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  • 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.


  • 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
  • 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


  • 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 ...

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