Diabetes mellitus

• Juvenile diabetes
• Diabetes type 1
• Diabetes type 1.5
• Diabetes type 2
• Gestational diabetes

• 250 Diabetes mellitus
• 249.91 Secondary diabetes mellitus with unspecified complication, uncontrolled

• 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

• 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.

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• 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

Demographics

• 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 year for type 1 diabetes and 0.4 per 100,000 for type 2 diabetes. Among children ages 10 years or older, the rate of new ...