1. Endocrine and Metabolic Systems

2. Endocrine system
Uses hormones as messengers to send info to cells to regulate functions
Hypothalamus
Pituitary gland
Adrenal gland
Thyroid gland
Parathyroid glands
Pancreatic islet cells
Kidneys
Ovaries or testes

3. Diabetes Mellitus (DM)
Disorder of metabolism of carbs, fat, and protein
Deficient insulin secretion
Or defects in insulin receptors

4. S/S of Diabetes Mellitus
Hyperglycemia – sugar in blood
Glycosuria – sugar in urine
Ketones (byproducts of fat metabolism) in the urine (ketonuria)
Polyuria – excessive urination
Polydipsia – excessive thirst
Polyphagia (excessive hunger) and weight loss
Fatigue and weakness
Blurred vision
Peripheral numbness and tingling
Prolonged healing times of wounds

5. Type I 5-10% of cases Juvenile onset
Dec. size and number of islet cells
Etiology: autoimmune, genetics, environment
Insulin dependent
Prone to ketoacidosis and ketonuria

6. Type II 90-95% of cases
Adult onset - Inadequate use of insulin and beta cell dysfunction
Etiology: combination of factors
Insulin resistance in muscle and fat tissue
Decline in insulin production
Inc. production of glucose by liver
Inappropriate glucagon secretion
Usually not insulin dependent
Linked to obesity

7. Metabolic syndrome Leads to Type II Three or more of the following:
Abdominal obesity
Triglycerides >150 mg/dL
Low HDLs (<40 mg/dL in men, <50 in women)
High BP (>130/85)
Fasting plasma glucose >110mg/dL

8. Hypoglycemia Rapid onset
Glucose <60 mg/dL (from not eating after insulin, too much insulin, exercise)
CNS changes
Sympathetic changes: diaphoresis, pallor, tachycardia, trembling, weakness
Hypoglycemic coma: LOC
If awake, give sugar; if unresponsive, call for help as IV glucose is required

9. Hyperglycemia Gradual onset Glucose >250 mg/dL (from untreated DM)
CNS changes
Thirst
Flushed and signs of dehydration
Nausea, vomiting, abdominal pain
Deep and rapid respirations
Fruity odor to breath
Hyperglycemic coma
Leads to damage in blood vessels and myelin sheath of nerves

10. Long Term Complications
Microvascular: Retinopathy, renal disease and neuropathy
Macrovascular: accelerated atherosclerosis leading to CVA, MI, PAD
Integumentary: changes in connective tissues, risk of ulcers and infection
Musculoskeletal: joint stiffness, osteoporosis, adhesive capsulitis, plantar fasciitis
Kidney and liver impairments
Vision impairments

11. Long Term Complications Neuromuscular
Polyneuropathy
Symmetrical
Distal to proximal
Altered sensations
Motor weakness
Autonomic Neuropathy
Cardiac neuropathy
Integumentary GI
Metabolic

12. Medical Goals Insulin – glucose homeostasis Monitor blood levels
Dietary control
Oral hypoglycemic agents
Insulin injections or pumps
Maintain normal lipid levels
Control HTN
Exercise, fitness, health promotion

13. Insulin Pump

14. PT Goals Exercise: Responses are dependent on level of control
Inc. glucose tolerance
Inc. insulin sensitivity
Improved lipid profiles
Dec. BP
Weight management
Inc. work capacity
Responses are dependent on level of control

15. Exercise Prescription following GXT
CV Training:
Intensity: 50-80%
Frequency: 3-4 days/wk
Duration: min
Resistance Training:
40-60% of 1 RM
One set of reps
Frequency: 2 days/wk

16. Exercise Flexibility Balance Patient education
Skin protection and foot care

17. Exercise Precautions Monitor glucose levels before, and after ex
No exercise when glucose <70 or >300 mg/dL
No exercise if (+) ketonuria
Pt. to eat at least 2 hours before exercise
Maintain hydration
Exercise with supervision
Do not inject insulin into exercising muscles (absorbed too quickly)
No exercise in extreme environmental temps