Pharmacological management of Diabetes Mellitus

Background

Diabetes mellitus is a disease characterized by the inability of peripheral tissues to uptake glucose, caused by a deficit in insulin or insulin intolerance. This disease is subdivided into two categories, type 1 and type 2. Type 1 diabetes pertains to autoimmune destruction of pancreatic beta cells leading to the inability to produce sufficient amounts of insulin. Type 2 diabetes occurs when insulin receptors are unresponsive or less sensitive to insulin. Regardless of underlying pathology, both result in lower uptake of glucose in cells and high arterial glucose levels (hyperglycemia).[1]

PT Relevance

Physical therapists play a crucial role in the treatment of those with diabetes and complications caused by the disease. According to the World Health Organization (WHO), 422 million Americans are living with diabetes and it will be the seventh leading cause of death by 2030[2]. With this kind of prevalence, encountering patients with diabetes is imminent, bolstering the importance of therapists to understand the disease, medications commonly used, and possible adverse effects. Having a clear understanding will allow physical therapists to identify medical emergencies, better manage treatment sessions, properly educate patients, and refer to the proper healthcare provider when warranted.

Listed below are commonly used medications in the treatment of diabetes mellitus and their implications:

Insulin

Pramlintide

Metformin

Sulfonylureas

Conclusion

The treatment of diabetes is dictated by the specific pathophysiology of the diagnosis. Regardless of the specific etiology, it is imperative for a physical therapist to be aware of the intended effects, as well as possible side effects such as 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.

References

  1. Diagnosis and Classification of Diabetes Mellitus. (2014, January 01). American Diabetes Association, 37, 581-590.
  2. Diabetes. (2017, November 15). Retrieved from World Health Organization : http://www.who.int/news-room/fact-sheets/detail/diabetes