Physiotherapy Protocal for Diabetes Mellitu Patients
Diet for Diabetes-The people should recommended proper diet which must not increase to much glucose levele in blood. It may be some juice or semiliquid diet.
It is a syndrome
in which abnormality in insulin secretion, action or combination of both may
produce disturbance in carbohydrate, fat and protein metabolism associated with
increase glucose level in blood.
It is a major
public health problem in globally fourth leading cause of death in United
States and also a common disease of developing countries. It affects central
nervous system, kidney, retina, musculo-skeletal system and primarily damage to
the cardiovascular system.
Due to imbalance
of insulin hampered transport mechanism of glucose in body cells and tissues. Excess
amount of glucose secrete out with urine.
Changes in
insulin secretion or action may be unhealthy food, sedentary life style, lack
of exercise, excessive stress.
Insulin works as a key of glucose binding sites.
Type 1 diabetes:
It occurs because of destruction of insulin producing beta cells of pancreas by immune system. The term used for this condition is insulin dependent diabetes because amount of production of insulin may be stop by beta cells so there is no insulin to control blood glucose level must need to use insulin injection.
It occurs because of destruction of insulin producing beta cells of pancreas by immune system. The term used for this condition is insulin dependent diabetes because amount of production of insulin may be stop by beta cells so there is no insulin to control blood glucose level must need to use insulin injection.
It may occur
at any age but usually starts in people under the age of 20.
Type 2 Diabetes: '
The body continues to produce insulin but over time it may be significant reduction of insulin secretion. The beta cells of pancreas produce either not enough insulin or the receptors (insulin binding cells) not available to recognize the insulin properly.
The body continues to produce insulin but over time it may be significant reduction of insulin secretion. The beta cells of pancreas produce either not enough insulin or the receptors (insulin binding cells) not available to recognize the insulin properly.
When there is inadequate amount of insulin or the insulin cells binding
site not able to bind insulin properly then cells cant able to use glucose
properly for metabolic activity.
Gestational diabetes:
Due to reduce the sensitive to insulin women suffer during pregnancy. All women not suffered with Gestational diabetes after birth usually it is resolve.
Due to reduce the sensitive to insulin women suffer during pregnancy. All women not suffered with Gestational diabetes after birth usually it is resolve.
- Positive Genetic history
- Sedentary life style
- Obesity
- Excess Stress
- Inadequate sleep
- Unhealthy food
- Ethnicity and race
- History of hypertension
- Dyslipidemia
- Positive family history (being more than 45 years of age)
- Having gestational diabetes
- Prediabetes
- Feeling of hungry
- Increase frequency
of urine
- Weakness, fatigue,
- Feeling of
tired
- Blurred Vision
- Feeling of more thirsty
- Dryness
- Altered consciousness
- Sudden Weight loss
- Headache
Glycosylated hemoglobin (HbA1C) use as a diagnostic tool by WHO and American Diabetes
Association. It reproduce the mean value of blood glucose over the past 2–3 month.
It is a standard biochemistry test to diagnose the blood glucose level.
Prediabetes
|
Normal
|
Diabetes Mellitus
|
Impaired Fasting plasma glucose 100mg-125mg.dl
|
Fasting plasma glucose <100mg.dl
|
>=200mg symptomatic with casual glucose
|
Impaired glucose tolerance =2-h ,140-199 mg. dl
|
Fasting plasma glucose >=126mg -200mg 2-h
|
Prediabetes is a condition increase
amount of blood glucose level in the fasting state,
called abnormality in
fasting glucose known as glucose intolerance with the response of dietary
carbohydrate and fat.
This is very high risky condition
to develop diabetes because the capacity to secrete more insulin is decrease
over time and insufficient insulin to normalize the blood glucose level.
How to manage or care of diabetes?
We can easily mange diabetes with Medicine, Diet, Exercise therapy
Medical management
We can easily mange diabetes with Medicine, Diet, Exercise therapy
Medical management
Hyperglycemia or hyperglycemia
may require medical management. It may be manage with oral or injectable (eg Insulin,
sulfonylurea respectively) type of drugs recommended by physicians.
Diet for Diabetes-The people should recommended proper diet which must not increase to much glucose levele in blood. It may be some juice or semiliquid diet.
Exercise for diabetic peoples to modify the symptoms.
How we can manage diabetes with physiotherapy?
How we can manage diabetes with physiotherapy?
- Maximize the patient quality of life, general health, and
wellbeing through maximizing physiological reverse capacity.
- Educate about DM, self-management, nutrition, weight
control, blood sugar regulation and its management (diet exercise stress and
insulin requirement) medications, smoking cessation, relaxation, stress-management,
and foot care, hygiene, infection control.
- Maximize aerobic capacity and efficiency of oxygen
transport
- Optimize physical endurance and exercise capacity
- Optimize general muscle strength
- Design comprehensive lifelong health and rehabilitation program
with the patient.
what are the exercise testingprocedure for diabetes Mellitus patientsin physiotherapy rehabilitation ?
EXERCISE TESTING
EXERCISE TESTING
The following are special points
to remember during exercise testing in individuals with DM;
• For light-to-moderate intensity
exercise testing may not be necessary for individuals with DM or prediabetes
who are asymptomatic for cardiovascular disease (CVD) and low risk (only 10%
risk of cardiac event over a 10-yr period) but during vigorous intensity
exercise program should undergo a medically supervised graded exercise test
(GXT) with electrographic (ECG) monitoring.
• If positive or nonspecific ECG
changes in response to exercise are noted or nonspecific ST and T wave changes
at rest are observed, follow-up testing may be performed.
- The regular exercise produce beneficial effect for both
type 2 DM and prediabetes
- Increase glucose tolerance
- Increase insulin sensitivity, decrease insulin requirement and HbA1C.
- Improved CVD risk factors
- Prevent or delay the transition to Type2 DM from
prediabetes
- Provides health and wellbeing.
Warm-up:
Cardiorespiratory and muscular endurance activities (light-to-moderate
intensity) at least 5–10 min.
Conditioning: Aerobic, resistance, neuromotor, and/ or sports activities
at least 20–60 min/day with bouts according to individuals.
Cool-down: cardiorespiratory and muscular endurance activities at
least 5–10 min with light-to-moderate intensity.
Stretching: After the warm-up or cool down phase at least 10 min of
stretching exercises needed.
Frequency: 3–7 dwk
Intensity: 40 %–< 60% VO2 R with RPE (rating of perceived
exertion) 11-13 on a 6-20 scale. Better blood glucose control may be achieved
at higher exercise intensities (>-60% VO2R).
Time: It should be minimum of 150 min /wk. of exercise with moderate
intensity or greater and to achieve Additional benefits we can increase up to
300 min /wk. with moderate-to-vigorous intensity with Aerobic activity bouts of
at least 10 mins.
Type: It includes activities that use large muscle groups in a
rhythmic and continuous fashion eg. Treadmill, cycle ergometer, swimming.
Progression: Because of adaptation progression should be needed, we can progress in
duration, intensities, time, type of exercises and aerobic bouts according to
patient.
FITT-VP
Frequency-Each major muscle group should be trained on 2–3 dwk.
Intensity-
- 60%–70% 1-RM (moderate-to-vigorous intensity) to improve strength.
- >=80% 1-RM (vigorous-to-very vigorous intensity) for experienced strength trainers to improve strength.
- 40%–50% RM (very light-to-light intensity) for older
individuals to improve strength in beginning of resistance exercise.
- 40%–50% 1-RM (very light-to-light intensity) may be
beneficial for sedentary individuals to improve strength.
- <50% 1-RM (light-to-moderate intensity) to improve
muscular endurance.
- 20%–50% 1-RM in older adults to improve power.
Time: No specific duration known for effectiveness.
Type: It should be involve each major muscle group with multi joint
or single joint exercises affecting more than one muscle group and targeting
agonist and antagonist muscle groups are recommended for all adults.
Repetitions:
- 8–12 repetitions is required to improve strength and
power in most adults.
- 10–15 repetitions is required to improve strength in
middle-aged and older individuals.
- 15–20 repetitions are recommended to improve muscular endurance.
- Sets:
- 2–4 sets are required to improve strength and power for most adults.
- A single set is effective especially among older people.
- 2 sets are effective to increase muscular endurance.
- 2–3 min rest intervals between each set of repetitions more effective.
- A rest of >=48 h between sessions for any single muscle group is suggested.
FITT-VP
Frequency: It should be >=2–3d/wk.
Intensity: Stretch the large group of muscle up to feeling of discomfort
or tightness.
Time: Holding a static stretch for 10–30s is recommended for
most adults and 30–60s for older individuals but it must be changed with stretching
techniques.
Type: It may be Static flexibility (i.e., active or passive),
dynamic flexibility, ballistic flexibility,
and PNF.
Volume: It should be 60 s of total stretching time for each
flexibility exercise.
Pattern:
- To produce more
effect of stretching it may require warm up with actively or passively through light-to-moderate
aerobic activity or application of externally moist heat packs respectively.
- 2–4 times repetition is recommended.
Progression:
Unknown
- Always monitor the symptoms of hypoglycemia because rapid
drop of glucose during exercise may produce hypoglycemia.
- Monitoring of glucose before and after several hours.
- The timing of exercise should be considered in individuals
taking insulin or hypoglycemic agents.
- Exercise with supervision is recommend to prevent risk of
hypoglycemia.
- Always monitor Blood Pressure, Heart Rate, and glucose level.
1. Linda S. et al: ACSM Guidelines for Exercise Testing and Prescription 9th
Edition Lippincott Williams and Wilkins 2013.
2. Susanna C. et al: Type 1 and Type 2 diabetes mellitus and incidence of
seven cardiovascular disease; International Journal of Cardiology; 262 (2018) 66–70.
3. Kumar et al: Effects of aerobics programme on physiological profile of
diabetic patients; International journal of physiology, nutrition and physical
education 2018; 3 (1): 1534-1537.
4. Rathore et al. Prevention and control of madhumeha through diet and
lifestyle; World journal of pharmaceutical research; 8, 5; 2019; 805-810.
5. Teich et al: Advances in exercise, physical activity, and diabetes
mellitus;
Diabetes technology & therapeutics; 21,
1, 2019.
6. Diagnosis and classification of diabetes mellitus diabetes care, 33, 1, 2010.
7. Prevention or delay of type 2 diabetes: Standard medical care in
diabetes; diabetes care; 42, 1, 2019.
8. Lee et al. The effects of exercise on vascular endothelial function in
type 2 diabetes mellitus: A systematic review and meta-analysis; Diabetol metab
syndr (2018) 10:15.
9. Kasper, Faust, Hauser; Harrison’s principle of internal medicine 19th
edition.
No comments:
Post a Comment
If you have and doubt and questions so please contact me on my mail Id umaneuro1234@gmail.com or in my comment box.