Diabetes Mellitus Barclay Dugger MEd, ATC, LAT Review on the pancreas Types of Diabetes NATA recommendations Types of insulin therapy Use of a glucometer One organ that functions like 2 Digestive organ: secretes fluid into ducts that carry it to the intestines Hormonal organ: secretes hormones directly into the blood Functions: Secretes insulin which assists w/ glucose transport Secretes glucagon which assists with breakdown of glycogen in liver What is Diabetes? Condition in which body is unable to produce or use insulin effectively. Diabetes is classified as Type 1 or 2. What is Type 1 Diabetes? Condition where body is unable to produce insulin. Onset is usually in people under 20 y/o. Type 2 Diabetes? Condition in which the body’s ability to use insulin effectively is decreased Type I Diabetes: Autoimmune-factors destroying the pancreas, causing beta cells in the pancreas to lack the ability to produce insulin which regulate blood glucose levels Genetic predisposition Viral infections, exposure to toxins Type II Diabetes: What is it? Pancreas produces adequate insulin but insulin receptors are not working properly Complications-concerns? No cure; increased fat in blood, commonly associated with obesity, ateriosclerosis, peripheral neuropathy, chronic infections, osteoporosis How can you detect it? Monitoring blood glucose levels Type I & Type II Diabetes: Signs/symptoms? Polydipsia (excessive thirst) Polyphagia (excessive hunger) Polyuria (frequent urination) weight loss may present initially with ketoacidosis Type I Diabetes: What is ketoacidosis? When the body is unable to move glucose from the blood to the cells, it turns to fats as an energy source Ketones are produced as a by product of the breakdown of fats for fuel These toxic acids build up in the blood and eventually spill over into the urine Ketones are responsible for the fruity odor noticed on the breaths of persons suffering from extreme hyperglycemia and DKA Time Measurement Taken Blood Serum Levels After fasting for 8 hours 60-80mm/dl 2-3 hours after fasting 100-140 mm/dl Random and unplanned Less than 126 Abnormal Blood Glucose Levels Each athlete with diabetes should have a diabetes care plan that includes blood glucose monitoring and insulin guidelines, treatment guidelines for hypoglycemia and hyperglycemia, and emergency contact information. Hypoglycemia typically presents with tachycardia, sweating, palpitations, hunger, nervousness, headache, trembling, or dizziness; in severe cases, loss of consciousness and death can occur. Mild hypoglycemia (the athlete is conscious and able to swallow and follow directions) is treated by administering approximately 10–15 g of carbohydrates (examples include 4–8 glucose tablets or 2 tablespoons of honey) and reassessing blood glucose levels immediately and 15 minutes later. Severe hypoglycemia (the athlete is unconscious or unable to swallow or follow directions) is a medical emergency, requiring activation of emergency medical services (EMS) and, if the health care provider is properly trained, administering glucagon. Physicians should determine a safe blood glucose range to return an athlete to play after an episode of mild hypoglycemia or hyperglycemia. Hyperglycemia can present with or without ketosis. Typical signs and symptoms of hyperglycemia without ketosis include nausea, dehydration, reduced cognitive performance, feelings of sluggishness, and fatigue. Hyperglycemia with ketoacidosis may include the signs and symptoms listed earlier as well as Kussmaul breathing (abnormally deep, very rapid sighing respirations characteristic of diabetic ketoacidosis), fruity odor to the breath, unusual fatigue, sleepiness, loss of appetite, increased thirst, and frequent urination. Type I-insulin injections Type II-diet and exercise Rapid-acting Short-acting Intermediate-acting Long acting Pre-mixed Onset: The amount of time insulin takes to enter blood stream. Peak: Time when insulin is most effective. Duration: How long the insulin lowers blood sugar. Rapid-acting- Used at time of meal Onset= 15-30 minutes Peak= 30-90 Duration= 1-5 hours Drug Name: Humalog, Lispro, Novolog, Aspart, Glulisine. Short-acting: Used from a meal to within 1 hour Onset= 30” – 1 hour Peak= 2-5 hours Duration= 2-8 hours Drug Name: Novolin, Vesolulin(insulin pump) Intermediate-acting: Used for half a day or before sleep Onset= 1-2.5 hours Peak= 3-12 hours Duration= 18-24 hours Drugs Name: Lente (L) Long-acting: About a full day Onset= 30” – 3 hours Peak= 6-20 hours Duration= 24-36 hours Drugs Names: Ultralente, Lantus, Levemir, Detemir. Pre-mixed: Used twice a day or before meals Onset= 10-30”, time it takes to enter blood stream Peak= 30”-12 hours, when most effective Duration= 14-24 hours, how long it lowers blood sugar Drug Names: Humulin 70/30, Humulin 50/50, Novolin 70/30, Novolog 50/50, http://www.youtube.com/watch?v=s8nzOrbe M5Q Jimenez, C., Corcoran, M.H., Crawley, J.T., Hornsby, W.G., Peer, K. S., Philbin, R.D., & Riddell, M.C. (2007). National athletic trainers’ association position statement: management of the athlete with type I diabetes mellitus. Journal of Athletic Training, 42 (4), 536-545 Cuppetta, M., Walsh, K. M. (2012) General Medical Conditions in the Athlete (Second Edition) Elsevier-Mosby Overview of pulmonary system Evaluation of patient with breathing difficultly Auscultation of lung sounds Asthma Exercise Induced Bronchospasm Spirometer use Nebulizer use The pulmonary system is involved primarily in the exchange of oxygen and carbon dioxide, which are vital in the production of the energy involved in metabolism at the cellular level. Respiration can be divided into ventilation and oxygenation. a. During ventilation, air moves through the respiratory tract. The upper respiratory tract: Nasal passages Paranasal sinuses Pharynx Larynx Responsible for warming, humidifying, and filtering the air as it reaches the lower respiratory tract The lower respiratory tract: Trachea Right and left bronchi Lung parenchyma History and Inspection The first step is to take a thorough history; it includes questions about how long a problem has existed, what exacerbates the condition, and the severity of symptoms. Describe the characteristics of the condition, and timing of it; shortness of breath should also be noted. The chest is inspected after the history is taken. The examiner inspects the chest for shape and configuration, including any skeletal deformities, as well as bruising of the ribs or chest wall. Respiratory Patterns Tachypnea: Refers to breathing that has become more rapid than 24 breaths per minute Hyperpnea: Refers to a type of tachypnea in which breaths are usually large and deep, resulting in hyperventilation Bradypnea: When breathing slows to fewer than 12 breaths per minute Hypopnea: When breathing becomes slow and shallow and is seen in an adaptive response to painful situations, such as rib fractures Dyspnea: Refers to the subjective sensation of difficulty in breathing or shortness of breath Orthopnea: Describes a type of dyspnea that begins or increases as the patient lies down Respiration Patterns Breathing involves several simultaneous patterns. Decreases in pH as well as corresponding increases in carbon dioxide result from normal cellular metabolism and stimulate an increase in ventilation to remove these by-products. Neural control of breathing comes from the phrenic nerve, which arises from cervical nerve roots C3, C4, and C5. Auscultation Auscultation is the skilled listening by a trained ear for sounds produced by the body. Perform auscultation after history, observation, and palpation in order to gather as much information as possible first. Perform in a quiet environment. Listen for the presence or absence of sounds as well as their frequency, loudness, quality, and duration. Make sure the earpieces of the stethoscope fit comfortably, and point the earpieces toward the face. The examiner must listen systematically at each position throughout inspiration and expiration and evaluate lungs in the anterior, posterior, and lateral aspects to ensure that each lobe of the lungs is properly examined. When the athletic trainer listens to the lungs, three different sounds can be appreciated in normal individuals. Bronchial breath sounds are loud, high-pitched, and predominantly expiratory. These sounds represent air moving through large airways and sound more tubular. Normally heard over the trachea Bronchiovesicular breath sounds are heard when air moves through medium-sized airways, such as the mainstem bronchi. Can be heard both anteriorly and posteriorly, toward the center of the thorax Sounds are of medium pitch and moderate intensity. Vesicular breath sounds predominate in most of the peripheral lung tissue and represent the air as it moves into the smaller airways, such as the bronchioles. These sounds are soft, low-pitched noises that involve mostly inspiration. https://www.youtube.com/watch?v=yFWWS IGB6-0 https://www.youtube.com/watch?v=O2yOP O0NBnM Most of the abnormal breath sounds heard will be superimposed on normal breath sounds and are called adventitious breath sounds. Crackles, or rales, are adventitious sounds that occur as a result of disruption of airflow in the smaller airways, usually by fluid. Wheezes are also adventitious sounds that represent airway obstruction from mucus, spasm, or even a foreign body. Stridor is also cause by airway obstruction and can often be confused