Diabetes Mellitus

A group of metabolic disorders resulting in hyperglycemia is called diabetes mellitus

 (DM), where relative or absolute deficiency of insulin is seen.

Functional anatomy and Physiology-

Fig- Biosynthesis, release and actions of insulin

Blood glucose is tightly regulated by DM, so a balance is preserved between entry, circulation, absorption and uptake by peripheral tissues.

Insulin is an anabolic hormone with profound effects on the metabolism of carbohydrate, fat and protein.


DM is better understood by its classification-

There are 2 main commonly seen types-

  1. Type 1 DM (insulin-dependent DM) [5-10%]
  • Type 1a (autoimmune)
  • Type 1b (idiopathic)
  1. Type 2 DM ( non-insulin dependent DM)[90%]

Other types are-

  1. Gestational diabetes
  2. Others-
  • Maturity onset diabetes of young (MODY)- genetic defect
  • Defect in insulin action ( type A insulin resistance)
  • Endocrinopathies (Cushing’s syndrome, glucagonoma, pheochromocytoma, acromegaly, thyrotoxicosis)
  • Diseases of exocrine pancreas (chronic pancreatitis, cystic fibrosis, hemochromatosis)
  • Drug induced (nicotinic acid, glucocorticoids,thiazides, protease inhibitor)
  • Associated with genetic syndromes ( Down’s syndrome, Klinefelter’s syndrome)
  • Infection induced ( congenital rubella, mumps, Coxsackievirus B) 
  • Uncommon forms of immune mediated DM (stiff-man syndrome, anti-insulin receptor antibodies)


Common pathology-

  • Reduced insulin secretion
  • Decreased glucose use by the body
  • Increased glucose production

Clinical features-

Common features of hyperglycemia-

  • Thirst and dry mouth
  • Polyuria and nocturia
  • Tiredness, fatigue and lethargy
  • Weight loss
  • Blurry vision
  • Genital candidiasis
  • Nausea, headache
  • Predilection of sweet food
  • Irritability, difficulty in concentration, apathy etc.

Contrasting features of type 1 and type 2 DM


Plasma-Glucose level

Sample typeNormal valueDiabetes mellitus
Fasting (> 8 hour)Below 100 mg/dl126 mg/dl or more 
Random<140 mg/dl200 mg/dl or more
2 hour after glucose intake of 75 Gm in water<140 mg/dl200 mg/dl or more


  • Lifestyle modification adaptation to fit and healthier habits like regular exercise and weight loss is important to control diabetes.
  • Dietary modification to control sugar and cholesterol intake and maintain blood sugar level.
  • Regular sugar level monitor.
  • Pharmacological management-

Type 1-

  1. Insulin injections- Humalog, Novorapid, Lantus etc.
  2. Continuous subcutaneous insulin infusion device (CSIID) or insulin pump
  3. Insulin analogue- Insulin lispro, Insulin aspart, Insulin glargine.

Type 2-

  1. Oral hypoglycemic drugs-
  • Enhance insulin secretion-
  1. Sulfonylureas
  2.  Glucagon-like peptide-1(GLP-1) receptor agonists
  3. Dipeptidyl peptidase-4 (DPP-4)
  • Overcome insulin resistance-
  1. Metformin
  2. Thiazolidinediones
  3. Others ( SGLT-2 inhibitor; alpha-Glucosidase inhibitor)

2. Insulin injection

  • Physiotherapy management-

A physical therapist can help diabetic patients in living a healthy life, regular physical activity promotes glycemic control and enhances insulin

action thus promotes weight loss, management of sores, management of diabetic nephropathy.

  • Regular physical activities help prevent or delay diabetes and its complications.
  • Exercise recommendation according to fitt principle-
Type 13 D vigorous or 5D moderateModerate (11-12 RPE) to vigorous (14-17 RPE)If moderate intensity at least 150 min/wkIf vigorous 60 min/wkWalk, jog, cycle, row, swim, aquatic activities, seated exercises, team sports
Type 27 D/week (no more than 2 days should lapse between bouts of activityModerate (11-12 RPE) to vigorous (14-17 RPE)At least 150 min/wk of moderate to vigorous intensityWalk, jog, cycle, row, swim, aquatic activities, seated exercises, team sports


  • Jennifer A. Pryor and Barbara A. Webber ( Physiotherapy for respiratory and cardiac problems)
  • Praveen Kumar and Michael Clark ( Clinical medicine)
  • Nicki R. Colledge, Brian R. Walker and Stuart H. Ralston ( Davidson’s principles and practice of medicine )
  •  J. Larry jamson, Anthony S. Fauci, Dennis L. Casper, Stephen L. Hauser, Dan L. Longo and Joseph Loscalzo (Harrison’s manual of medicine)
  • Lee Goldman and Andrew I. Schafer ( Goldman – Cecil medicine)
  • Wolters Kluwer ( American college of sports medicine’s exercise testing and prescription)