Pharmacological Management of Diabetes Mellitus

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

Introduction

Insulin pen

Diabetes (a chronic disease) can be managed effectively with lifestyle modifications (eg weight reduction, diet and exercise) and use of pharmacological agents.

Having an understanding of these medicines will allow physical therapists to identify medical emergencies, manage treatment sessions, educate patients, and refer to the proper healthcare provider when warranted.

Commonly Used Medications

1. Insulin is a hormone made by beta cells in the pancreas. When we eat, insulin is released into the blood stream where it helps to move glucose from the food we have eaten into cells to be used as energy. With type 1 diabetes, the body produces little or no insulin as the cells that produce insulin have been destroyed by an autoimmune reaction in the body. Insulin replacement by daily injections is required. With type 2 diabetes the body produces insulin but the insulin does not work as well as it should (referred to as insulin resistance). To compensate the body makes more but eventually cannot make enough to keep the balance right. Lifestyle changes can delay the need for tablets and/or insulin to stabilise blood glucose levels. When insulin is required, it is important to understand that this is just the natural progression of the condition.
2. Pramlintide a synthetic amylin analog that is an injectable drug used with insulin to reduce blood sugar levels in patients with type 1 and type 2 diabetes.
3. Metformin is used together alongside diet to lower high blood sugar levels in patients with type 2 diabetes. Metformin has various actions, being, lowers the amount of glucose absorbed from intestines, decreases how much glucose is made in the liver and improves insulin sensitivity.
4. Sulfonylureas are a type of medicine used in the management of Type 2 diabetes. They work by stimulating beta cells of the pancreas to produce insulin hence lowering blood glucose levels. Their action is needs person to have functioning Beta cells, therefore, only work in people with type 2 diabetes.

Conclusion

Physical therapist need to be aware of the intended effects, as well as possible side effects of medications for diabetes, 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.