SlideShare uma empresa Scribd logo
1 de 16
Baixar para ler offline
PHYSICAL THERAPY
IMPLICATIONS FOR
CARDIOVASCULAR AND
PULMONARY COMPLICATIONS IN
DIABETES MELLITUS
DIABETES MELLITUS
DIABETES MELLITUS (DM) IS A CHRONIC METABOLIC
DISORDER CHARACTERIZED BY HYPERGLYCEMIA AND CAUSED
BY INADEQUATE INSULIN PRODUCTION OR INEFFECTIVE
INSULIN ACTION.
TYPE I: (IDDM)
 Develops before adulthood.
 Autoimmune destruction of
insulin producing pancreatic
beta cells occurs.
 Result: Little or No insulin
production.
 Survival is dependent on
insulin therapy.
TYPE II: (NIDDM)
 Heterogeneous disorder occurring in
later stages of life (rarely <40).
 70 to 90% people have it because of
obesity, lack of exercises and familial
tendencies.
 Patients are insulin resistant at the
cellular level because of receptor or
post receptor defects.
 Hyperglycemia results from an
increased rate of hepatic glucose
production as a consequence of
hepatic insulin resistance.
Insulin causes the inhibition of
glucose production by the liver
and the promotion of glucose
transport across cell membrane
and its subsequent metabolism
within the cell.
Deficiency results in an inability
to utilize glucose as fuel,
impaired protein metabolism,
increased fat mobilization with
increased level of free fatty
acids.
Metabolism of free fatty acids in
the liver causes formation of
ketone bodies and ketoacidosis
develops.
Anti-insulin hormones like
Glucagon, Growth hormone,
Cortisol and Catecholamines
also participate in glucose
metabolism.
Insulin and Glucose
Physiology
COMPLICATIONS
 Microangiopathy with thickening or damage to the
capillary basement membrane (e.g., retinopathy,
nephropathy) and Macroangiopathy by
atherosclerosis (e.g., coronary artery,
cerebrovascular and peripheral vascular disease)
cause damage to organs like eyes, kidneys, heart
and peripheral nerves.
 Combination of microangiopathy (peripheral
neuropathy) and macroangiopathy (arterial
insufficiency) leads to the frequent complications of
tissue necrosis and infection and sometimes
amputation.
CARDIOVASCULAR DISEASES
 In diabetic patients atherosclerotic heart disease,
hypertension, defects in impulse conduction
through the heart, congestive heart failure,
autonomic neuropathy, cerebrovascular disease
and peripheral vascular diseases dominate.
 Other cardiovascular abnormalities which are
particularly more common in DM are sinus node
dysfunction and AV node conduction
abnormalities.
AUTONOMIC DEFECTS
 These are very common in long standing diabetics.
 Individuals usually complain of postural hypotension.
 Predominantly the parasympathetic nervous system (PNS) is involved.
 Resting heart rate can determine the autonomic neuropathy.
 In patients with PNS dysfunction HR is elevated at rest and during early
phase of exercise, but as the effort progresses, the normal activation of the
sympathetic nervous system allows virtually normal HR and BP responses.
 In combined defects there is minimal response to stimuli such as valsalva
maneuver, standing up, and deep breathing, a fall in BP during standing
and blunted HR and BP responses to all phases of exercise.
PULMONARY DISORDERS
 Hyperglycemic patients have higher incidences of
pulmonary infections than non-diabetics.
 Patients with autonomic neuropathy may have more sleep
related breathing problems.
 PFTs show mild abnormalities in lung elastic recoil,
diffused capacity and pulmonary capillary blood volume,
which are directly related to the duration of DM.
 Ketoacidosis causes hyperventillation,
pneumomidiastinum and mucus plugs in the major
airways.
IMPLICATIONS FOR PHYSICAL THERAPY
INTERVENTION
 Adequate metabolic control should be established before an
exercise programme is initiated.
 HR and BP evaluations should be incorporated in all physical
therapy evaluations as DM patients exhibit abnormal
hemodynamic responses to activities.
 Self monitoring of blood glucose levels is essential.
 Avoid vigorous and prolonged exercise if blood glucose levels are
250- 300 mg/dl and should not exercise at all if blood glucose
exceeds 300 mg/dl or if there is any ketosis. Likewise exercises
are contraindicated when blood glucose levels are 80-100 mg/dl
because of greater risk of hypoglycemia.
SIGNS AND SYMPTOMS OF HYPOGLYCEMIA
ADRENERGIC
 Weakness
 Sweating
 Tachycardia
 Palpitations
 Tremors
 Nervousness
 Irritability
 Tingling
 Hunger
 Nausea
 Vomiting
NEUROGLUCOPENI
C
 Headache
 Hypothermia
 Visual disturbances
 Mental dullness
 Confusion
 Amnesia
 Seizures
 Coma
 To minimize the risk of hypoglycemia, patients should
avoid exercising at the time of peak insulin effect.
 Start with moderate workloads and increase intensity
gradually.
 Use a consistent pattern of exercises (time, duration and
intensity)
 Avoid injecting insulin into tissue near the exercising
muscle if patient will be exercising soon thereafter (
within 40 min after regular insulin or within 90 min after
intermediate insulin).
 Strenuous exercises should be avoided until reasonable
diabetic control is achieved.
AMPUTEE WITH DIABETES MELLITUS
Additional considerations:
 Surgical healing following amputation is often delayed or
complicated due to the circulatory abnormalities, impaired
ability to fight infection, poor blood glucose control and
neuropathies associated with diabetics.
 The energy demands for prosthetic gait are higher than
normal and increase the risk of cardiovascular
complications during rehabilitation.
 Attention to wrist alignment when using assistive gait
devices is important because of the higher incidence of
carpal tunnel syndrome.
The Elderly Diabetic Patient: Special considerations
 50 % of type II DM patients are above 60 years of age.
 Depression, impaired cognitive function, and lack of recognition of
thirst and subsequent dehydration are important factors to be taken
into account in the management of older diabetic patients, who may
also have impaired physical function, an increased rate of injurious
falls, and increased prevalence of pressure ulcers, amputations and
tuberculosis.
 Hyperglycemia can result in a decreased pain threshold and
incontinence.
 Older diabetic patients report reduced physical function compared
with other older people as a result of multifactorial impairment that
includes visual deterioration, peripheral neuropathy and balance
problems.
 Functional impairment is associated with increased falls.
UNIQUE ASPECTS OF DIABETES MELLITUS IN
ELDERLY
Syndrome
 Cognitive impairment.
 Depression/suicide
 Amputation
 Decreased pain threshold
 Functional impairement
 Falls
 Dehydration
 Incontinence, tuberculosis and
hypogonadism
Preventive measures
 Control hyperglycemia and provide
written instructions.
 Screen using Geriatric Depression
Scale and Treat depression.
 Pay special attention to foot care.
 Control hyperglycemia.
 Balance exercises and monitoring of
orthostatic blood pressure.
 Drink fluids regularly.
 Control hyperglycemia.
 Numerous factors, such as decreased thirst perception,
decreased exercise tolerance, deteriorating vision, arthritis,
cognitive problems, depression and social problems, make
the management of older people with diabetes extremely
difficult.
 Exercise is the fundamental therapy for diabetes in older
people, but should be undertaken in moderation and not in
excess. Endurance exercises are only one component of
the complete exercise prescription; strengthening, posture,
flexibility and balance exercises are key to maintaining
function and preventing falls.
REFERRENCES
 Cardiopulmonary implications of specific diseases :
Joane Watchie.
 The Elderly Type 2 Diabetic Patient: Special
Considerations John E. Morley* Geriatric Research, Education
and Clinical Center, St Louis VAMC, and Division of Geriatric Medicine, St Louis
University Medical School, St Louis, Missouri, USA.
 Google search.
Physical Therapy Implications For Cardiovascular And Pulmonary Complications

Mais conteúdo relacionado

Mais procurados

Relaxation positions for breathelessness patients
Relaxation  positions for  breathelessness patientsRelaxation  positions for  breathelessness patients
Relaxation positions for breathelessness patientsSREEJESH R
 
Diabetes Mellitus and Physical Therapy
Diabetes Mellitus and Physical Therapy Diabetes Mellitus and Physical Therapy
Diabetes Mellitus and Physical Therapy Prochnost
 
Cardio Respiratory Assesment
Cardio Respiratory AssesmentCardio Respiratory Assesment
Cardio Respiratory AssesmentRahul Ap
 
Test for peripheral arterial and venous circulation
Test for peripheral arterial and venous circulationTest for peripheral arterial and venous circulation
Test for peripheral arterial and venous circulationDr. Nithin Nair (PT)
 
Physical Therapy Management of Patients with Diabetes
Physical Therapy Management of Patients with DiabetesPhysical Therapy Management of Patients with Diabetes
Physical Therapy Management of Patients with DiabetesKyle Veazey
 
ppt.Hypertension and Exercise
ppt.Hypertension and Exerciseppt.Hypertension and Exercise
ppt.Hypertension and Exercisedrvinodkr
 
Differences b-w Adult & pediatric lungs.pptx
Differences b-w Adult & pediatric lungs.pptxDifferences b-w Adult & pediatric lungs.pptx
Differences b-w Adult & pediatric lungs.pptxAditiSingh683531
 
Assessment of coordination
Assessment of coordinationAssessment of coordination
Assessment of coordinationIram Anwar
 
Orthotics and prosthetics UG lecture
Orthotics and prosthetics UG lectureOrthotics and prosthetics UG lecture
Orthotics and prosthetics UG lectureDhananjaya Sabat
 
Common operations & physiotherapy
Common operations & physiotherapyCommon operations & physiotherapy
Common operations & physiotherapyGagan Gupta
 
Principles of exercise prescription
Principles of exercise prescription   Principles of exercise prescription
Principles of exercise prescription Apeksha Pahade
 
Exercise Prescription For Diabetes
Exercise Prescription For DiabetesExercise Prescription For Diabetes
Exercise Prescription For Diabetesrobstennis
 
Physiotherapy management of chronic obstructive pulmonary disease ppt by Oluw...
Physiotherapy management of chronic obstructive pulmonary disease ppt by Oluw...Physiotherapy management of chronic obstructive pulmonary disease ppt by Oluw...
Physiotherapy management of chronic obstructive pulmonary disease ppt by Oluw...OluwadamilareAkinwan
 

Mais procurados (20)

PT in thoracic surgery
PT in thoracic surgeryPT in thoracic surgery
PT in thoracic surgery
 
Assessment of shoulder
Assessment of shoulderAssessment of shoulder
Assessment of shoulder
 
Tilt table
Tilt tableTilt table
Tilt table
 
Relaxation positions for breathelessness patients
Relaxation  positions for  breathelessness patientsRelaxation  positions for  breathelessness patients
Relaxation positions for breathelessness patients
 
Diabetes Mellitus and Physical Therapy
Diabetes Mellitus and Physical Therapy Diabetes Mellitus and Physical Therapy
Diabetes Mellitus and Physical Therapy
 
Cardio Respiratory Assesment
Cardio Respiratory AssesmentCardio Respiratory Assesment
Cardio Respiratory Assesment
 
Test for peripheral arterial and venous circulation
Test for peripheral arterial and venous circulationTest for peripheral arterial and venous circulation
Test for peripheral arterial and venous circulation
 
Physical Therapy Management of Patients with Diabetes
Physical Therapy Management of Patients with DiabetesPhysical Therapy Management of Patients with Diabetes
Physical Therapy Management of Patients with Diabetes
 
Deconditioning
DeconditioningDeconditioning
Deconditioning
 
ppt.Hypertension and Exercise
ppt.Hypertension and Exerciseppt.Hypertension and Exercise
ppt.Hypertension and Exercise
 
Differences b-w Adult & pediatric lungs.pptx
Differences b-w Adult & pediatric lungs.pptxDifferences b-w Adult & pediatric lungs.pptx
Differences b-w Adult & pediatric lungs.pptx
 
Assessment of coordination
Assessment of coordinationAssessment of coordination
Assessment of coordination
 
Orthotics and prosthetics UG lecture
Orthotics and prosthetics UG lectureOrthotics and prosthetics UG lecture
Orthotics and prosthetics UG lecture
 
Common operations & physiotherapy
Common operations & physiotherapyCommon operations & physiotherapy
Common operations & physiotherapy
 
Exercise in elderly
Exercise in elderlyExercise in elderly
Exercise in elderly
 
Exercise Tolerance Test
Exercise Tolerance TestExercise Tolerance Test
Exercise Tolerance Test
 
Principles of exercise prescription
Principles of exercise prescription   Principles of exercise prescription
Principles of exercise prescription
 
Exercise Prescription For Diabetes
Exercise Prescription For DiabetesExercise Prescription For Diabetes
Exercise Prescription For Diabetes
 
Cardiopulmonary Case Study
Cardiopulmonary Case StudyCardiopulmonary Case Study
Cardiopulmonary Case Study
 
Physiotherapy management of chronic obstructive pulmonary disease ppt by Oluw...
Physiotherapy management of chronic obstructive pulmonary disease ppt by Oluw...Physiotherapy management of chronic obstructive pulmonary disease ppt by Oluw...
Physiotherapy management of chronic obstructive pulmonary disease ppt by Oluw...
 

Destaque

Exercise Physiology In Pediatrics
Exercise Physiology In PediatricsExercise Physiology In Pediatrics
Exercise Physiology In PediatricsApeksha Besekar
 
Effect of Sit To Sit And Activity On Forward Bending Test
Effect of Sit To Sit And Activity On Forward Bending TestEffect of Sit To Sit And Activity On Forward Bending Test
Effect of Sit To Sit And Activity On Forward Bending TestApeksha Besekar
 
The Seventh Cranial Nerve
The Seventh Cranial NerveThe Seventh Cranial Nerve
The Seventh Cranial NerveApeksha Besekar
 
Bursare In Lower Extrimity
Bursare In Lower ExtrimityBursare In Lower Extrimity
Bursare In Lower ExtrimityApeksha Besekar
 
Primitive And Tonic Reflexes
Primitive And Tonic ReflexesPrimitive And Tonic Reflexes
Primitive And Tonic ReflexesApeksha Besekar
 
Parkinson’s disease ( shobs )
Parkinson’s disease ( shobs )Parkinson’s disease ( shobs )
Parkinson’s disease ( shobs )Shobhit Shah
 
Role of Primary Heath Care Nurse in caring Hypertensive patient & family
Role of Primary Heath Care  Nurse in  caring Hypertensive patient & family Role of Primary Heath Care  Nurse in  caring Hypertensive patient & family
Role of Primary Heath Care Nurse in caring Hypertensive patient & family Shanta Peter
 
Ptpm010 Ptm Of Physical Mobility Impairment Medical Journal…
Ptpm010 Ptm Of Physical Mobility Impairment Medical Journal…Ptpm010 Ptm Of Physical Mobility Impairment Medical Journal…
Ptpm010 Ptm Of Physical Mobility Impairment Medical Journal…Abdul Rehman S Mulla
 
PTPM008B PTM of Oncology and Palliative Care-related Medic…
PTPM008B PTM of Oncology and Palliative Care-related Medic…PTPM008B PTM of Oncology and Palliative Care-related Medic…
PTPM008B PTM of Oncology and Palliative Care-related Medic…Abdul Rehman S Mulla
 
PTPM008 PTM of Oncology and Palliative Care-related Medic…
PTPM008 PTM of Oncology and Palliative Care-related Medic…PTPM008 PTM of Oncology and Palliative Care-related Medic…
PTPM008 PTM of Oncology and Palliative Care-related Medic…Abdul Rehman S Mulla
 
7 habits of highly effective Physiotherapists
7 habits of highly effective Physiotherapists7 habits of highly effective Physiotherapists
7 habits of highly effective Physiotherapistssubhash khatri
 

Destaque (20)

Parkinson's Disease
Parkinson's DiseaseParkinson's Disease
Parkinson's Disease
 
Exercise Physiology In Pediatrics
Exercise Physiology In PediatricsExercise Physiology In Pediatrics
Exercise Physiology In Pediatrics
 
Parkinson’s disease
Parkinson’s diseaseParkinson’s disease
Parkinson’s disease
 
Ankle Foot Orthosis
Ankle Foot OrthosisAnkle Foot Orthosis
Ankle Foot Orthosis
 
Parkinson's disease ppt
Parkinson's disease pptParkinson's disease ppt
Parkinson's disease ppt
 
Effect of Sit To Sit And Activity On Forward Bending Test
Effect of Sit To Sit And Activity On Forward Bending TestEffect of Sit To Sit And Activity On Forward Bending Test
Effect of Sit To Sit And Activity On Forward Bending Test
 
The Seventh Cranial Nerve
The Seventh Cranial NerveThe Seventh Cranial Nerve
The Seventh Cranial Nerve
 
Bursare In Lower Extrimity
Bursare In Lower ExtrimityBursare In Lower Extrimity
Bursare In Lower Extrimity
 
Primitive And Tonic Reflexes
Primitive And Tonic ReflexesPrimitive And Tonic Reflexes
Primitive And Tonic Reflexes
 
Spinal Cord Injury
Spinal Cord InjurySpinal Cord Injury
Spinal Cord Injury
 
Respiratory System2
Respiratory System2Respiratory System2
Respiratory System2
 
Parkinson’s disease
Parkinson’s diseaseParkinson’s disease
Parkinson’s disease
 
Parkinson’s disease ( shobs )
Parkinson’s disease ( shobs )Parkinson’s disease ( shobs )
Parkinson’s disease ( shobs )
 
Role of Primary Heath Care Nurse in caring Hypertensive patient & family
Role of Primary Heath Care  Nurse in  caring Hypertensive patient & family Role of Primary Heath Care  Nurse in  caring Hypertensive patient & family
Role of Primary Heath Care Nurse in caring Hypertensive patient & family
 
Ptp&M013 Npte 2
Ptp&M013 Npte 2Ptp&M013 Npte 2
Ptp&M013 Npte 2
 
Ptpm010 Ptm Of Physical Mobility Impairment Medical Journal…
Ptpm010 Ptm Of Physical Mobility Impairment Medical Journal…Ptpm010 Ptm Of Physical Mobility Impairment Medical Journal…
Ptpm010 Ptm Of Physical Mobility Impairment Medical Journal…
 
PTPM008B PTM of Oncology and Palliative Care-related Medic…
PTPM008B PTM of Oncology and Palliative Care-related Medic…PTPM008B PTM of Oncology and Palliative Care-related Medic…
PTPM008B PTM of Oncology and Palliative Care-related Medic…
 
Organization
OrganizationOrganization
Organization
 
PTPM008 PTM of Oncology and Palliative Care-related Medic…
PTPM008 PTM of Oncology and Palliative Care-related Medic…PTPM008 PTM of Oncology and Palliative Care-related Medic…
PTPM008 PTM of Oncology and Palliative Care-related Medic…
 
7 habits of highly effective Physiotherapists
7 habits of highly effective Physiotherapists7 habits of highly effective Physiotherapists
7 habits of highly effective Physiotherapists
 

Semelhante a Physical Therapy Implications For Cardiovascular And Pulmonary Complications

ANAESTHESIA FOR PATIENT WITH DIABETES MELLITUS
ANAESTHESIA FOR PATIENT WITH DIABETES MELLITUSANAESTHESIA FOR PATIENT WITH DIABETES MELLITUS
ANAESTHESIA FOR PATIENT WITH DIABETES MELLITUSshashikantsharma109
 
Surgery in diabetes patients Dr nesar Ahmad
Surgery in diabetes patients   Dr nesar AhmadSurgery in diabetes patients   Dr nesar Ahmad
Surgery in diabetes patients Dr nesar AhmadStudent
 
Diabetes Mellitus ~ As Dental Emergency
Diabetes Mellitus ~ As Dental EmergencyDiabetes Mellitus ~ As Dental Emergency
Diabetes Mellitus ~ As Dental EmergencyAbhishek Sharma
 
Diabetes 2010
Diabetes 2010Diabetes 2010
Diabetes 2010NorthTec
 
Anesthesia considration for DIABETES MELLITUS
Anesthesia considration for DIABETES MELLITUSAnesthesia considration for DIABETES MELLITUS
Anesthesia considration for DIABETES MELLITUSibrahimelkathiri1
 
diabetes mellitus by Tushar 202345.pptx
diabetes mellitus by Tushar 202345.pptxdiabetes mellitus by Tushar 202345.pptx
diabetes mellitus by Tushar 202345.pptxTushar Mankar
 
1. diabetic neuropathy
1. diabetic neuropathy1. diabetic neuropathy
1. diabetic neuropathysm171181
 
Antidiabetic Drugs.ppt pharmacy students
Antidiabetic Drugs.ppt pharmacy studentsAntidiabetic Drugs.ppt pharmacy students
Antidiabetic Drugs.ppt pharmacy studentsFranciKaySichu
 
Diabetes mellitus
Diabetes mellitusDiabetes mellitus
Diabetes mellitusRayhan Rony
 
Diabetes Mellitus patients in dental management
Diabetes Mellitus patients in dental managementDiabetes Mellitus patients in dental management
Diabetes Mellitus patients in dental managementMedicineAndFamily
 
Endocrine week 5 pt
Endocrine week 5 ptEndocrine week 5 pt
Endocrine week 5 ptiothman
 
Diabetes Mellitus
Diabetes MellitusDiabetes Mellitus
Diabetes MellitusKhalid
 
Diabetes Mellitus Ppt May 2006 Revised
Diabetes Mellitus   Ppt May 2006 RevisedDiabetes Mellitus   Ppt May 2006 Revised
Diabetes Mellitus Ppt May 2006 RevisedNorthTec
 
antidiabetic_drugs_2.ppt
antidiabetic_drugs_2.pptantidiabetic_drugs_2.ppt
antidiabetic_drugs_2.pptjeniferkol
 
Antidiabetic_Drugs_.ppt
Antidiabetic_Drugs_.pptAntidiabetic_Drugs_.ppt
Antidiabetic_Drugs_.pptAymanshahzad4
 
Complications of diabetes mellitus
Complications of diabetes mellitusComplications of diabetes mellitus
Complications of diabetes mellituspavithra vinayak
 
DIABETES MELLITUS & PERIOPERATIVE ANAESTHETIC MANAGEMENT
DIABETES  MELLITUS & PERIOPERATIVE ANAESTHETIC MANAGEMENTDIABETES  MELLITUS & PERIOPERATIVE ANAESTHETIC MANAGEMENT
DIABETES MELLITUS & PERIOPERATIVE ANAESTHETIC MANAGEMENTTuhin Mistry
 

Semelhante a Physical Therapy Implications For Cardiovascular And Pulmonary Complications (20)

ANAESTHESIA FOR PATIENT WITH DIABETES MELLITUS
ANAESTHESIA FOR PATIENT WITH DIABETES MELLITUSANAESTHESIA FOR PATIENT WITH DIABETES MELLITUS
ANAESTHESIA FOR PATIENT WITH DIABETES MELLITUS
 
Surgery in diabetes patients Dr nesar Ahmad
Surgery in diabetes patients   Dr nesar AhmadSurgery in diabetes patients   Dr nesar Ahmad
Surgery in diabetes patients Dr nesar Ahmad
 
Diabetes Mellitus ~ As Dental Emergency
Diabetes Mellitus ~ As Dental EmergencyDiabetes Mellitus ~ As Dental Emergency
Diabetes Mellitus ~ As Dental Emergency
 
Diabetes 2010
Diabetes 2010Diabetes 2010
Diabetes 2010
 
Anesthesia considration for DIABETES MELLITUS
Anesthesia considration for DIABETES MELLITUSAnesthesia considration for DIABETES MELLITUS
Anesthesia considration for DIABETES MELLITUS
 
diabetes mellitus by Tushar 202345.pptx
diabetes mellitus by Tushar 202345.pptxdiabetes mellitus by Tushar 202345.pptx
diabetes mellitus by Tushar 202345.pptx
 
1. diabetic neuropathy
1. diabetic neuropathy1. diabetic neuropathy
1. diabetic neuropathy
 
endocrine 1.ppt
endocrine 1.pptendocrine 1.ppt
endocrine 1.ppt
 
Diabetes Mellitus
Diabetes MellitusDiabetes Mellitus
Diabetes Mellitus
 
Antidiabetic Drugs.ppt pharmacy students
Antidiabetic Drugs.ppt pharmacy studentsAntidiabetic Drugs.ppt pharmacy students
Antidiabetic Drugs.ppt pharmacy students
 
Diabetes mellitus
Diabetes mellitusDiabetes mellitus
Diabetes mellitus
 
Diabetes Mellitus patients in dental management
Diabetes Mellitus patients in dental managementDiabetes Mellitus patients in dental management
Diabetes Mellitus patients in dental management
 
Antidiabetic_Drugs_2.ppt
Antidiabetic_Drugs_2.pptAntidiabetic_Drugs_2.ppt
Antidiabetic_Drugs_2.ppt
 
Endocrine week 5 pt
Endocrine week 5 ptEndocrine week 5 pt
Endocrine week 5 pt
 
Diabetes Mellitus
Diabetes MellitusDiabetes Mellitus
Diabetes Mellitus
 
Diabetes Mellitus Ppt May 2006 Revised
Diabetes Mellitus   Ppt May 2006 RevisedDiabetes Mellitus   Ppt May 2006 Revised
Diabetes Mellitus Ppt May 2006 Revised
 
antidiabetic_drugs_2.ppt
antidiabetic_drugs_2.pptantidiabetic_drugs_2.ppt
antidiabetic_drugs_2.ppt
 
Antidiabetic_Drugs_.ppt
Antidiabetic_Drugs_.pptAntidiabetic_Drugs_.ppt
Antidiabetic_Drugs_.ppt
 
Complications of diabetes mellitus
Complications of diabetes mellitusComplications of diabetes mellitus
Complications of diabetes mellitus
 
DIABETES MELLITUS & PERIOPERATIVE ANAESTHETIC MANAGEMENT
DIABETES  MELLITUS & PERIOPERATIVE ANAESTHETIC MANAGEMENTDIABETES  MELLITUS & PERIOPERATIVE ANAESTHETIC MANAGEMENT
DIABETES MELLITUS & PERIOPERATIVE ANAESTHETIC MANAGEMENT
 

Último

Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxsumanchaulagain3
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?Ryan Addison
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...bkling
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisNilofarRasheed1
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 

Último (20)

Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptx
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid Arthritis
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 

Physical Therapy Implications For Cardiovascular And Pulmonary Complications

  • 1. PHYSICAL THERAPY IMPLICATIONS FOR CARDIOVASCULAR AND PULMONARY COMPLICATIONS IN DIABETES MELLITUS
  • 2. DIABETES MELLITUS DIABETES MELLITUS (DM) IS A CHRONIC METABOLIC DISORDER CHARACTERIZED BY HYPERGLYCEMIA AND CAUSED BY INADEQUATE INSULIN PRODUCTION OR INEFFECTIVE INSULIN ACTION. TYPE I: (IDDM)  Develops before adulthood.  Autoimmune destruction of insulin producing pancreatic beta cells occurs.  Result: Little or No insulin production.  Survival is dependent on insulin therapy. TYPE II: (NIDDM)  Heterogeneous disorder occurring in later stages of life (rarely <40).  70 to 90% people have it because of obesity, lack of exercises and familial tendencies.  Patients are insulin resistant at the cellular level because of receptor or post receptor defects.  Hyperglycemia results from an increased rate of hepatic glucose production as a consequence of hepatic insulin resistance.
  • 3. Insulin causes the inhibition of glucose production by the liver and the promotion of glucose transport across cell membrane and its subsequent metabolism within the cell. Deficiency results in an inability to utilize glucose as fuel, impaired protein metabolism, increased fat mobilization with increased level of free fatty acids. Metabolism of free fatty acids in the liver causes formation of ketone bodies and ketoacidosis develops. Anti-insulin hormones like Glucagon, Growth hormone, Cortisol and Catecholamines also participate in glucose metabolism. Insulin and Glucose Physiology
  • 4. COMPLICATIONS  Microangiopathy with thickening or damage to the capillary basement membrane (e.g., retinopathy, nephropathy) and Macroangiopathy by atherosclerosis (e.g., coronary artery, cerebrovascular and peripheral vascular disease) cause damage to organs like eyes, kidneys, heart and peripheral nerves.  Combination of microangiopathy (peripheral neuropathy) and macroangiopathy (arterial insufficiency) leads to the frequent complications of tissue necrosis and infection and sometimes amputation.
  • 5. CARDIOVASCULAR DISEASES  In diabetic patients atherosclerotic heart disease, hypertension, defects in impulse conduction through the heart, congestive heart failure, autonomic neuropathy, cerebrovascular disease and peripheral vascular diseases dominate.  Other cardiovascular abnormalities which are particularly more common in DM are sinus node dysfunction and AV node conduction abnormalities.
  • 6. AUTONOMIC DEFECTS  These are very common in long standing diabetics.  Individuals usually complain of postural hypotension.  Predominantly the parasympathetic nervous system (PNS) is involved.  Resting heart rate can determine the autonomic neuropathy.  In patients with PNS dysfunction HR is elevated at rest and during early phase of exercise, but as the effort progresses, the normal activation of the sympathetic nervous system allows virtually normal HR and BP responses.  In combined defects there is minimal response to stimuli such as valsalva maneuver, standing up, and deep breathing, a fall in BP during standing and blunted HR and BP responses to all phases of exercise.
  • 7. PULMONARY DISORDERS  Hyperglycemic patients have higher incidences of pulmonary infections than non-diabetics.  Patients with autonomic neuropathy may have more sleep related breathing problems.  PFTs show mild abnormalities in lung elastic recoil, diffused capacity and pulmonary capillary blood volume, which are directly related to the duration of DM.  Ketoacidosis causes hyperventillation, pneumomidiastinum and mucus plugs in the major airways.
  • 8. IMPLICATIONS FOR PHYSICAL THERAPY INTERVENTION  Adequate metabolic control should be established before an exercise programme is initiated.  HR and BP evaluations should be incorporated in all physical therapy evaluations as DM patients exhibit abnormal hemodynamic responses to activities.  Self monitoring of blood glucose levels is essential.  Avoid vigorous and prolonged exercise if blood glucose levels are 250- 300 mg/dl and should not exercise at all if blood glucose exceeds 300 mg/dl or if there is any ketosis. Likewise exercises are contraindicated when blood glucose levels are 80-100 mg/dl because of greater risk of hypoglycemia.
  • 9. SIGNS AND SYMPTOMS OF HYPOGLYCEMIA ADRENERGIC  Weakness  Sweating  Tachycardia  Palpitations  Tremors  Nervousness  Irritability  Tingling  Hunger  Nausea  Vomiting NEUROGLUCOPENI C  Headache  Hypothermia  Visual disturbances  Mental dullness  Confusion  Amnesia  Seizures  Coma
  • 10.  To minimize the risk of hypoglycemia, patients should avoid exercising at the time of peak insulin effect.  Start with moderate workloads and increase intensity gradually.  Use a consistent pattern of exercises (time, duration and intensity)  Avoid injecting insulin into tissue near the exercising muscle if patient will be exercising soon thereafter ( within 40 min after regular insulin or within 90 min after intermediate insulin).  Strenuous exercises should be avoided until reasonable diabetic control is achieved.
  • 11. AMPUTEE WITH DIABETES MELLITUS Additional considerations:  Surgical healing following amputation is often delayed or complicated due to the circulatory abnormalities, impaired ability to fight infection, poor blood glucose control and neuropathies associated with diabetics.  The energy demands for prosthetic gait are higher than normal and increase the risk of cardiovascular complications during rehabilitation.  Attention to wrist alignment when using assistive gait devices is important because of the higher incidence of carpal tunnel syndrome.
  • 12. The Elderly Diabetic Patient: Special considerations  50 % of type II DM patients are above 60 years of age.  Depression, impaired cognitive function, and lack of recognition of thirst and subsequent dehydration are important factors to be taken into account in the management of older diabetic patients, who may also have impaired physical function, an increased rate of injurious falls, and increased prevalence of pressure ulcers, amputations and tuberculosis.  Hyperglycemia can result in a decreased pain threshold and incontinence.  Older diabetic patients report reduced physical function compared with other older people as a result of multifactorial impairment that includes visual deterioration, peripheral neuropathy and balance problems.  Functional impairment is associated with increased falls.
  • 13. UNIQUE ASPECTS OF DIABETES MELLITUS IN ELDERLY Syndrome  Cognitive impairment.  Depression/suicide  Amputation  Decreased pain threshold  Functional impairement  Falls  Dehydration  Incontinence, tuberculosis and hypogonadism Preventive measures  Control hyperglycemia and provide written instructions.  Screen using Geriatric Depression Scale and Treat depression.  Pay special attention to foot care.  Control hyperglycemia.  Balance exercises and monitoring of orthostatic blood pressure.  Drink fluids regularly.  Control hyperglycemia.
  • 14.  Numerous factors, such as decreased thirst perception, decreased exercise tolerance, deteriorating vision, arthritis, cognitive problems, depression and social problems, make the management of older people with diabetes extremely difficult.  Exercise is the fundamental therapy for diabetes in older people, but should be undertaken in moderation and not in excess. Endurance exercises are only one component of the complete exercise prescription; strengthening, posture, flexibility and balance exercises are key to maintaining function and preventing falls.
  • 15. REFERRENCES  Cardiopulmonary implications of specific diseases : Joane Watchie.  The Elderly Type 2 Diabetic Patient: Special Considerations John E. Morley* Geriatric Research, Education and Clinical Center, St Louis VAMC, and Division of Geriatric Medicine, St Louis University Medical School, St Louis, Missouri, USA.  Google search.