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Condition/Disorder Synonyms

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  • Juvenile diabetes

  • Diabetes type 1

  • Diabetes type 1.5

  • Diabetes type 2

  • Gestational diabetes

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ICD-9-CM Codes

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  • 250 Diabetes mellitus

  • 249.91 Secondary diabetes mellitus with unspecified complication, uncontrolled

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ICD-10-CM Codes

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  • E08.8 Diabetes mellitus due to underlying condition with unspecified complications

  • E09.8 Drug or chemical induced diabetes mellitus with unspecified complications

  • E08.65 Diabetes mellitus due to underlying condition with hyperglycemia

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Preferred Practice Patterns

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  • As of January 2013, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology. Therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.

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Key Features

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Description

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  • Diabetes mellitus

    • Primary diabetes mellitus

      • Type 1: Inability of the body to produce insulin, formerly referred to as juvenile diabetes

      • Type 1.5: Latent autoimmune diabetes in adults (LADA), signs of both type 1 and type 2 diabetes where the body can initially produce some insulin but ultimately cannot

      • Type 2: Insulin resistance; inability of the body to produce adequate insulin or inability for adequate insulin uptake by the body to sufficiently regulate insulin/glucose, some insulin is produced by the pancreas

      • Impaired glucose tolerance (IGT)

      • Gestational diabetes mellitus

    • Secondary diabetes mellitus

      • Destructive pancreatic disease

      • Endocrine diseases

      • Drug induced diabetes

      • Stress diabetes

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Essentials of Diagnosis

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  • Frequent urination

  • Unexplained weight loss; especially with Type 1

  • Excessive thirst

  • Increased hunger

  • Inappropriate sweating

  • Dizziness

  • Nausea

  • Decreased activity tolerance

  • Hyperosmolar Hyperglycemic Nonketotic Syndrome

    • Rare condition in which blood sugar is 600 mg/dl or above and can result in death; in those who may have diagnosed or undiagnosed diabetes can result in coma and death

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General Considerations

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  • May cause pathology in multiple organ systems

    • Kidney and urinary tract

    • GI: liver, pancreas

    • Cardiovascular: heart, peripheral circulation

    • Neuromuscular: neuropathy

    • Integumentary

    • Vision

    • Reproductive system

  • May result in secondary problems; such as aerobic capacity and muscle endurance impairment, sarcopenia, weakness/impaired muscle performance, musculoskeletal problems, neuromuscular problems, weight loss or weight gain—indicating the need for physical therapy intervention depending on severity

  • Increased incidence of tendonitis

  • Increased incidence of frozen shoulder

  • Exercise may cause hypoglycemia

  • Exercise may interfere with timed insulin uptake if performed in area of injection site soon after injecting

  • Metabolic syndrome: presence of

    • High blood pressure

    • High cholesterol

    • Belly fat

    • Elevated blood sugar

  • Hyperlipidemia

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Demographics

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  • Occurs in males and females

  • Higher incidence in African Americans and Hispanics

  • Type 2 is more common in individuals who are obese, and is on the rise in children secondary to sedentary lifestyle and obesity

  • During 2002 to 2005, 15,600 children were newly diagnosed with type 1 diabetes annually, and 3,600 youth were newly diagnosed with type 2 diabetes annually1

  • Among children younger than 10 years, the rate of new cases was 19.7 per 100,000 each ...

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