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.

Types-

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)

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 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

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-

  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-
TypeFrequencyIntensityTimetype
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

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)