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