Diabetes

Background

  • Diabetes is a disease in which blood glucose (sugar) levels are above normal
  • Most of the food we eat is broken down into glucose and stored for energy
  • The pancreas (organ), makes a hormone called insulin that helps glucose get into the cells of our body
    • With diabetes, your body either does not make enough insulin or it cannot use its own insulin as well as it should
      • This causes sugar to build up in your blood
  • Diabetes can cause serious health complications including:
    • Heart disease, blindness, kidney failure, and lower extremity amputations
  • Diabetes is the 7th leading cause of death in the U.S

Symptoms

  • A physician needs to give a diagnosis of diabetes
  • Common symptoms include:
    • Frequent urination, excessive thirst, unexplained weight loss, extreme hunger, sudden vision changes, tingling or numbness in hands or feet, feeling very tired most of the time, very dry skin, sores that are slow to heal, more infections than usual, and others
  • A person may have some or none of these symptoms

Types of Diabetes

Type 1 Diabetes (previously called insulin dependent orjuvenile onset diabetes mellitus)

  • So/o-10% of all diagnosed cases of diabetes
  • Autoimmune disease
    • When the immune system turns against a part of the body
    • In diabetes, the immune system attacks and destroys the insulin­ produced beta cells in the pancreas
      • The pancreas then produces little to no insulin
  • A person with type 1 diabetes must take insulin daily to live
  • Currently, it is unknown as to why this occurs
  • It develops most often in children and young adults but can appear at any age

Type 2 Diabetes (previously called non insulindependent or adult onset diabetes mellitus)

  • 90-95% of all diagnosed cased of diabetes
  • Often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and certain ethnicities
  • Type 2 diabetes is increasingly being diagnosed in children and adolescents, especially among African American, Mexican American, and Pacific Islander youth
  • When diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively (insulin resistance)
    • After several years, insulin production decreases
    • The result is the same as for type 1 where glucose builds up in the body, but the body cannot make efficient use of it for energy
  • Symptoms of type 2 diabetes are not as sudden as type 1
    • Some symptoms include: fatigue, frequent urination, increased thirst or hunger, weight loss, blurred vision, and slow healing of wounds/ sores
      • Some people have no symptoms
  • There are other less common forms of Diabetes Mellitus not mentioned here

Risk Factors

  • Type 1 diabetes risk factors are less well defined than type 2 diabetes
    • Autoimmune, genetic, and environmental factors seem to be involved
  • Type 2 diabetes risk factors include:
    • Older age, obesity, family history of diabetes, prior history of gestation diabetes, impaired glucose tolerance, physical inactivity, and race/ ethnicity
      • African Americans and some Asian Americans and Pacific Islanders are at a higher risk for type 2 diabetes

Diagnosed and Undiagnosed  Diabetes Among People Aged 20 Years or Older, U.S., 2010

Group

Number or % who have Diabetes

Age 20 years

25.6 million or 11.3% of all people in this age group

Age 65 years

10.9 million or 26.9% of all

people in this age group

Men

13 million or 11.8% of all men

aged 20 years or older

Women

12.6 million or 10.8% of all women aged 20 years or older

Non-Hispanic White

15.7 million or 10.2% of all non-Hispanic whites aged 20 years or older

Non-Hispanic Blacks

4.9 mllion or 18.7% of all non-Hispanic blacks aged 20 years or older

Treatment

  • Basic treatment for type 1 diabetes include healthy eating, physical activity, and insulin injections
    • Insulin taken needs to balanced with food intake and daily activities
    • Blood glucose levels must be closely monitored through frequent blood glucose testing
  • Basic treatment for type 2 diabetes include healthy eating, physical activity, and blood glucose testing
    • In addition, many require oral medication, insulin, or both to control blood glucose levels
  • People with diabetes take control of their day to day care to keep levels from getting to low to too high
  • Diabetic patients should see physical therapists for an individualized exercise plan , a physician to help manage their medication and blood glucose levels, endocrinol ogists who may specialize in diabetes care, ophthalmo logists for eye examinations, podiatri sts for routine foot care and dieticians for nutrition management

Exercise

  • Physical activ ity can help control blood glucose (sugar), weight, blood pressure, and raise your "good" cholesterol while lowering your "bad " cholesterol
    • It can also help prevent heart and blood flow problems which reduces your risk for heart disease and nerv e problems (commons problems for diabetic patients)
  • Diabetic patients should exercise at a moderate intensity for at least 30 minutes for 5 or more days a week
    • Moderate exercise includes walking briskly, mowing the lawn, dancing, swimming or bicycling
  • It is important to exercise everyday 
    • Better to exercise 10-20 minutes a day rather than 1 hour a week
  • If you are not used to exercise then start off with a lower amount and each week increase the time
  • For an individualized exercise plan speak with your physical therapist
  • Strength training exercises as well as cardiovascular activity is important to help build your muscles
    • Stretching is helpful to prevent muscle soreness

Exercise Safety Considerations

  • Do not lift heavy weights if you have problems with blood pressure, blood vessels or your eyes
    • If you have diabetic wounds on your feet then seek alternative exercise routines such as bicycling (avoid impact exercise like running)
  • Exercise can lower your blood sugar levels so to prevent hypoglycemia:
    • Check your blood glucose before you exercise
      • If it is <100 then have a small snack and bring food or glucose tablets with you to exercise with just in case
    • Check your blood sugar levels after you exercise to see how the activity affected you
  • When you exercise your blood sugar levels can also increase!
  • Do not exercise if your blood sugar levels are >300 or >250
  • Wear comfortable cotton socks that fit you when you exercise
    • Check your feet for blisters, cuts, etc. after you exercise
  • Drink plenty of fluids during physical activity because your blood sugar levels can be affected by dehydration

References