Pharmacological management of Diabetes Mellitus

Original Editor - Ashton Randolph Top Contributors - Ashton Randolph, Kim Jackson and Lucinda hampton

Introduction[edit | edit source]

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Diabetes mellitus is a disease characterized by the inability of peripheral tissues to uptake glucose, caused by a deficit in insulin or insulin intolerance. This disease is subdivided into two categories, type 1 and type 2.

  1. Type 1 diabetes pertains to autoimmune destruction of pancreatic beta cells leading to the inability to produce sufficient amounts of insulin.
  2. Type 2 diabetes occurs when insulin receptors are unresponsive or less sensitive to insulin.

Regardless of underlying pathology, both result in lower uptake of glucose in cells and high arterial glucose levels (hyperglycemia).[1]

Physical Therapy Relevance[edit | edit source]

Physical therapists play a crucial role in the treatment of those with diabetes and complications caused by the disease. According to the World Health Organization (WHO):

  • The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014
  • Prevalence has been rising more rapidly in low- and middle-income countries than in high-income countries[2]
  • It will be the seventh leading cause of death by 2030[3].
  • Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications[2].

With this kind of prevalence, encountering patients with diabetes is imminent, bolstering the importance of therapists to understand the disease, medications commonly used, and possible adverse effects. Having a clear understanding will allow physical therapists to identify medical emergencies, better manage treatment sessions, properly educate patients, and refer to the proper healthcare provider when warranted.

Commonly Used Medications[edit | edit source]

Insulin[edit | edit source]

Pramlintide[edit | edit source]

Metformin[edit | edit source]

Sulfonylureas[edit | edit source]

Conclusion[edit | edit source]

The treatment of diabetes is dictated by the specific pathophysiology of the diagnosis. Regardless of the specific etiology, it is imperative for a physical therapist to be aware of the intended effects, as well as possible side effects, eg hypoglycemia and ketoacidosis, that may be prevalent with certain medications.

  • Maintaining proper glucose levels can prevent sequelae of the disease, and can also impact the treatment session.
  • Physical therapists are in a unique position because of the amount of time we spend with patients, and it is imperative that we play a role in monitoring their well-being.

References[edit | edit source]

  1. Diagnosis and Classification of Diabetes Mellitus. (2014, January 01). American Diabetes Association, 37, 581-590.
  2. 2.0 2.1 WHO Diabetes Available:https://www.who.int/news-room/fact-sheets/detail/diabetes (accessed 24.9.2021)
  3. Diabetes. (2017, November 15). Retrieved from World Health Organization : http://www.who.int/news-room/fact-sheets/detail/diabetes