Treating Diabetes
Insulin
used in management of type I and II diabetes - human insulin produced by recombinant DNA technology - several insulin products = differ in onset and duration of action
Drug Categories
type I - insulin type II - insulin - oral hypoglycemics - antihyperglycemics
Hypoglycemia Treatment Adverse Effects
- weight gain - allergic reactions = more common with beef and pork insulins - lipoatrophy - lipohypertrophy
Glucagon Emergency Kit
* if unresponsive, assume hypoglycemia and administer glucagon* - prescribed by physician - includes a pre filled syringe of glucagon - keep at least 1 kit in emergency supplies if any athletes are insulin dependent
Drug Interactions
- any drug that can affect glucose level should be used with caution • hypoglycemia or hyperglycemia - nonselective β-blockers - corticosteroids - β-agonists - nasal decongestants - thiazide diuretics - alcohol
Travel with Diabetes
- athlete should carry pre-packaged meals and snacks in the event that meals are delayed. - athletes with diabetes should notify airport security screeners of their medical condition - an athlete with diabetes must carry all diabetes equipment and supplies onto the aircraft in case of emergency. - prescriptions and a letter from a physician (on letterhead) showing the need for the aforementioned supplies should also be taken with. - the athlete should also carry a health insurance card at all times, along with emergency phone numbers The ADA can provide a form of medical identification card to persons with Diabetes.
Insulin Therapy
- blood glucose must be closely monitored - dosages changed accordingly - insulin pumps - new pancreas?
Treatment of Type II Diabetes
- diet and exercise - medication as needed • oral antidiabetic drugs • injectable antidiabetic agents
Intermediate Acting Insulin
- generic name = NPH - trade name = humulin N, novolin N - onset = 1-2 hours - peak = 6-14 hours - duration = 18-24 hours
Type I Diabetes
- insulin dependent - onset: <30 yoa - does not respond to diet alone - often not obese at diagnosis
Type I Diabetes Treatment Components
- insulin replacement therapy - proper diet - exercise - self monitoring of blood glucose
Role of the AT
- know and be able to recognize the symptoms of uncontrolled diabetes - patient education - be a source of encouragement to diabetic athletes - be able to recognize hypoglycemia and have a carbohydrate source available - encourage regular medical exams - provide education regarding appropriate foot care
Develop a Plan
- meet with the athlete, parents, physician - review the athlete's medication regimen and dosing times - review the glucose monitoring system • must be monitored throughout the day - availability of carbohydrate snacks • pre-exercise • snacks available in case of hypoglycemia - glucose monitoring equipment - glucagon kit availability - travel plans with medications
Treatment Therapies for DM
- non drug management - insulin therapy
Type II Diabetes
- non insulin dependent - onset: > 30 yoa; rapidly rising in younger population - diet can affect disease early on - commonly obese at dx
Insulin Administration
- not effective orally - administered by subcutaneous injection • regular and rapid onset insulin can be given IV storage - unopened vials in refrigerator - vial in current use may be kept at room temperature for 1 month
Treatment of Hypoglycemia
- oral administration of 15 to 20 g of any glucose-containing carbohydrate - severe hypoglycemia is a medical emergency - unconscious patients require parenteral glucose or glucagon
Uses of Insulin
- rapid and short acting insulins are used at meals to control postprandial glucose levels - intermediate and long acting insulin to mimic basal level of insulin
Blood Glucose Levels
GOAL: maintain normal or near normal blood glucose levels, blood pressure, and lipid control - normal blood glucose levels (fasting): 60-100mg/dL - near normal levels: 100-180 mg/dL - normal levels 2 hours after eating: <140 mg/dL
Diabetic Medication and Rehab Concerns
Variables that effect insulin absorption rate: - exercise of the injected area (exercise within 1 hour may increase absorption) - massage injection (do not vigorously massage injection site within 1 hour of injection) - thermal modalities: • Heat increases absorption • Cold decreases absorption • Avoid using thermal modalities 1-3 hours pos injection
Diabetes Care Plan
a comprehensive care plan should include the following: - blood glucose monitoring guidelines (frequency, and pre-exercise values) - insulin therapy guidelines (including type, dosages, and adjustment strategies, and correction dosages.) - list of other medications - guidelines for hypoglycemia recognition and treatment. - guidelines for hyperglycemia recognition and treatment. coaches are crucial in the recognition of hypoglycemia and hyperglycemia
Insulin Vial
this is a method of administering insulin. - you are to evenly disperse medication particles by rolling the vial between the palms of your hands *do not shake the vial*
Insulin Pen
alternate method of carrying and administering insulin - contains cartridge of insulin - can be used once or reusable - you can adjust the amount of insulin administered
Insulin Pump
becoming more popular and is battery operated - pump is filled every few days with appropriate insulin - internal pumps are available and are implanted just under the skin and contains insulin that can last for months - pumps deliver small basal rate of insulin throughout the day and the basal administration helps to maintain a more constant level of glucose
Long Acting Insulin
slowest onset but longer duration - generic name = glargine, detemir - trade name = lantus, levemir - onset = 1-2 hours - peak = none to flat like - duration = 18-24 hours
Diabetes and the Athlete
diabetes can participate in athletic activities at all levels - need good glycemic control - no complication that preclude activity - monitor for hypoglycemia if athlete is using insulin
Non Drug Management
diet and exercise - improve glycemic control - reduces risk of long term complications (macrovascular disease)
Type II DM and Insulin
has an anabolic effect when combined with human growth hormone - banned by the WADA - athlete must file for a therapeutic use exemption before international competition not banned by the NCAA
Diabetes Medication: Adverse Effects
hypoglycemia - low blood sugar - can be due to dosing error, administering error, significant unplanned change in diet or exercise - hypoglycemia unawareness • loss of early warning symptoms of hypoglycemia
Type II Medications
if able to control BG levels without insulin (this is the best of possibilites) - oral hypoglycemic meds • need to be careful, may lead to hypoglycemia - antihyperglycemic meds • don't work at the pancrease; work at the muscle, liver and fat cells • won't lead to hypoglycemia • e.g. metformin used along with dietary changes and exercise recommendations
Insulin Administration (conit...)
location for subcutaneous injection - arm - thigh - abdomen = most consistent and least effected by exercise - buttock rotate injection site for comfort and consistent absorption *when an extremity is injected with insulin and then exercise the increased blood flow to that limp will increase absorption and metabolic effect on insulin
Diabetes Medication: Side Effects and Adverse Reactions
primary concern when administering insulin is hypoglycemia hypoglycemia may occur from: - too high of dosages - depleted glycogen stores due to exercise or skipping meals - delayed/missed meal
Short Acting Insulin
quick onset but longer duration than rapid acting - generic name = regular - trade name = humulin R, novolin R - onset = 0.5 to 1 hours - peak hours = 2-4 hours - duration = 5-8 hours
Rapid Acting Insulin
quick onset but short duration - generic names = lispro, aspart, glulisine - trade name = humalog, novolog, apidra - onset = 0.25 to .5 hours - peak hours = 0.5 to 2 hours - duration = 3-6 hours