=I Iabetes =

=
- =

Diabetes a
is
group of metabolic disease characterised by
inability to produce sufficientinsulin on use it

properly, resulting in
hyperglycemia.
Ensulin -

produced by B cells in Pancreas

↳ needed by muscle, fatand lives
utilise
to glucose

PATHOSIOLOGY -

TYPE-I DIBBETES? -

caused by B destruction difficiency of insulin

cell
resulting in

I insulin supplied by regular injections / insulin pump

* Prove to develop idiabetic ketoacidosis
when hypoglycemia
occurs

2 types -

immune mediated

6
-

ideopathic

juvenile dusta s insular dependent diabetes

before age of 30

It
isautoimmune disease-immune system
attacks the body's own tissue

symptoms of type I -

frequent mination extience hunger

excessive thrust ·fatigue
unexplained weightloss
 Pancali cells cannotsecrete insulin-iglucose reannot
taken
be down:
ghoose always high
bith
tut
from or due to dugs.
TYPE
C DIABETES -

vadultouton insulin dependent

occurs to
after
-susulin

defective
Resistance
insulin
of
secretion
peripheral tissue
3 common
expues

we insulin resistance body cannot

* effectively use

insulin the muscle or line

in even
thought
sufficient insulin is
being produced rally in course

disease.
of
↓
online panas. cannot insulin secretion to
enough
compensate for insulin resistance a hypoglycania occurs.

oral agents

S
Medication ⑤

X
insulin
R
exacisc

Ketoacidosis
*
rarely occurs.

Symptoms -

-Frequent Injection
-

Blushed vision

Tingling in hands feet

-vents
bruises slow to heal
skin, gun bladden Infection
·recurring or

3
genetic influence lack of physical activity
obesity HTM isk
↑w/ arge dyslipscllma
 * dyslipidemia tain
hyper obesity diabetes +
to

=metabolic syndrome

RESTATIONAL
- >
DIABETES -

diagnosed during pregnancy by oval

an glucose tolerance
rest.
Risk factors -

family history of gestational

diabetes
previous delivery of large birth
weight (+ky)
obesity

COPLICATIONS

All
complications -

hypoglycemia
·

hypoglycemia

Hyperglycania s

high blood
↳
sugar
·diabetes out contr
of
↳ blood glucose level thatare frequently above

Its glycemic goals.

·diables ketoacidosis
·
hypcrosmolar marketo syndrome
diabsent control
of

Blood glucose excite

High -
kidneys glucose + water
which leads to red wine production
a
dehydration
symptoms -
head a the

weakness
fatigue
Rx
:

chinking of noncambolaydate
plenty containing beverages
regular self monitoring of blood glucose
 according
medication doctor
to

diabetic acidosis evaluated w/ usive dipstick test

in pts whom diabetes is in
poor control a
insulin is absentor low.

↳ very

move in
type I

If there is insulin, body

no cannotuse glucose
t
effectively as high amountof fatmetabolism accus
provide energy.
necessary

Before a
byproductof fatmetabolism in absence
is
of
carbohygh
↳adauate my
t

lives (red risk is death)

of roma

Normal level before in body. 0.1 mmd I2

I
diabetic ketoacidosis
- Irmmd/L
upts

Other symptoms -

· abdominal pain
·
nausea

vomiting
·
rapid deep breathing
·
sweetor finity swelling breath

Excise is contraindicated B
*

opogannadiwherhyperglycerispodonda and end

 severe delycation
-> extreme dehydration can lead to

decuase mentation or Soma

rising blood glucose

excessive mination
↓
throws outprotein

& Exercise containdicated.

Hypoglycemia -
↳ insall shock (insulin Realtion
blood glucose level drops below
mgldh
60-70

occurs in
presence of following factors:
·too much insulin or selected oval
antidiabetic agents
·
too little carbohydrate intake
Missed meals
·excessive or
poorly planned exercise

hypoglycemia can occur

after exercise (modeats
to
high intensity
lasting longer than 30min
↳ either thee to red insulin
sensitivity, ongoing glucose
utilisation,
movitis blood glucose pie he postexercise

symptoms -

-
autonomic
·

neuroglycopeni
Blood glass decreases -glucagon, epinepluine, growth
cortisol
hormone and released is a
circulating glucose
symptoms - shakiness ·
humousness
↓ ·
sloealing ·
anxiety
dueh release · weaknes ·lingling of month is fingers
of epinephine, hunger
 to
Blood
glucose delivery brain deceases -

-
headache
visual disturbances
- mental dullness
·

confusion
- amnesia
· seizures
Rx -

·testing blood glucose

it conscious, consumption of approx 159 cobolychati
-

·if unconscious, inof glucagon.

throw complications-
· Mariovascular disease-
↳
large vessel's athaosconic
Microvascular disease
↳ small vessel
·
Menopathy

Marovascular-
vessels to heart, brain, a Lowen extremities can
affected
->
Blockage of vessels in lower limb ->PAs, intermitient
clandication, excise intolerance
Microvascular -

causes
retinopathy is nephropathy causes abnormal function
and damage to small vessels
of eyes, kidney. Resulting
in

as
Blinders and
stage
senal failure

Periphual G Autonomic Neuropathy -

before hands
puripheral legs
affects
symptoms as loss of sendor reflexes
expriences
sensory
complication progresses feetbecomes numb -
pt
at
high risk
of footinjuries.
weakness, &
Muscle
Atrophy
foot
deformities.
 in blood
impains
healing -> severe
flow -

potential gangrene

amputation

Antonia No
pati
↳ system
any
cardiovascular autonomic neuropathy -
high URRest, exercise UR

response,
abnormal BP, redistributor of
blood flow during ex

should focus
Physicalelevated
Examination on

resting pulse rate

~
loss
of
sensation / reglexes in LL

foot sores Jules healing poorly

-
excessive
bruising ·

~
vascular
rcinal vabudmalities

Exercise
Professional should consider -

I
· Chronic will
complications
UDAC, plasma glucose, proteinuiea
.
BO

·self monitoring
G
blood glucose love

·Body Lot BMI.

·
Medication use a fairy
I never
give
exercise
dining peak paid of medicine as

Exercise history can cause

hypoglycemia.
plan
Nutitional

Cheria for diables mellites?

diagnosisof diabetes
-

·
symptoms of +
casual plasma glucose
concentiation
scoongldh
· Eashay plasma glecose>12sugldh
·she plasma glucose >
Cony/dL

Adverse effects of exercise -

cardiac dysfunction
in 18
increments
Excessive
·Postexecisc orthostatic
hypotension
· Retinal hemorrhage
Red prolinia
·wosening of hyperglycania/ Kitosis
foot ulcers.

Treatment
·
Exercise
·

Medicines
multitonal therapy

S self

each
managementeducation
macronutrient should be considered when
mulational plan.
developing a

protein intake
should be more

intake
choist limited to
soomg daily

Exercise Prescription? -

Aerobic
5-35 times per week
1- 50-75% maximal aerobic capacity
of
7 -

20 60 min

I walking, cycling, swimmity.

lather than intensity
Progression alter
-
elevation

Begin at a
computable intensityabout10-15min
then a dilation as to leabad.
Resistance -

F. Atleast a times per week (never on consecutive days)

1. About60of 18M.
7 10-15seses set, the sets
per
-

7
Free cobs, machines, elastic bands.
-

progression of 5-10%
* in diabetic pts improve glucose tolerance a
insulin sensitivity.

flexibility -

1. Postaebic exercise session

1 -

7-1030 see per exercise each muscle

of group
I - shall stretching

special comidnala -

insulin action
Avoid ex
during peak

1
-

cool down
⑨
walm upt

inspectfeel daily,Modaforth
evalues
-

hydration.
Adequate
~

execcise acts like insulin in thatitmometes peripheral

glucose uptake. Risk
of hypoglycana .

Physiological. Adaptation of excise -

-Russ in Blood
glucose
improve metabolic control
-

improve the, likeds

Body composition
weight loss
well
psychological being.
 =tension
Transitoryor sustainedelevation
messure
ofsysbankalavaloneon
in
result other
consequences.

HTM

d
↳Primary Secondary
unknown I known cause

·Isolated systolic vine-

sBOI 140 or more, prp less than 90

·
MalignantUTM
-

elevated BP associated w/ papilledoma

↳
DBP > 190.

white
coatHTM-pason's BP elevated when measured by
butnormal outside
a physician a
health cans selling.
CLASSIFICATION
-
-

Normal- <120180
120-139180-89
Phypatansion -

190-159190-99
stage
( HTM -

100/100
stage 2 CTH -

>

Pathophysiology! -

Regulation of BP by various systems - renal, hormonal, vascular,

peripheral as cential
advenergic
BP cardiac
=

output1 Total peripheral Resistance

HTM:Red TOR by inducing vasoconstriction to a co or both
is normal condiac outputand elevated TOR
 Based on
galis
salt sensitivity
inappropriatesent section by kichneys
environment
alcohol is saltintake
obesity, physical activityand
↳

Renal hypertension -

l
dang need in seal
handling of sodium's fluids,
alternation in venal passive
leading to section of
materials
resulting in a sysbank on local change in

antial tone.

advenal
andomine -

abnormality of glands
endothelium -> predisposes individual to
HTM -

damages atherosclnosis
G one vascular pathologies.
endothelium
In
presence of hyperlipideula a
damaged
atheroscladic planuc develops
In absence, intima
thickens.
Increased on heart
offerload may load to
leftunticular
hypahopehy ->
congestive heart
failure.
Signs a
Symptoms -

No
specific symptom
Headache -

severe HTM

to in
↳ localized occipital igion, present an
awakening
morning.
dizziness
palpitations
easy falignability contribut
epistaxis, hamaturia, blushing of
vision vascular disease

ing to HTM
Diagnostic testing -

diagnosed based on or more

leadings ateach
of
two or

visits initial visit

more often an
sucening
Anscultably method.

Laboratory fests -

minalysis, hematicit, blood chaistry, ECG

helps delamine targetorgan damage as
risk faces.
erealize clearance, IR, serum valedium, phosphate
a mic acid

containdications -

anterial atlasts
severe hypertension (SDP>200, DBP>10

Abnormal BP Response
Normal
during
-
exercise TORA ↑ in 10
compensates for 700

systolic BP , Diastolic BP remains

same or d

6002
of 1 in 70R

HypuSousive patients -
in NBP both
dining as
after
exercise. Unable to reduce TPR

Indications for test

seminating excise

·significant ↓ In systolic BP
from baseline systolic BP

despite
are in workload
·
excessive & in BO-SBP>280 and DBP > 115
mulig.
TREATMENT -

- >

lifestyle modification pharmacological

+ Rx.

goal:BP<130180 in pts w/ faBM/chronic kidney disease

BP <140/90 normal people

 controls BP is
modifical
Lifestyle
-
other risk
factors of an

↳
Wh reduction enhances effectsof antihyperusives
s

the effect on SUD.

DASH
diet-distary approach
to stop HTM.

↳ rich in
fruits, vegetables, low
fat dairy
products we reduced
contents
of dietary chostol as saturated as stal fat
* Reduce BP
by 8% 14
muntig
alcohol consumption
excessive lisk
factor for BP
=

SAReduction -

29/21
↳
Changes of nhill in
hypotensives
1.310.8 in norms tensive
mung
Ma
mediate restriction to no more than 100
midday
Pharmacological therapy

7
Based an By elevator

presauce of targetagain damage

presence of cup/cus risk factors
2 or more
antihypertensive to reach the goal

Thiazide type
cimetic -

mostly for uncomplicated HTM

ficantfailure -

dicieties, P Blockens, Act inhibitors, aldosterone

antagonists
Postmyocardial Injanation - B Blockers, AL
inhibities, aldo showe

antagonists
Calium blockas
Pls
high
at risk of CD -
manual +

above
as
scrn Polassian creative -> mac atleastonce or

twice a
year.
 Modifications
Life Style
-

not Reduch
·
DASH
·
Sodium Reduction
Physical Activity
Moderation Alcon consumption
.

of
Exercise Prescription -

Sandinance training -
Reduces & in 10
Exercise training associated of -

·
I in plasma norepinephile levels - a BO
heral I BP
improves function...
·

Changes in carterial structure, a puipheral vascular insistance

HTN +

Hypaistlinemia insulin resistance obdinal obesity

+ And highly recidas high lipoprotein
density
+

Metabolic syndrome
=

Exercise a insulin sensitivity - a seven insulin ? B8

Aerobic exercise -

5-3to 7 days look

1- 90% to 70%Og 00eR Or HRR O RPE G 11 -

14

7- 305 50 min
of continuous intermillent
7
lay muscle group focusing
-

expenditure - 2000 cal look

energy 700

B Blocken, la Channel Blockers as vosodilators cause

may
hypotension
postexation
certain clivities -
I in serum potassium, predisposing the ptto
arhyhandas
Resistance training -

F-263
days lack
set, 15
7
-

one 1050 reps

1 -
90 to 60%. (RM

station/device -8to10 exacise that condition major muscle

group.

special consideration -

Add endurance only after initialing dry therapy

notbe allowed 7200
should to exercise
of Resting
SBP

o DBP > 110

-BP termination
exitaria for
exacise - >2801115
·
a
dineties B Blockers impair the moregulation during exercise
in hotis humid environment
about is heatintolerance
inform signs symptoms of
-strength desistance training letrecommended as
only
people of
form of exercise for LM.

works
only col acrobis on in incit
training.
drenG_Adolescents
children require special consideration
executesting
when
execuing as

a result of growth
is
immativityof
the their physiologic
systems at seta
and
regulatory dining exercise

ExercicTestay in children adolescentunless thereisa

health concern

Protocol of exercise should based on

testing
be season

the testis being personned the capacity

functional
of child/ adolescent
- should be familiaried w/ the protocol and
procedure before
to
minimise stress a the potential for
testing maximise
successful test

-Both meadmill a
cycle ergonster.
↳ dlisits a
peak oxygen uptake
higher maximum UR

cycle engonsters -

provide less risk

for injury, need to
be sized.
conceally
·
Reuic extra motivation a support

Exercise Prescription -

fre- Atleast3-4 days look -

prequably daily
3 breathing, scaling un
Moduate thatRes
Intensity -

IPA a

vigorous
Time -

Sominday moduat is
somialday vigorous
Arah 60min
a whatever they
type -

enjoyable developmentally appropriate, like

include
walking, games, dance
special considuations
-

-Provide prophe instructions

a supervision.
Resistance -
reps
8th 15
of an exercise to the point of
modal mechanical
fatiguei
resistances
W)
red.
good form before

have system
·

they thermoregulating
immature exercise -
in

environments
theumonial a pople hydration
a
who are on
avant
physically inactive may notbe able to
achieve hominiday, gradually a
pasuency as time
· children w/ disease - exacise failored
posciption to their
condition, symptoms is capacity
functional
Goal -
a sedentary activities + ↑ thatpromote
activities

lifelony activity a fitness

Kasch Pulsa
3 Min
Recovery Test -

climbs step testto see levelof RomeIasshe a

were

us

a down min
pen
metronome at
9) beats/min.
done for 3 min.

If HR >180 -
Seminat

Physiological Responses to acute exercise of

children compared w
adults -

Absolute or uptake (VOC) lower Respiratory exchang

Relative Oc uptake
-higher Rato - lower

HR
higher
-

Co lower
SV ->

lawle
SBP
-

lower
PBP ·

lower

Respiratory Rate
higher
tidal volume ·

lower

minute ventilation lowen

 uption
-
the
of
Older Adults people >55 as people 50-6 years of
years
-

clinically significant conditions

or physical limitations that
affect movement, physical fitness physical activity.
Exercise
following
causes Bengil
thatimpair
-
slows physiological changes of aging exercise

capacity.
-

optimising age related

change in
body composition
-providing psychological is cognitive well
being
chronic disease
managing
a

dducing risk
of physical disability
~

increasing longevity

Exercise
Testay at her moderate
risk
for advert responses
to exercise undergo ex
testing
·sutical workoad should be low (3 METS)

cycle agometer
prefered to treadmill
for those we good
balance, poor neomuscular codination, impaired vision.
not limitation is foot
impaired gait patterns, bearing
problems.
↑
Add a headmill chandrail support -
for reduced balance
decreased muscular strength, poor remomuscular coordinations
fear
·
Tecodwill workload needs to be adapted according to
walking
ability by increasing grade than
rather speed.
·
For those who have
adjusting
difficulty to exerciseprotocol,
should
initial
stage be extended
Exercise induced dyshythm as are more
frequent
Described meds ECGand
can influence hemodynamic
changes
Exercise Prescription -

weakness, deconditioning
~ low capacity,muscle
functional
more common in adults.
Individuals who moblem
fall fluently on have mobility
should
perform specific excuse to improve balance,
agility
and propriocepting draining
·

healthy adults
↳ moduate -
to 6 METS

vigorous <GMETS
-

-
older adults based
-

on individuals fitness within contextof

percieved physical exection
->
10ptscale -
O is no effort
too much
10 is
effort noticable

activity.
moderate 5 to 6. HR's breathing
'
vigorous 7708 -
large & AR
breathing
-

Aerobic Activity
-

look mduat
F-min 5
days -

3
days look vigorous
-

1.5 s -
moderati
700 -

vigorous
7 -
300 upto
60 min
day in bouts
of atleastlomin to tal
150-300 min lok -> moduati
hot-> vigorous
20 to 30 min
(day a 15-100 hin

7.
Anything that does notimpose excessive orthopedic
stress. WALKING
-

Aquatic
exercise is
stationary cycle exercise for those wh
limited not
bearing
 Muscle
Shengthening -

F. Atleast2 dayslok
1 -
moderate 5 to

vigorous 7t8
7 -

Progressive of training or not

bearing calisthenics involving
major muscle group 10 to 15
Veges
slain
if climbing,

Flexibility -

7. At leastdays look
I - mediate
-> 5t

activity thatmaintain
7.
Any on a
flexibilityusing sustain-
ea stretches for each
major muscle

Batane -

Nauscular
training combines balance, agility and proprioc
eptic training, effective in reducing falls a preventing if
lik
performed days 2.5

thatgradually reduce
progressively difficultposture
BOS

movements
thatperturb
dynamic the 203 (tanderswalks
a circle teams)
~

stressing postural muscle groups

(had stands, be
stands
reducing sensory inputstanding of eyes closed
tai chi
* supervision required.

special considerations
Intensity should low
·
as divation be at
beginning for those
who

rare deconditioned 1 functionally limited

Progression should be individualised to seance a methance
·strength-susevis initially
should peccede
in
early stages -
muscle
strengthening aerobic

training in very fail adults.

·
gradually exceed the intensity
Incorporation of behavioral
strategies, such as social
in
support
self efficacy, ability to make healthy choices percieved
safely enhance participation
-

Provide regular feedback, the reinforcement