LA Sheehan, Francine Coxon, Katie Chisholm, Jon Chien, and Brooke Cable

1. LA Sheehan, Francine Coxon, Katie Chisholm, Jon Chien, and Brooke Cable

2. General Overview • very serious, chronic disease • one of the leading causes of death in Canada • presently, over 2 million Canadians • expected rise to 3 million in 2010 • epidemic

3. What is Diabetes? • body cannot properly store/use food for fuel • Insulin • hormone • Produced by beta cells in the pancreas • Allows glucose to move from blood stream into muscles to be used in energy production • In diabetes insulin is produced in insufficient amounts, or it is produced but cannot be used properly

4. Types of Diabetes • Type 1 (insulin-dependent or juvenile diabetes) • body mistakes beta cells for foreign bodies and destroys them, so they can no longer produce insulin • daily injections of insulin are required • Most often seen in children and young adults • Only 10% of all those with diabetes

5. Types of Diabetes Type 2 • pancreas no longer able to meet demand for insulin and/or the body can no longer use insulin properly • most often seen in adults (increasing rates of childhood obesity causing growth of type 2 in children and young adults) • almost 90% of all cases

6. Types of Diabetes Gestational Diabetes • temporary condition during pregnancy • occurs in 3.5 - 3.8% of all pregnancies • Increases risk for developing other types later in life for both mother and child

7. Complications • All types involve an inability to store glucose, and lead to increased blood glucose levels • high blood sugar can lead to complications and huge damage to the body • Common complications – heart disease, kidney disease, nerve damage, vision problems/blindness, impotence, and • amputations

8. Causes? • Although it is known that diabetes is due to insufficient or ineffective insulin, it is not known what causes the body to attack the insulin producing cells or what causes the pancreas to be unable to meet the demands. • However, many factors which increase the risk of developing diabetes have been identified…

9. Risk Factors for Developing Type I Diabetes • Genetics (non-modifiable) • Increased risk if mother experienced gestational diabetes

10. Risk Factors for Developing Type II Diabetes Being: • Age 40 or older • A member of a high-risk ethnic group (Aboriginal, Hispanic, Asian, South Asian, or African descent) • Overweight (especially if weight is carried around the middle) Having: • A parent, or sibling with diabetes • Giving birth to a baby that weighed more than 4kg (9lb) at birth • Had gestational diabetes during pregnancy • Impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) • High blood pressure • High cholesterol or other fats in the blood Having been diagnosed with: • Polycystic ovary syndrome • Acanthosis nigricans (darkened patches of skin) • Schizophrenia

11. Gestational Diabetes Risk Factors for Developing Gestational Diabetes • A previous diagnosis of GDM • Age over 35 years • Obesity • A history of polycystic ovary syndrome • Hirsutism (excessive body and facial hair) • Acanthosis nigricans (a skin disorder characterized by the appearance of darkened patches of skin) • Being a member of a population considered to be at high risk for diabetes, including women of Aboriginal, Hispanic, South Asian, Asian or African descent.

12. Subjective Assessment:Signs & Symptoms of Diabetes • Unusual thirst • Frequent urination • Weight change (gain or loss) • Extreme fatigue or lack of energy • Blurred Vision • Frequent or recurring infection • Cuts and bruises that are slow to heal • Tingling or numbness in the hands or feet • Trouble getting or maintaining an erection • Special Note: Some people do not have early warning signs of low blood sugar.

13. Type I Diabetes Signs & Symptoms of High Blood Sugar (Hyperglycemia Above 11 mmol/L) • Abnormal thirst • Increased urinate • Increased exhaustion

14. Signs & Symptoms of Low Blood Sugar (Below 4 mmol/L) • Hunger • Shakes or light-headedness • Nervous or irritable • Sweaty • Weak • Nauseous or dizziness • Faster heart rate • Confusion • A numbness or tingling in tongue or lips • Difficulty with concentration, seeing or speaking • Headache • Experience mood changes

15. Signs & Symptoms of Very Low Blood Sugar • Confusion and disorientation • Loss of consciousness • Seizures

16. Causes of Low Blood Sugar(Hypoglycemia) • Not eating enough food • Missing or delaying a meal • Exercising without taking the necessary precautions • Taking too much insulin • Drinking alcohol

17. Type II Diabetes Signs & Symptoms of High Blood Sugar (Hyperglycemia Above 11 mmol/L) • Abnormal thirst • Increased urinate • Increased exhaustion

18. Signs & Symptoms of Low Blood Sugar (Below 4 mmol/L) • Shaky, light-headed • Nervous, irritable • Confused • Hungry • Faster heart rate • Sweaty, headachy • Weak • A numbness or tingling in your tongue or lips

19. Signs & Symptoms of Very Low Blood Sugar • Confusion and disorientation • Loss of consciousness • Seizures

20. Causes of Low Blood Sugar (Hypoglycemia) • More physical activity than usual • Not eating on time • Eating less than normally required • Taking too much medication • Drinking alcohol

21. Objective Assessment:Complications of Type I & II Diabetes • When patients present with specific signs and symptoms related with possible injuries, the Kinesiologist must be aware of the underlying problems associated with diabetes. • If positive neural signs are found during an objective assessment, it may be caused by and injury itself or from complications related to diabetes.

22. Digestive Problems • It is estimated that between 30 and 50 percent of all people with diabetes will have some sort of problem with their gastrointestinal (digestive) tract and is linked to how long a person has had diabetes, their blood sugar control, the presence of other diabetes complications, cigarette smoking, and a lower level of HDL cholesterol. Warning Signs: The most common signs of gastroparesis are nausea and vomiting. Other symptoms include heart burn, constantly feeling full, getting full easily once you start to eat, slight abdominal pain and abdominal bloating. Some people may also have symptoms that note the presence of generalized autonomic neuropathy, such as impotence, abnormal sweating or dizziness on rising due to orthostatic hypotension (low blood pressure that develops when a person stands).

23. Foot Ulcers • There are approximately two million persons in Canada with diabetes. It is estimated that 4-10% of those with diabetes will develop a foot ulcer. The numbers get even worse because statistics show that 14-24% of those persons with diabetes and foot ulcers will require amputation (either a partial foot amputation or a leg amputation) because the ulcer won't heal. Risk Factors: • Neuropathy or loss of feeling is the single biggest risk factor for developing a foot ulcer. • Foot deformity • Prior history of foot ulcers • Loss of circulation.

24. Hypothyroidism • Studies have shown that the incidence of hypothyroidism seems to be increased in both people with type 1 and type 2 diabetes, especially women over the age of 40. Symptoms: • Fatigue • Hair loss • Weight gain • Constipation • Listlessness and depression • Memory loss and mental 'dullness' • Muscle and joint pain • High cholesterol levels • Feeling cold (when no one else is) • Husky voice • Dry skin • In women, heavy menses

25. Sexual Dysfunction • Enough said! Diabetic Retinopathy • There are two types of diabetic retinopathy, non-proliferative or proliferative (background). Non-proliferative diabetic retinopathy is the most common form of blood vessel damage in the eye due to diabetes. It accounts for about 80 percent of all cases. • About one-third of all diabetics have diabetic retinopathy.

26. Dry Skin • Diabetes affects many body organs, including the largest of the body, the skin. Dry skin (also called xerosis or asteatosis) is one of the numerous dermatological problems associated with diabetes. Some skin conditions are specific to diabetes, but most of them also occur in the general population. In addition, the clinical symptoms and complications of skin disease are frequently more severe in the context of diabetes. Potential Effects: • It can cause intense itching and irritation; • It can lead to secondary infection, localized folliculitis (inflammation of the hair follicles on the skin) or even cellulitis; • It can lead to ulceration particularly on diabetic feet with loss of sensation.

27. Treatment Unfortunately, THERE IS NO CURE!

28. Treatment Education • Diabetes education is an important first step. All people with diabetes need to learn about their condition in order to make healthy lifestyle choices and manage their diabetes

29. Treatment Physical Activity • Regular physical activity helps your body lower blood glucose levels, promotes weight loss, reduces stress and enhances overall fitness.

30. Treatment Nutrition • What, when and how much you eat all play an important role in regulating how well your body manages blood glucose levels.

31. Treatment Weight Management • Maintaining a healthy weight is especially important in the management of type 2 diabetes.

32. Treatment Medication • Type 1 diabetes is always treated with insulin. Type 2 diabetes is managed through physical activity and meal planning and may require medications and/or insulin to assist your body in making or using insulin more effectively.

33. Treatment Lifestyle Management • Learning to reduce stress levels in day-to-day life can help people with diabetes better manage their disease.

34. Treatment Blood Pressure • High blood pressure can lead to eye disease, heart disease, stroke and kidney disease, so people with diabetes should try to maintain a blood pressure at or below 130/80.To do this, you may need to change your eating and physical activity habits and/or take medication.

35. Role of Kinesiologist Prevention (type II) • Educate clients on unhealthy lifestyle habits that could lead to type II diabetes Identification • Be able to spot the signs of diabetes • Refer to physician for blood or any other necessary diagnostic tests Management • Healthy lifestyle choices • Exercise • Referrals to specialists, i.e., nutritionist, podiatrist, optomitrists

36. Three Exam Questions What are the three types of diabetes? • Type 1 • Type 2 • Gestational

37. Three Exam Questions What are three signs or symptoms of diabetes? • Unusual thirst • Frequent urination • Weight change (gain or loss) • Extreme fatigue or lack of energy • Blurred Vision • Frequent or recurring infection • Cuts and bruises that are slow to heal • Tingling or numbness in the hands or feet • Trouble getting or maintaining an erection

38. Three Exam Questions What are the three roles of theKinesiologist? • Prevention • Identification • Management