PET3932 SECTION 2 QUIZ 4 STUDY GUIDE Diabetes Mellitus Read ACSM book p 278 284 Bb Diabetes Med handout Diabetes Mellitus DM A group of metabolic diseases characterized by an elevated blood glucose concentration i e hyperglycemia as a result of defects in insulin secretion and or inability to use insulin 7 of the U S population has DM Absolute or insufficient amount of insulin Pancreas isn t producing insulin Insulin is needed as a carrier to take blood from plasma to the muscles Glucose can t be carried without insulin Hyperglycemia classic sign of diabetes elevated blood glucose Type 1 Diabetes 5 10 of all cases Most often caused by autoimmune destruction of the insulin producing cells of the pancreas Primary characteristics absolute insulin deficiency and a high propensity for ketoacidosis Need insulin for survival their pancreas doesn t or hardly produces any insulin Glucose in urine need to take insulin on a regular basis Symptomology Unexpected unexplained weight loss can t use glucose as an energy source use protein fat instead Tired irritable Frequent thirst urination Glucose in urine If a Type 1 has no insulin plasma glucose increases b c it can t get into the muscles Body s natural mechanism dilute large amounts of glucose this is why diabetics get thirsty urinate a lot their body tells them to intake water to dilute the glucose then rid it by urinating except the problem doesn t resolve itself this way Type 2 Diabetes 90 of all cases secretory defect Caused by insulin resistant skeletal muscle adipose tissue and liver combined with an insulin Common feature excess body fat with fat distributed in the upper body i e abdominal or central obesity these can also cause progression towards prediabetes They have receptor sites on their muscle that can t receive insulin glucose Especially true for them body uses protein fat as energy source instead of glucose If a Type 2 isn t on insulin then they will respond the same way as any other person in terms of glucose levels normal people get shaky tired irritable when they haven t eaten For a Type 2 receptor sites are still open so exercise can help them be more receptive Prediabetes Individuals are at very high risk to develop diabetes as the capacity of the cells to hypersecrete insulin diminishes over time and becomes insufficient to restrain elevations in blood glucose a condition characterized by Elevated blood glucose in response to dietary carbohydrate termed impaired glucose tolerance IGT and or Elevated blood glucose in the fasting state termed impaired fasting glucose IFG HbA1c glycated hemoglobin test used to look at plasma glucose concentration control over 2 3 months long term glycemic control For diabetic treatment goal is 6 5 7 glucose so if they re HbA1c is 7 they probably have diabetes For non diabetic goal is 4 6 glucose IGT Impaired Glucose Tolerance or IR Insulin Resistance Diagnostic Criteria p 279 table 10 5 Diagnosed with OGTT Oral Glucose Tolerance Test drink it body should take glucose levels back to normal in 2 hrs if they do not have IGT or IR this test isn t used that often Prediabetes on way to diabetes 140 199 mg dL Diabetes 200 mg dL IFG Impaired Fasting Glucose Diagnostic Criteria p 279 table 10 5 Test that most physicians use Prediabetes 100 125 mg dL So 100 mg dL is good this would indicate a normal IFG Diabetes 126 mg dL Goals for fasting plasma glucose IFG levels Diabetic treatment goal 130 mg dL Diabetic post meal goal 180 mg dL Hyperglycemia impaired fasting glucose 125 mg dL or a casual glucose taken anytime 200 mg dL WITH symptoms notice that this is the same criteria for DM casual glucose MUST have symptoms included patient might have just eaten a dozen donuts so their glucose level might be through the roof but that doesn t mean they have hyperglycemia b c they don t have any symptoms review symptoms from above for diabetes Casual glucose levels is that which is measured at any time Develops gradually over time if the patient can t take insulin due to economic needs etc Symptoms of hyperglycemia include Polyuria fatigue weakness increased thirst and acetone breath the fruity breath that Dr Kasper described it as Hypoglycemia blood glucose level 70 mg dL Is any rapid drop in glucose happens suddenly Caused by too much insulin and or exercise Take glucose tablet or eat fast acting carb Symptoms include Shakiness weakness abnormal sweating nervousness anxiety tingling of the mouth and fingers and hunger The fundamental goal for the management of DM Glycemic control using diet exercise and in many cases medications such as insulin or oral hypoglycemic agents Oral glucose drug antidiabetes medications p 2 of handout Most work on receptor sites type 2 so they ll except insulin Don t have large effect on sudden drops in glucose Don t interfere with HR BP EKG results etc Most of these are taken 1 3 times a day with a meal These are the antidiabetes medications Sulfonylurea stimulates beta cells to release more insulin Meglitinide works with similar action to sulfonylureas Nateglinide works with similar action to sulfonylureas Biguanide sensitizes the body to the insulin already present Thiazolidinedione helps insulin work better in muscle and fat lowers insulin resistance Alpha glucose inhibitor slows or blocks the breakdown of starches and certain sugars action slows the rise in blood sugar levels following a meal Taking insulin pancreas is still putting out insulin working hard but gets to a point where it stops individual hasn t been able to control glucose level through exercise diet glucose level is out of control don t technicallyyy need it for survival like a type 1 patient b c they ve made certain lifestyle decisions but if they don t make changes obviously they need it to survive Exercise will allow a Type 1 or 2 patient to take less insulin b c Insulin acts like exercise lowers blood glucose level Large amounts of both could cause hypoglycemia dizziness etc 3 things that need to be done with a diabetic Metabolic control before exercise Glucose monitoring before during after exercise Carbohydrate intake monitored Contraindication for exercise for Type 1 diabetic 250 300 mg dL take insulin if they haven t already If a patient took insulin 10 hrs ago example but has a contraindication glucose level since insulin takes 30 60 mins to work peaks around 1 2 hours it is okay for the patient to take insulin again Call their doctor have someone bring the patient their insulin You want the patient