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-
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.
Types-
DM is better understood by its classification-
There are 2 main commonly seen types-
- Type 1 DM (insulin-dependent DM) [5-10%]
- Type 1a (autoimmune)
- Type 1b (idiopathic)
- Type 2 DM ( non-insulin dependent DM)[90%]
Other types are-
- Gestational diabetes
- 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)
Pathogenesis-
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
Investigation-
Plasma-Glucose level
Sample type | Normal value | Diabetes mellitus |
Fasting (> 8 hour) | Below 100 mg/dl | 126 mg/dl or more |
Random | <140 mg/dl | 200 mg/dl or more |
2 hour after glucose intake of 75 Gm in water | <140 mg/dl | 200 mg/dl or more |
Management-
- 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-
- Insulin injections- Humalog, Novorapid, Lantus etc.
- Continuous subcutaneous insulin infusion device (CSIID) or insulin pump
- Insulin analogue- Insulin lispro, Insulin aspart, Insulin glargine.
Type 2-
- Oral hypoglycemic drugs-
- Enhance insulin secretion-
- Sulfonylureas
- Glucagon-like peptide-1(GLP-1) receptor agonists
- Dipeptidyl peptidase-4 (DPP-4)
- Overcome insulin resistance-
- Metformin
- Thiazolidinediones
- 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 | Frequency | Intensity | Time | type |
Type 1 | 3 D vigorous or 5D moderate | Moderate (11-12 RPE) to vigorous (14-17 RPE) | If moderate intensity at least 150 min/wkIf vigorous 60 min/wk | Walk, jog, cycle, row, swim, aquatic activities, seated exercises, team sports |
Type 2 | 7 D/week (no more than 2 days should lapse between bouts of activity | Moderate (11-12 RPE) to vigorous (14-17 RPE) | At least 150 min/wk of moderate to vigorous intensity | Walk, jog, cycle, row, swim, aquatic activities, seated exercises, team sports |
Reference-
- 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)