Pharmacological Management of Diabetes Mellitus

Original Editor - Ashton Randolph Top Contributors - Ashton Randolph, Lucinda hampton, Kim Jackson and Aminat Abolade

Introduction

Insulin pen

Diabetes (a chronic disease) can be managed effectively with lifestyle modifications (eg weight reduction, diet and exercise) and use of pharmacological agents.

Having an understanding of these medicines will allow physical therapists to identify medical emergencies, manage treatment sessions, educate patients, and refer to the proper healthcare provider when warranted.

Commonly Used Medications

1. Insulin is a hormone made by beta cells in the pancreas. When we eat, insulin is released into the blood stream where it helps to move glucose from the food we have eaten into cells to be used as energy. With type 1 diabetes, the body produces little or no insulin as the cells that produce insulin have been destroyed by an autoimmune reaction in the body. Insulin replacement by daily injections is required. With type 2 diabetes the body produces insulin but the insulin does not work as well as it should (referred to as insulin resistance). To compensate the body makes more but eventually cannot make enough to keep the balance right. Lifestyle changes can delay the need for tablets and/or insulin to stabilise blood glucose levels. When insulin is required, it is important to understand that this is just the natural progression of the condition.
2. Pramlintide is designed to be used in conjunction with insulin for patients who fail to control their glycemic levels with insulin alone. Pramlintide is similar in its structure and function to islet amyloid polypeptide (IAPP), which is a hormone secreted along with insulin by Beta cells located within the pancreas . The role of this hormone is to aid in controlling postprandial hyperglycemia, by suppressing glucagon secretion, reducing the rate of gastric emptying, and regulating food intake by sending satiety signals to the brain.
3. Metformin reduces blood glucose levels by decreasing glucose production in the liver, decreasing intestinal absorption, and increasing insulin sensitivity.Metformin decreases both basal and postprandial blood glucose. Metformin is considered weight neutral with the potential for modest weight loss. It is also unlikely to cause hypoglycemia and may be potentially cardioprotective.
4. Sulfonylureas is utilized in the treatment of type 2 diabetes mellitus when metformin is not sufficient. Sulfonylureas increase the release of insulin through the stimulation of pancreatic beta cells. Sulfonylureas, consequently, are a more potent medication in the earlier stages of type 2 diabetes when a patient has an increased pancreatic beta-cell function.

Conclusion

Physical therapist need to be aware of the intended effects, as well as possible side effects of medications for diabetes, eg 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.