NPTE - Diabetes

Type 1 DM

Autoimmune destruction of pancreatic beta-cells

Usually <30y/o

Insulin-dependent; prone to ketoacidosis

Type 2 DM

Insulin resistance, later beta-cell dysftn

>40y/o common

Often lifestyle-related; oral meds —> insulin

Gestational diabetes

Insulin resistance during pregnancy

Pregnancy-related

Increases the risk of Type 2 later

Prediabetes

Elevated glucose but not diagnostic

Can be reversed with diet and exercise

Fasting glucose

Normal: <100mg/dL

Prediabetes: 100-125 mg/dL

Diabetes: > 126mg/dL

Oral glucose tolerance (OGTT)

Normal: <140mg/dL

Prediabetes: 140-199 mg/dL

Diabetes: > 200 mg/dL (2hrs post-load)

A1C (glycated hemoglobin)

Normal: <5.7%

Prediabetes: 5.7-6.4%

Diabetes: >6.5%

Random glucose with sxs

Diabetes: > 200 mg/dL

Classic sxs of Diabetes

Polyuria (frequent urination)

Polydipsia (excessive thirst)

Polyphagia (excessive hunger)

Fatigue

Blurred vision

Slow wound healing

Microvascular (small vessels) complications of diabetes

neuropathy: stocking-glove distribution, loss of protective sensation

retinopathy: vision loss - refer to ophthalmology

nephropathy: kidney damage - watch for edema, proteinuria

Macrovascular (large vessels) complications of diabetes

CAD (MI risk)

CVA (stroke risk)

PVD —> increased risk of amputation

Hypoglycemia

caused by too much insulin, skipped meals, excessive exercise

shaky, pale, sweating, HA, confusion

give fast carbs (15g)

Hyperglycemia

caused by missed insulin, illness, stress

thirst, dry mouth, blurred vision, fatigue

stop activity, check BG

Diabetic Ketoacidosis (DKA)

Caused by Type 1DM, severe insulin deficit

Fruity breath, Kussmaul breathing, N&V

Emergency referral

Boards red flag

<70mg/dL = hypoglycemia —> give15g carbs (juice, glucose tabs)

> 250-300mg/dL = hold PT, esp with ketones present

exercise frequency

3-7d/wk

Exercise intensity

50-80% VO2max/HRR

RPE 11-13

exercise time

20-60mins/d

Exercise type

Aerobic + resistance

BG check (exercise)

Before, possibly during, and after

exercise precautions

Pre-exercise BG should be: 100-250mg/dL

Avoid exercise at peak insulin action (risk of hypoglycemia)

Inject insulin in the abdomen, not the exercised limbs

Carry a quick sugar source during sessions

Diabetic foot considerations

daily foot inspections

wear proper shoes

no barefoot walking

monofilament testing (5.07 = 10g) to assess protective sensation

educate on early wound signs

Boards tips pt 1

Type 1 —> requires insulin

Type 2 —> lifestyle is 1st-line intervention

A1C reflects avg BG over 2-3mo

For neuropathy: focus on balance, CC activities, foot care

For retinopathy: avoid Valsalva, head-down positions, and high-intensity lifting

For nephropathy: monitor BP and avoid high-load exercise

pts with loss of protective sensation are at high risk for ulcers and infection

Boards tips Pt 2

type 1 = insulin-dependent + DKA risk

type 2 = modifiable via lifestyle 1st

<70mg/dL = give glucose; >250mg/dL = hold exercise

neuropathy —> focus on proprioception and fall prevention

always check for foot ulcers and calluses

avoid high-intensity/impact exercise if there’s PVD, retinopathy, or nephropathy

Fasting BG

Normal: 70-100mg/dL

<70 = hypoglycemia; >126 = diabetes

A1C

Normal: <5.7%

long-term glycemic control

Urine ketones

(+) ketones = potential DKA

Triglycerides

Normal: <150mg/dL

Often elevated in uncontrolled DM