Diabetes

UNDERSTANDING
DIABETES MELLITUS
& ITS MANAGEMENT
-By Dr. Rima Jani PT

Introduction
• Diabetes is a disease that occurs when your blood glucose, also called
blood sugar, is too high.
• Blood glucose is your main source of energy and comes from the food
you eat.
• Diabetes is a chronic disease that occurs when the pancreas is no longer
able to make insulin, or when the body cannot make good use of the
insulin it produces.
Prepared by Dr. Rima Jani PT
2

Pathophysiology
• Pancreatic islets house three major cell types, each of which produces a
different endocrine product: Alpha cells (A cells) secrete the hormone
glucagon. Beta cells (B cells) produce insulin and are the most abundant of the
islet cells.
• Insulin is a hormone made by the pancreas, that acts like a key to let glucose
from the food we eat pass from the blood stream into the cells in the body to
produce energy.
•
3

Cont…
• All carbohydrate foods are broken down into glucose in the blood.
• Insulin helps glucose get into the cells.
• Not being able to produce insulin or use it effectively leads to raised glucose
levels in the blood (known as hyperglycemia).
• Over the long-term high glucose levels are associated with damage to the
body and failure of various organs and tissues
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5

Types of
Diabetes
Mellitus
• There are three main types of
diabetes –
• Type 1
• Type 2 and
• Gestational Diabetes.
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Type 1 Diabetes
• Type 1 diabetes can develop at any age, but occurs most
frequently in children and adolescents.Around 10% of all people
with diabetes have type 1 diabetes.
• In type 1 diabetes, body produces very little or no insulin, which
means that an individual needs daily insulin injections to
maintain blood glucose levels under control.
• It is caused by an autoimmune reaction where the body’s
defense system attacks the cells that produce insulin. As a
result, the body produces very little or no insulin.
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Risk Factors for Type 1
Diabetes
• Risk factors for type 1 diabetes are still being researched. However, having
a family member with type 1 diabetes slightly increases the risk of
developing the disease.
• Environmental factors and exposure to some viral infections have also
been linked to the risk of developing type 1 diabetes.
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Warning
Signs
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Symptoms of Type 1 Diabetes
• Polydipsia (Abnormally increased thirst)
• Dry mouth
• Sudden unexplained weight loss
• Polyuria (Frequent urination)
• Lack of energy, tiredness
• Increased Appetite
• Blurred vision
• Bedwetting
10

Diagnosis of Type 1 Diabetes
• Random blood sugar test.
• Primary screening test. A random blood sugar level of 200 (mg/dL), or
11.1 (mmol/L), or higher suggests diabetes.
• Glycated hemoglobin (A1C) test. An A1C level of 6.5 percent or
higher on two separate tests indicates diabetes.
• Fasting blood sugar test. A fasting blood sugar level of 126 mg/dL
(7.0 mmol/L) or higher suggests type 1 diabetes.
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Additional tests include:
• Blood tests to check for antibodies that are common in
type 1 diabetes
• Urine or blood tests to check for the presence of ketones,
which also suggests type 1 diabetes rather than type 2
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Complications
of Type1
Diabetes
• SHORTTERM COMPLICATIONS
• Hypoglycemia – too low blood sugar levels
• Ketoacidosis – which can occur if insulin doses are
missed or blood glucose levels become too high
• LONGTERM COMPLICATIONS
• Heart Disease
• Stroke
• Retinopathy
• Kidney Disease
• Neuropathy
13

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Insulin and
other
medications
• Type 1 diabetes needs lifelong
treatment with one or more types
of insulin to survive
15

Types of Insulin
• Rapid-acting insulin: starts working within 15 minutes.
• Short-acting insulin: starts working around 30 minutes after
injection.
• Intermediate-acting insulin: starts working within about one to
three hours and lasts 12 to 24 hours.
• Long- and ultra-long-acting insulin: may provide coverage for as
long as 14 to 40 hours.
16

Healthy
eating
• A healthy diet should regularly include foods that are high in
nutrition and low in fat and calories, such as:
• Vegetables
• Fruits
• Lean protein
• Whole grains
• Also need to count carbohydrates in foods so that you can use that information
when figuring out insulin doses.
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Physiotherapy
Management
• Although diet and exercise have a role to play
in type 1 diabetes management, they cannot
reverse the disease or eliminate the need for
insulin.
• According to the American Diabetes
Association (ADA), most adults with type 1
diabetes should aim to get at least 150
minutes of moderate- to vigorous-
intensity aerobic exercise per week.
• Examples include swimming, cycling, jogging,
walking, dancing, and playing team sports
such as basketball or soccer.
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Type1
Diabetes
Research
Researchers from around the globe
are looking for ways to improve
type 1 diabetes treatment and to
investigate possible cures.
Important research areas include:
• Artificial Pancreas
• Encapsulated Islet Cells
• DiabetesVaccines
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Combined insulin pumps/continuous glucose
monitors
• A device called a sensor-augmented pump combines an insulin pump
and a continuous glucose monitor with a sophisticated algorithm to
automatically deliver insulin when it's needed.The goal is to develop a
completely automatic "closed loop" system, called the artificial
pancreas.
• The research will likely be ongoing until a fully automated system is
available.
20

Type 1
Diabetes is
not the end of
hope
• One Famous personality with
type 1 diabetes is Pop-rock
sensation Nick Jonas…
• Source: https://www.diabetes.co.uk/
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• Type 2 diabetes is more common in adults and accounts for around 90%
of all diabetes cases. In this condition body does not make good use of the
insulin that it produces.
• It is generally characterized by insulin resistance, where the body does
not fully respond to insulin.
• Because insulin cannot work properly, blood glucose levels keep rising,
releasing more insulin.
Type 2 Diabetes
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• For some people with type 2 diabetes this can eventually exhaust the
pancreas, resulting in the body producing less and less insulin,
causing even higher blood sugar levels (hyperglycemia).
• The cornerstone of treatment is healthy lifestyle, including increased
physical activity and healthy diet.
• However, type 2 diabetes needs to be treated with oral drugs and/or
insulin to keep blood glucose levels under control.
Type 2 Diabetes
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Risk Factors
• Family history of diabetes
• Overweight
• Unhealthy diet
• Physical inactivity
• Increasing age
• High blood pressure
• Ethnicity
• Impaired glucose tolerance (IGT)*
• History of gestational diabetes
• Poor nutrition during pregnancy
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Symptoms of Type 2 Diabetes
• Excessive thirst and dry mouth
• Frequent urination
• Lack of energy, tiredness
• Slow healing wounds
• Recurrent infections in the skin
• Blurred vision
• Tingling or numbness in hands and feet.
• These symptoms can be mild or absent and so people with type 2 diabetes may live several years with the
condition before being diagnosed.
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Complications
of Type 2
Diabetes
• Short-term complications:
• Hypoglycemia
• Hyperosmolar hyperglycemic nonketotic
syndrome (HHNS), which is very high blood
glucose.
• Long-term complications:
• Diabetic Retinopathy
• Nephropathy (Kidney Disease)
• Diabetic Neuropathy
• Macrovascular problems
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Management of Type 2 Diabetes
Healthy lifestyle:
• Healthy diet
• Regular physical activity
• No smoking and
• No alcohol consumption
• Maintaining a healthy body weight.
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• Over time, a healthy lifestyle may not be enough to keep
blood glucose levels under control and people with type 2
diabetes may need to take oral medication. If treatment with
a single medication is not sufficient, combination therapy
options may be prescribed.
• When oral medication is not sufficient to control blood
glucose levels, people with type 2 diabetes may require
insulin injections.
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Medications
for type 2
diabetes
• Metformin: reduces insulin resistance and allows
the body to use its own insulin more effectively.
It is regarded as the first-line treatment for type
2 diabetes in most guidelines around the world.
• Sulfonylureas: stimulate the pancreas to
increase insulin production. Sulfonylureas
include gliclazide, glipizide, glimepiride,
tolbutamide & glibenclamide.
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Physiotherapy
Management
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• Before beginning any exercise program,
patient with DM should undergo detailed
evaluation
• A careful medical history, physical
examination should be done focusing on sign
and symptoms of disease affecting the heart,
blood vessels, eyes, kidneys and nervous
system.
Exercise
Prescription
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Exercises
• Check blood glucose BEFORE AND AFTER exercise :
• 100-150 mg/dL before
• >/= 110 mg/dL after
• Do NOT exercise if BGL is: < 100 mg/dL or > 250-300 mg/dL
• Optimal timing for exercise is 2-3 hours after meal (between peaks of
fast-acting and slower- acting components of insulin) Low to
moderate intensity is best to prevent abrupt changes in BGL
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Exercise
Protocol
• Aerobic Exercises
o Aim to get at least 30 minutes of cardio (aerobic)
exercise most days of the week.
• StrengthTraining
o Lifting weights for 20-30 minutes two or three times a
week is sufficient to get the full benefits of strength
training.
• FlexibilityTraining
o With flexibility training, you’ll improve how well your
muscles and joints work. Stretching before and after
exercise (especially after exercise) reduces muscle
soreness and actually relaxes your muscles.
35

Exercise Protocol
• Aerobic Exercise include:
• Tennis
• Dancing and Zumba
• Jogging/Running
• Walking
• Basketball
• Swimming
• Biking
• Brisk walking is best form of Aerobic exercises
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Dose:
• 150 min a week
• at least 30 minutes of cardio
• 3-5 days each week
• Moderate to vigorous intensity
• Include proper warm up and cool down
exercises

Exercise Protocol
• Resistance Exercise (strength
training):
• Done with free weights, resistance
bands, equipment or with body
weight.
• Target major muscles of UL, LL &
Trunk
37
Dose:
• 2 to 3 times a week
• 10-15 reps with 2-3 sets.
• Low to moderate intensity
• Include proper warm up and cool
down exercises

Resistance
Exercise
(strength
training):
• It is highly effective adjunct for
weight loss
• Only type of exercise offering
some protection against
sarcopenia and decreasing muscle
strength/physical function
occurring with age
38

Flexibility • Static stretches of muscles
• 20-30 sec hold
• 2-3 sets
• Yoga postures
39

Predictors for
acute glucose
response to
exercise
included:
• Pre-exercise glucose
• % age adjusted max HR
• Duration of exercise
• Minutes since eating
• Hgb A1c
• Age
40

Gestational
diabetes
• Gestational diabetes (GDM) is a type of
diabetes that consists of high blood glucose
during pregnancy and is associated with
complications to both mother and child.
• GDM usually disappears after pregnancy but
women affected and their children are at
increased risk of developing type 2 diabetes
later in life.
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Symptoms of
Gestational
Diabetes
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Complications
of Gestational
Diabetes
• Health complications for baby after
birth includes:
• Breathing problems, including respiratory
distress syndrome (also called RDS)
• Jaundice
• Low blood sugar (also called hypoglycemia)
• Obesity later in life.
• Diabetes later in life.
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Management
of
Gestational
Diabetes
• Careful meal planning to make sure
you get enough nutrients without
too much fat and calories
• Daily exercises like walking
• Keeping weight gain under control
• Taking insulin to control your blood
sugar levels, if needed.
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Patient Education
Exercise helps improve insulin sensitivity
It counteracts several negative outcomes of the disease process
• Atherosclerosis (change in lipid concentrations)
• Cardiovascular disease (improved CV function)
• Poor wound healing (boosting immune system)
• Neuropathy
Exercise can improve weight-control efforts.
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Remember that physical activity usually lowers blood sugar, and can affect
blood sugar levels for hours after exercise, possibly even overnight.
On beginning of a new activity, check blood sugar more often than usual
until you learn how the body reacts to the activity.
One might need to adjust meal plan or insulin doses to compensate for the
increased activity.
Timing of insulin and/or meds may be the most important self-controlled
factor
Patient Education
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Diabetes

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