醫(yī)學(xué)康復(fù)學(xué)課件：09 糖尿病的康復(fù)（英）18

1、Diabetes Mellitus RehabilitationWuMan1Diabetes Mellitus Rehabilitationu1. Overviewu2. Rehabilitation evaluationu3. Rehabilitation treatmentu4. Diabetic foot Rehabilitationu5. Summaryu6. Review questions21. Overviewu1.1 Definitionu1.2 Current situationu1.3 Classificationu1.4 Clinical manifestationsu1

2、.5 Complications31.1 DefinitionuDiabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period.uDiabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding p

3、roperly to the insulin produced.41. Overviewu1.1 Definitionu1.2 Current situationu1.3 Classificationu1.4 Clinical manifestationsu1.5 Complications51.2 Current situationuIDF: 2017-425 millionsuChina: 2017-114 millions6World Diabetes DayuWorld Diabetes Day (WDD) is celebrated every year on November 14

4、. The World Diabetes Day campaign is led by the International Diabetes Federation (IDF) and its member associations. It engages millions of people worldwide in diabetes advocacy and awareness. uWorld Diabetes Day was created in 1991 by the International Diabetes Federation and the World Health Organ

5、ization in response to growing concerns about the escalating health threat that diabetes now poses. 7World Diabetes DayuWorld Diabetes Day became an official United Nations Day in 2007 with the passage of United Nation Resolution 61/225. The campaign draws attention to issues of paramount importance

6、 to the diabetes world and keeps diabetes firmly in the public spotlight.uWorld Diabetes Day is a campaign that features a new theme chosen by the International Diabetes Federation each year to address issues facing the global diabetes community. 8World Diabetes DayuWhile the themed campaigns last t

7、he whole year, the day itself is celebrated on November 14, to mark the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in 1921. 9World Diabetes Day campaign themesu1991 Diabetes Goes Publicu1992 Diabetes: A Problem of All Ag

8、es in All Countriesu1993 Growing Up with Diabetesu1994 Diabetes and Growing Olderu1995 The Price of Ignoranceu1996 Insulin for Life!10World Diabetes Day campaign themesu1997 Global Awareness: Our Key to a Better Lifeu1998 Diabetes and Human Rightsu1999 The Costs of Diabetesu2000 Diabetes and Lifesty

9、le in the New Millenniumu2001 Diabetes and Cardiovascular Disease11World Diabetes Day campaign themesu2002 Your Eyes and Diabetesu2003 Diabetes and Kidneysu2004 Diabetes and Obesityu2005 Diabetes and Foot Careu2006 Diabetes and the Disadvantaged and Vulnerable12World Diabetes Day campaign themesu200

10、7-2008 Diabetes in Children and Adolescentsu2009-2013 Diabetes education and preventionu2014-2016 Healthy living and diabetesu2017 Women and diabetes our right to a healthy future131. Overviewu1.1 Definitionu1.2 Current situationu1.3 Classificationu1.4 Clinical manifestationsu1.5 Complications141.3

11、Classification The current taxonomy was introduced by the World Health Organization in 1999.uType 1 DM uType 2 DM uOther specific typesuGestational diabetes151. Overviewu1.1 Definitionu1.2 Current situationu1.3 Classificationu1.4 Clinical manifestationsu1.5 Complications161.4 Clinical manifestations

12、uThe classic symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss.uComplications171. Overviewu1.1 Definitionu1.2 Current situationu1.3 Classificationu1.4 Clinical manifestationsu1.5 Complications181.5 ComplicationsuAcut

13、e complicationsdiabetic ketoacidosis (DKA)hyperosmolar hyperglycemic state (HHS)uInfectious diseases191.5 ComplicationsuLong-term complicationsMicroangiopathymacrovascular diseasediabetic neuropathydiabetic footother 20Diabetes Mellitus Rehabilitationu1. Overviewu2. Rehabilitation evaluationu3. Reha

14、bilitation treatmentu4. Diabetic foot Rehabilitationu5. Summaryu6. Review questions212. Rehabilitation evaluationu2.1 Physiological function evaluationu2.2 Psychological status evaluationu2.3 ADL evaluation222.1 Physiological function evaluationuBiochemical index testplasma glucose HbA1cFasting lipi

15、d profileLiver function test, Renal function test23diagnostic criteriauNormal:FPG 3.9-6.0mmol/LOGTT 2h PG 7.7mmol/LuImpaired fasting glucose (IFG):FPG 6.1-6.9mmol/LuImpaired glucose tolerance (IGT): OGTT 2h PG 7.8-11.0mmol/LuDM:FPG 7.0mmol/LOGTT 2h PG 11.1mmol/L24WHO diabetes diagnostic criteria (19

16、99)Diagnostic criteriaPlasma glucoseSymptoms of high blood sugar and casual plasma glucose11.1mmol/LorFasting plasma glucose level (FPG)7.0mmol/LorPlasma glucose two hours after a 75 g oral glucose (2h PG)11.1mmol/LA positive result, in the absence of unequivocal high blood sugar, should be confirme

17、d by a repeat of any of the above methods on a different day.25WHO diabetes diagnostic criteria (1999)Condition 靜脈血漿葡萄糖FPG2h PGNormal 6.1mmol/L7.8mmol/LImpaired fasting glycaemia (IFG)6.1- 7.0mmol/L7.8mmol/LImpaired glucose tolerance (IGT)7.0mmol/L7.8- 11.1mmol/LDiabetes mellitus (DM)7.0mmol/L11.1mm

18、ol/LThe American Diabetes Association since 2003 uses a slightly different range for impaired fasting glucose of 5.6 to 6.9 mmol/l.26HbA1cuThe hemoglobin A1c or glycosylated hemoglobin reflects average glucoses over the preceding 2-3 months. uNormal: 3.2%-6.4%272.1 Physiological function evaluationu

19、Target organ damage evaluationretinaperipheral nerveheartbrainrenalfoot282. Rehabilitation evaluationu2.1 Physiological function evaluationu2.2 Psychological status evaluationu2.3 ADL evaluation292.2 Psychological status evaluationuHamilton anxiety scale (HAMA)uHamilton depression scale (HAMD)uBrief

20、 Psychiatric Rating Scale (BPRS)uSymptom Check-List90 (SCL-90)302. Rehabilitation evaluationu2.1 Physiological function evaluationu2.2 Psychological status evaluationu2.3 ADL evaluation312.3 ADL evaluationuBarthel index of ADLuFAQ32Diabetes Mellitus Rehabilitationu1. Overviewu2. Rehabilitation evalu

21、ationu3. Rehabilitation treatmentu4. Diabetic foot Rehabilitationu5. Summaryu6. Review questions333. Rehabilitation treatmentu3.1 Overviewu3.2 Dietary treatmentu3.3 Exercise treatmentu3.4 Medicationu3.5 Diabetes educationu3.6 Self-monitoring of blood glucose343.1 OverviewuIDFDietary treatmentExercis

22、e treatmentMedicationDiabetes educationSelf-monitoring of blood glucoseuPsychological treatmentusurgery353. Rehabilitation treatmentu3.1 Overviewu3.2 Dietary treatmentu3.3 Exercise treatmentu3.4 Medicationu3.5 Diabetes educationu3.6 Self-monitoring of blood glucose363.2 Dietary treatment1. To calcul

23、ate total caloriesuCalculate Ideal weightIdeal weight (kg)=height (cm)-105uCalculate total calories per dayResting state: 25-30kcal per kg daily Light manual labor: 30-35kcal per kg dailyModerate physical labor: 35-40kcal per kg daily Heavy manual labor: more than 40kcal per kg daily37e.g.38體形休息 (千卡

24、/公斤體重)輕體力(千卡/公斤體重)中體力(千卡/公斤體重)重體力(千卡/公斤體重)肥胖/超重20-2525-3030-3535-40正常25-3030-3535-4040以上消瘦30-3535-4040-4545-503940413.2 Dietary treatment2. Nutrient contentuCarbohydrate: 50%-60% of total caloriesuFat: 0.6-1.0g per kg daily, 30% of total calories, polyunsaturated fatuProtein: 0.8-1.2g per kg daily,1

25、5% of total caloriesuOther: dietary fiber14g/kcal daily, salt15.0mmol/L or with tendency of severe hypoglycemia; infection; heart failure or cardiac arrhythmia; severe diabetic nephropathy; severe diabetic retinopathy; severe diabetic foot; recently occurred thrombus.503.3 Exercise treatment3. Exerc

26、ise prescriptionuType of exercise: Light-Moderate Intensity aerobic exercisewalking, running, swimminglow resistance power bicycle training513.3 Exercise treatment3. Exercise prescriptionuType of exerciseType 1 DM-swimming, rope skippingWith diabetic peripheral neuropathy-swimming, upper limb moveme

27、nt, low resistance power bicycle training Diabetic patients with sores of lower limb-upper limb movementWith diabetic retinopathy-walking, low resistance power bicycle trainingElderly diabetic patients-brisk walking, Tai chi chuan523.3 Exercise treatment3. Exercise prescriptionuIntensity of exercise

28、THR=220-age*(60%-80%) 53e.g.545556573.3 Exercise treatment3. Exercise prescriptionuDuration of exerciseinclude 3 phases: Warm-up, Conditioning, and Cool-down.40min, 20-30min(THR)30-60min after mealuFrequency of exercise: 3-4 times per week or 7 times per week4. The cautions of exercise583. Rehabilit

29、ation treatmentu3.1 Overviewu3.2 Dietary treatmentu3.3 Exercise treatmentu3.4 Medicationu3.5 Diabetes educationu3.6 Self-monitoring of blood glucose59Diabetes Mellitus Rehabilitationu1. Overviewu2. Rehabilitation evaluationu3. Rehabilitation treatmentu4. Diabetic foot Rehabilitationu5. Summaryu6. Re

30、view questions604. Diabetic foot RehabilitationuDefinition: A diabetic foot is a foot that exhibits any pathology that results directly from diabetes mellitus or any long-term (or chronic) complication of diabetes mellitus. Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome.uConsequences: foot