Diabetes Mellitus is a group of metabolic disorders characterized by raised blood glucose level i.e hyperglycemia due to impaired insulin secretion, insulin action or both.

EPIDEMIOLOGY AND TYPES

TYPES

Type 1 Diabetes Mellitus ( β-cell destruction, usually leading to absolute insulin deficiency )

Type 2 Diabetes Mellitus ( ranging from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance)

Gestational Diabetes

Other Types Include
MODY
LADA
Secondary Diabetes Mellitus

CAUSES

Obesity, Being Overweight, Sedentary Lifestyle and Lack of physical activity

Genetic Factors

Environmental Factors

Cushing Syndrome

Acromegaly

Hyperthyroidism

Cystic Fibrosis

Haemachromatosis

Pancreatitis

Pancreatic Cancer

Certain Medications like Diuretics, Niacin, Pentamidine, Glucocorticoids, Anti-Seizure drugs etc

CLINICAL FEATURES

increased thirst and urination

increased hunger

fatigue

blurred vision

numbness or tingling in the feet or hands

sores that do not heal

unexplained weight loss

DIAGNOSIS

Test For Type 1 and Type 2 Diabetes Mellitus

Random blood sugar test. A blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) or higher suggests diabetes.

Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL is normal. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. If it’s 126 mg/dL or higher on two separate tests, confirms diabetes.

Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours.

A blood sugar level less than 140 mg/dL is normal. A reading of more than 200 mg/dL after two hours indicates diabetes. A reading between 140 and 199 mg/dL indicates prediabetes.

Glycated hemoglobin (A1C) test. This blood test, which doesn’t require fasting, indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells.

The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal

MANAGEMENT

For type 1 intramuscular insulin is needed.

For type 2 oral hyperglycemic drugs like
Metformin and Sulfonylureas. Insulin sensitizers such as Rosiglitazone and Pioglitazone are also prescribed.

Other Includes Weight Management, Lifestyle Modifications etc

Physiotherapy includes Exercise Therapy following six exercise have found to be very helpful in diabetes

Walking

Tai-Chi

Weight training

Yoga

Stationary Bicycling

Swimming

Guidelines For Proper Exercise Regime includes

Do not exercise if the blood glucose level is less than 100 mg/dl or greater than 250 mg/dl.

Exercise indoor instead of outdoor to minimize the risk of integumentary and musculoskeletal trauma, as well as for the patient to have an immediate access to necessary things to address hypoglycemia, hyperglycemia or diabetic ketoacidocis.

Always have a carbohydrate snack at hand every exercise session. A glass of orange juice or milk is a good pickup for a patient who is experiencing hypoglycemia.

Exercise in a comfortable temperature. Never exercise in extreme temperatures.

For Type 1 patients, never exercise during the peak times of insulin.

Type 2 diabetics are advised to have an average of 30 minutes of exercise duration per session.

Type 1 diabetics may need to reduce insulin or increase food intake prior to the start of an exercise program.

During prolonged exercise duration, a 10-15 grams of carbohydrate snack is recommended for every 30 minutes.

Patients who are on Sulfonylureas are red flags because it can cause exercise-induced hypoglycemia.

Menstruating women need to increase insulin during menses, especially if they’re not active.

There should be no short-acting insulin injections close to the muscles to be exercised within one hour of exercise.

Patients should eat 2 hours before exercising.

Proper Blood Glucose monitoring should be conducted.

Patients are advised to drink 0.5 l of fluid before exercise.

If blood glucose is less than 100 mg/dl but not less than 70mg/dl, the physical therapist may provide carbohydrate snack and then recheck the glucose level after 15 minutes.