Diabetes Part 3. PP slides 75-128 Flashcards Preview

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Flashcards in Diabetes Part 3. PP slides 75-128 Deck (44)
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First line of medical management for Type I diabetics

–Insulin, diet and exercise are the primary treatments for type I diabetes 


Medical management of Type II diabetics

  • Diet and exercise are the first approach used to lower blood glucose levels in type II diabetes. 
  • Often weight loss & diet can reverse the hyperglycemia 
  • When weight loss & diet are insufficient to control the hyperglycemia, oral hypoglycemic drugs are used to lower blood glucose levels


8 classes of commonly used hypoglycemic drugs

Nice to know, not need to know 

  • Sulfonylureas – oral
  • Meglitinides – oral
  • Biguanides – oral (metformin) 
  • Thiazolidinediones – oral
  • Glucagon-like peptide (GLP) agonists – injected
  • Dipeptidyl peptidase-4 inhibitors – injected
  • Alpha-glucosidase inhibitors - oral
  • Sodium-glucose cotransporter-2 (SGLT-2) inhibitors

* To save mental space, I am not adding all the extra info she included in the power point about these drug classes. On recording sounded like it was info we can refer to in the furture. 



most commonly prescribed medication for diabetes (aside from insulin) 

Need to Know



What are brittle diabetics?

Poorly controlled diabetics


How is insulin typically administered?



When do you eat after taking insulin?

within the hour


Typical reductions in A1C values for metformin 


Dr. T said that was a great reduction


Another awesome thing about metformin

and its potential adverse reactions

–Recent (4/11) large scale study indicated that metformin had a much less risk of MI than other anti-diabetic agents

–Adverse reactions include:

•GI disturbances including metallic taste in the mouth, mild anorexia, nausea, abdominal discomfort, and diarrhea

•Less likely to cause hypoglycemia than other oral antidiabetics


Types of insulin 

classified by speed of absorption, length of effect

–Rapid acting (NovoLog, Humalog, Apidra)

–Intermediate acting (Humulin R, Novolin R) [R = regular]

–Long-acting – Lantus, Levemir

–Insulin mixtures


4 general points about insulin 

  • Always used in type I diabetes
  • Occasionally insulin administration is needed in cases of type II diabetes
  • When blood glucose levels cannot be adequately controlled by the oral anti-diabetic drugs because insulin needs to be injected
  • Used to supplement the oral anti-diabetic drugs


How is insulin sourced? 

•Originally purified from porcine or bovine origin

•Synthesized from Escherichia coli bacteria, genetically altered to produce human insulin


Points about subcutaneous injection

•rate and amount absorbed varies inversely with BMI

•grouped by length of action: rapid, intermediate and long acting


Best option for insulin in active diabetics 

–Insulin infusion pump has become popular with a more continuous delivery of short acting insulin and is the best option for very active diabetics


Insulin pump- “open loop” vs “closed loop” 

(I just put everything on this slide)

–Open loop- current form where testing of blood is necessary

–Closed loop- machine tests blood and doses automatically

–Other methods of artificial pancreas

•Bioengineering- biocompatible beta cells

•Gene therapy- DNA production of insulin-producing cells


Effect of resistance training on HbA1C?

–Structured resistance training was associated with 0.57% decrease in HbA1c

–Highly dependent upon duration of intervention

   •Doing > 150 min/wk of structured exercise appears to further increase the benefit, up to 0.89% decrease in HbA1c levels

   •Doing exercise < 150 min/wk, on average was linked to a much lower 0.36% reduction


Effect of exercise on blood glucose levels 

–A combination of aerobic and resistance exercise training may be more effective in improving blood glucose control than either alone

–However, more studies are needed to determine whether total caloric expenditure, exercise duration, or exercise mode is responsible


How does tai chi or yoga affect diabetics? 

mixed results on how it may impact diabetes


Benefits of exercise, specifically on lipids

–Both aerobic & resistance training improve insulin action, blood glucose control, and fat oxidation and storage in muscle

–Blood lipid responses to training are mixed:

    •May result in a small reduction in LDL cholesterol

     •No change in HDL cholesterol or triglycerides

–Combined weight loss & physical activity may be more effective than aerobic exercise training alone on lipids


Impact of exercise and BP in diabetic

–Aerobic training may slightly reduce systolic BP, but reductions in diastolic BP are less common, in individuals with type 2 diabetes


Info about weightloss and cardiovascular health re: exercise and DM 

–Observational studies suggest that greater physical activity & fitness are associated with decrease  risk of all-cause & cardiovascular mortality

–Recommended levels of physical activity may help produce weight loss

–However, up to 60 min/day may be required when relying on exercise alone for weight loss


Effect of supervised training program with diabetics 

Individuals with type 2 diabetes engaged in supervised training exhibit greater compliance and blood glucose control than those undertaking exercise training without super

Also good to monitor to ensure there is no rapid drop in blood glucose


True or False: –Increased physical activity & physical fitness can decrease symptoms of depression & increase health-related QOL in those with type 2 diabetes



ACSM/ADA recommendations for physical activity for persons with type 2 diabetes

–At least 150 min/wk of moderate to vigorous aerobic exercise spread out during at least 3 days during the week, with no more than 2 consecutive days between bouts of aerobic activity

–Encouraged to increase their total daily unstructured physical activity

–Flexibility training may be included but should not be undertaken in place of other recommended types of physical activity


 Things to check in Pre-exercise evaluation 

•Before undertaking exercise more intense than brisk walking, sedentary persons with type 2 diabetes will likely benefit from a complete evaluation

•ECG exercise stress testing for asymptomatic individuals at low risk of CAD is not recommended but may be indicated for higher risk individuals


Concerns of metabolic control prior to exercise 

•Avoid exercise if fasting glucose levels are >250 mg/dl and ketosis is present

•Use caution if glucose levels are >300 mg/dl and no ketosis is present provided they are feeling well and are adequately hydrated

•Ingest added carbohydrate if glucose levels are <100 mg/dl

*above concerns apply even in inpatient- need to consult medical team 


S/S of hyperglcemia

  • thirsty
  • frequent urination
  • lethargic
  • confusion
  • dehydration


  • Test your blood glucose before, during and after the activity to monitor how it affects your blood glucose level. This is important when beginning or changing your exercise program
  • Before you exercise, take less insulin or eat more food at mealtime or as a snack.
  • avoid injecting insulin into your arms and legs that you will use during your activity or exercise.
  • If your blood glucose is less than 70 mg/dL (3.8 mmol/L), take 1 to 2 carbohydrate choices and make sure your blood glucose is in goal range before you begin the activity or exercise.

  • If you were in goal range before the activity and the activity drops your blood glucose more than 30 to 50 mg/dL (1.6 to 2.7 mmol/L) or hypoglycemia occurs — blood glucose less than 70 mg/dL (3.8 mmol/L) — stop exercising and take 1 carbohydrate choice. Recheck your blood glucose after 15 minutes and repeat until your blood sugar returns to a safe range. Then, return to your exercise and take 1 carbohydrate every 30 to 60 minutes while you're active.

  • Don't exercise if your blood glucose is greater than 300 mg/dL (16 mmol/L). Exercising with blood glucoses over 300 mg/dL (16 mmol/L) can raise your blood glucose even more, because exercise causes the body to release or produce extra glucose and there won't be enough insulin available to use it.

  • For longer duration or very strenuous activities, such as downhill/cross country skiing or long bike rides, take 1 carbohydrate choice every 30 to 60 minutes during the activity. Check your blood glucose every 1 to 2 hours during the activity.


Things to keep in mind with Blood glucose monitoring before and after exercise

  • ACSM/ADA guidelines (12/10) suggest that the risk of exercise-induced hypoglycemia is minimal unless recent administration of insulin or insulin like medication

  • Transient hyperglycemia can follow intense physical activity   

  • Learn the patient’s specific glycemic response to different exercise conditions

  • Identify when changes in insulin or food intake are necessary

  • Carbohydrate-based foods/drinks should be available and used as needed during or after exercise to avoid hypoglycemia.   

  • If insulin has been taken, do not begin exercise until at or near peak (30-90 min for short acting)


How may modalities affect diabetes 

–Heating modalities increases absorption speed of insulin from subcutaneous sites

–Cold decreased speed of absorption of insulin from subcutaneous sites

–Electromagnetic modalities (diathermy) cannot be use in patients with insulin pumps and electrical modalities should be used with caution