No diaphragmatic breathing Self care - Relaxation + stress relief - Pt education on where to apply hydro - Appropriate exercise, diet, and monitoring of blood sugar levels - Modi ed hydro when applicable for better circulation fi fi Tx Focus - ↑peripheral circulation to ↑nerve health, tissue health, and healing. - Concerns for Hypertension. - Injection sites. - Concerns for blood sugar, and how massage may e ect it. - Compression syndromes. ff