Diabetes Mellitus
Introduction
Pathophysiology
Types of Diabetes Mellitus
Type 1, 2 and
gestational diabetes
rescent research in Type 1 diabetes
Risk factors and causes
Complications short term and long term of diabetes
Management
Treatment with Insulin
Diabetic drugs
Healthy Diet
Exercises prescription
aerobic exercises,
resistance exercises and
flexibility
2. 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
3. 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.
•
Prepared by Dr. Rima Jani PT
3
4. 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
Prepared by Dr. Rima Jani PT
4
6. Types of
Diabetes
Mellitus
• There are three main types of
diabetes –
• Type 1
• Type 2 and
• Gestational Diabetes.
Prepared by Dr. Rima Jani PT
6
7. 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.
Prepared by Dr. Rima Jani PT
7
8. 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.
Prepared by Dr. Rima Jani PT
8
10. 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
Prepared by Dr. Rima Jani PT
10
11. 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.
Prepared by Dr. Rima Jani PT
11
12. 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
Prepared by Dr. Rima Jani PT
12
13. 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
Prepared by Dr. Rima Jani PT
13
15. Insulin and
other
medications
• Type 1 diabetes needs lifelong
treatment with one or more types
of insulin to survive
Prepared by Dr. Rima Jani PT
15
16. 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.
Prepared by Dr. Rima Jani PT
16
17. 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.
Prepared by Dr. Rima Jani PT
17
18. 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.
Prepared by Dr. Rima Jani PT
18
19. 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
Prepared by Dr. Rima Jani PT
19
20. 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.
Prepared by Dr. Rima Jani PT
20
21. 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/
Prepared by Dr. Rima Jani PT
21
22. • 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
Prepared by Dr. Rima Jani PT
22
23. • 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
Prepared by Dr. Rima Jani PT
23
25. 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
Prepared by Dr. Rima Jani PT
25
27. 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.
Prepared by Dr. Rima Jani PT
27
28. 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
Prepared by Dr. Rima Jani PT
28
29. Management of Type 2 Diabetes
Healthy lifestyle:
• Healthy diet
• Regular physical activity
• No smoking and
• No alcohol consumption
• Maintaining a healthy body weight.
Prepared by Dr. Rima Jani PT
29
30. • 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.
Prepared by Dr. Rima Jani PT
30
31. 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.
Prepared by Dr. Rima Jani PT
31
33. • 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
Prepared by Dr. Rima Jani PT
33
34. 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
Prepared by Dr. Rima Jani PT
34
35. 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.
Prepared by Dr. Rima Jani PT
35
36. Exercise Protocol
• Aerobic Exercise include:
• Tennis
• Dancing and Zumba
• Jogging/Running
• Walking
• Basketball
• Swimming
• Biking
• Brisk walking is best form of Aerobic exercises
Prepared by Dr. Rima Jani PT
36
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
37. Exercise Protocol
• Resistance Exercise (strength
training):
• Done with free weights, resistance
bands, equipment or with body
weight.
• Target major muscles of UL, LL &
Trunk
Prepared by Dr. Rima Jani PT
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
38. 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
Prepared by Dr. Rima Jani PT
38
39. Flexibility • Static stretches of muscles
• 20-30 sec hold
• 2-3 sets
• Yoga postures
Prepared by Dr. Rima Jani PT
39
40. Predictors for
acute glucose
response to
exercise
included:
• Pre-exercise glucose
• % age adjusted max HR
• Duration of exercise
• Minutes since eating
• Hgb A1c
• Age
Prepared by Dr. Rima Jani PT
40
41. 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.
Prepared by Dr. Rima Jani PT
41
44. 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.
Prepared by Dr. Rima Jani PT
44
45. 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.
Prepared by Dr. Rima Jani PT
45
47. 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.
Prepared by Dr. Rima Jani PT
47
48. 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
Prepared by Dr. Rima Jani PT
48
Impaired glucose tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes.
The A1C test result reflects your average blood sugar level for the past two to three months. Specifically, the A1C test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated).
Impaired glucose tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes.