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Writer's picturePhysical Therapy International Service
Jan 25 min read

Diabetes

Authors: Jenna Little and Ella Bonner




Diabetes Mellitus is a common comorbidity in the United States and has a negative affect on the physical, mental, and emotional wellbeing of millions of individuals each year. There are two main types of diabetes, Type 1 and Type 2 diabetes. Type 1 diabetes is when the body cannot make insulin, an important hormone responsible for lowering blood glucose levels, or makes very little. This occurs because the individual's immune system kills the cells that live in the pancreas, which is responsible for the production of insulin. Type 2 diabetes is when the body is resistant to the insulin’s action making it hard to control blood glucose levels. This type of diabetes happens over time and is most commonly found in adults compared to other groups. Type 2 diabetes also affects more Americans, with about 37 million people impacted, while type 1 diabetes affects about 1.3 million people. While those with Type 1 diabetes must take insulin, it depends on other factors for those with type 2 diabetes.


There are many factors that could increase one’s risk of developing diabetes such as genetic, environmental, and lifestyle considerations. For Type 1, the risk factors are mostly related to genetics but environmental conditions can have an effect as well. The environmental factors includes exposure to viruses, nitirites and nitrates, gluten, too early of a consumption of cow’s milk prior to human breast milk, vaccinations, and drastically different environments that can start an autoimmune response leading to diabetes. Alternatively, risk factors for Type 2 diabetes typically show up in adulthood as environmental factors. Although, with the rise of obesity, especially in the United States, Type 2 is starting to show up earlier in one’s life than ever before. Risk factors for Type 2 includes high serum acid from the breakdown of some components of food, sleep quality and quantity, increased nicotine levels from smoking, depression disorder, increased blood pressure, cardiovascular disorders, abnormal levels of lipids and cholesterol, normal aging, ethnicity, and family history.


According to the International Diabetes Foundation (IDF), 540 million people globally are impacted by diabetes. This is 10.5% of the world's population between ages 20-79. Globally, over 90% of individuals have type 2 diabetes, making those with type 1 diabetes the minority. According to the CDC, 90-95% of Americans with diabetes have type 2 diabetes, and 5% of Americans have type 1. These statistics are significant and must be taken into consideration for individual’s own health and for health providers treating patients. 


Since diabetes is an internal system malfunction, it can be difficult to assess for this condition since it can mimic other disorders closely. To see if someone has abnormalities within their pancreas or with their insulin levels, there are three basic tests doctors can use to assess for diabetes. These tests include the Hemoglobin A1C test, a fasting plasma glucose test, and a two-hour glucose test. These three can be used for both types of diabetes and can give the provider an idea on how the body is physiologically responding to glucose levels. 


If an individual has Type 1 diabetes, they must take insulin because their pancreas cannot produce it on its own. This requires taking insulin multiple times throughout the day with food and drink. There different options whe it comes to the intake of insulin. Inidviduals can use a needle and syringe, insulin pen, insulin pump, or even an artificial pancreas. An artificial pancreas mimics a healthy pancreas and is able to control blood glucose levels for the person. Individuals can also take medicine to control their blood sugar levels as well which can either slow the digestion of food and drink through the stomach or manage the speed and/or heights of blood glucose levels after eating. 


If someone has type 2 diabetes, they should make changes in their lifestyle to maintain their blood glucose levels. This includes eating healthy meals and drinking enough to hydrate their body, limit caloric intake to control weight, and ensure they are partaking in appropriate and recommended amounts of physical activity. Those with Type 2 diabetes are often prescribed medication such as diabetic pills or injectable medication such as insulin. Other types of injected medications may help, like glucagon, which increases blood glucose levels and helps you feel less hungry to lose weight. 


While these are the most common options for diabetes management, they may not work for every individual. If these options are not helpful, other treatments may be more beneficial such as weight loss surgery for both Type 1 and 2 diabetes and pancreatic islet transplantation for Type 1 diabetes. Weight loss surgery can be helpful for obese individuals with Type 2 diabetes since losing weight will help control blood glucose levels and keep them in a healthy range. Pancreatic islet transplantation is helpful for individuals with Type 1 diabetes who have problems maintaining healthy blood glucose levels. Because Type 1 diabetes destroys pancreatic islets, this procedure can replace the destroyed islet cells to produce and release insulin. 


Physical therapists play a significant role when it comes to diabetes which includes advocacy for daily physical activity and body movement. This can be for treatment and management of diabetes or prevetative to lower the risk of obtaining it. A physical therapist can help with the management of the disease by prescribing specific exercises and giving recommendations for physical activity to help with symptom management and to improve the individual’s quality of life. Individuals with the disease can sometimes obtain complications in their muscles, peripheral nerves, vasculature and bones most commonly in their distal extremities such as their hands and feet. Issues like balance, proprioception, and sensation can be distorted impacting their function in their daily life. If this happens, a physical therapist can help the individual modify movement to manage the complications and ensure the patient is still getting daily movement in. Additionally, while a patient is attending their physical therapy appointments, the therapist can do screenings to watch the potential diabetes risk factors and monitor symptoms associated to refer out as needed to their providers such as a primary care physician (PCP), endocrinologist or podiatrist. 


Diabetes is a common but potentially devastating disease that can show up at any stage of life. While those with type 1 diabetes rely on insulin to manage their blood sugar, those with type 2 diabetes control their condition through medical management and lifestyle changes. Despite the differences between the two different types, there are some overlapping risk factors, tests, and treatment options for the disease. Physical activity is essential in managing blood glucose levels and reducing risks for issues like cardiovascular disease or diabetic neuropathy. Physical therapy can play an important role, especially with the advocacy of daily movement and management of symptoms and function. With the proper care, medical management and intervention, and lifestyle changes those with diabetes can live healthy and happy lives.







Resources: 

Ismail L, Materwala H, Al Kaabi J. Association of risk factors with type 2 diabetes: A systematic review. Comput Struct Biotechnol J. 2021 Mar 10;19:1759-1785. doi: 10.1016/j.csbj.2021.03.003. PMID: 33897980; PMCID: PMC8050730. https://pmc.ncbi.nlm.nih.gov/articles/PMC8050730/ 


Sonia Butalia, Gilaad G. Kaplan, Bushra Khokhar, Doreen M. Rabi,

Environmental Risk Factors and Type 1 Diabetes: Past, Present, and Future,

Canadian Journal of Diabetes, Volume 40, Issue 6, 2016, Pages 586-593,

ISSN 1499-2671 


Duong KNC, Tan CJ, Rattanasiri S, Thakkinstian A, Anothaisintawee T, Chaiyakunapruk N. Comparison of diagnostic accuracy for diabetes diagnosis: A systematic review and network meta-analysis. Front Med (Lausanne). 2023 Jan 24;10:1016381. doi: 10.3389/fmed.2023.1016381. PMID: 36760402; PMCID: PMC9902703. 


Harris-Hayes M, Schootman M, Schootman JC, Hastings MK. The Role of Physical Therapists in Fighting the Type 2 Diabetes Epidemic. J Orthop Sports Phys Ther. 2020 Jan;50(1):5-16. doi: 10.2519/jospt.2020.9154. Epub 2019 Nov 28. PMID: 31775555; PMCID: PMC7069691. 

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