Diabetes Mellitus

• If you have diabetes, your body is not able to properly process and utilize glucose from the food you eat. There are different types of diabetes, each with different causes, yet they all share the common problem of having too much glucose in your bloodstream.
• Treatments involve medications and/or insulins. Certain types of diabetes can be cured by adopting a healthy lifestyle.

What is diabetes?

• Diabetes happens when your body is not able to take up sugar (glucose) in its cells and utilize it for energy. These outcomes in a build-up of over-sugar in your bloodstream.
• Mismanagement of diabetes can conduct to serious consequences, causing damage to a wide range of your body’s organs and tissues — involving your heart, kidneys, eyes, and nerves.

Why is my blood glucose level high? How does this happen?

• The process of digestion involves breaking down the food you eat into various different nutrient sources. When you ingest carbohydrates (for ex., bread, rice, pasta), your body breaks this down into sugar (glucose). When glucose is in your bloodstream, it needs to assist – a “key” – to get to its final destination where it is used, which is inside your body’s cells (cells make up your body’s tissues & organs). This assist or “key” is insulin.
• Insulin is a hormone created by your pancreas, an organ located beyond your stomach. Your pancreas releases insulin into your bloodstream. Insulin acts as the “key” that uncloses the cell wall “door,” which allows glucose to involve your body’s cells. Glucose produces the “fuel” or energy tissues and organs require to properly function.

If you have diabetes:

• Your pancreas does not create any insulin or enough insulin.
• Or
• Your pancreas makes insulin but your body’s cells do not respond to it and can not use it as they normally should.
• If glucose can not acquire into your body’s cells, it stays in your bloodstream, and your blood glucose level rises.

What are the different types of diabetes?

The types of diabetes are:

• Type 1 diabetes: This type is an autoimmune disease, explanation your body attacks itself. In this case, the insulin-processing cells in your pancreas are destroyed. Up to 10% of people who have diabetes have Type 1 diabetes. It is commonly diagnosed in children and young adults (but can develop at any age). It was once better called “juvenile” diabetes. People with Type 1 diabetes require to gain insulin every day. This is why it is known as insulin-dependent diabetes.
• Type 2 diabetes: With this type, your body either does not make enough insulin or your body’s cells do not respond normally to the insulin. This is the most usual type of diabetes. Up to 95% of people with diabetes have Type 2 diabetes. It commonly happens in middle-aged and older people. Other common names for Type 2 involve adult-onset diabetes and insulin-resistant diabetes. Your parents or grandparents may have known as it “having a touch of sugar.”
• Prediabetes: This type is the stage previous Type 2 diabetes. Your blood glucose levels are higher than normal yet not high enough to be officially diagnosed with Type 2 diabetes.
• Gestational diabetes: This type develops in certain women during their pregnancy. Gestational diabetes usually goes away later in pregnancy. However, if you have gestational diabetes you are at higher risk of developing Type 2 diabetes later on in life.

Less common types of diabetes involve:

• Monogenic diabetes syndromes: These are infrequent inherited forms of diabetes accounting for up to 4% of all cases. Ex. are neonatal diabetes & maturity-onset diabetes of the young.
• Cystic fibrosis-related diabetes: This is a form of diabetes personal to people with this disease.
• Drug or chemical-induced diabetes: Examples of this type occur after organ transplant, following HIV/AIDS treatment, or are associated with glucocorticoid steroid use.
• Diabetes insipidus is a distinct infrequent condition that causes your kidneys to produce a large amount of urine.

How common is diabetes?

• Certain 34.2 million people of all ages – about one in ten – have diabetes in the U.S. (United States) Certain 7.3 million adults aged 18 & older (about 1 in 5) are unaware that they have diabetes (just under 3% of all U.S. adults). The number of people who are diagnosed with diabetes improves with the age. More than 26% of adults age 65 & older (about 1 in 4) have diabetes.

Who gets diabetes? What are the risk factors?

• Factors that improve your risk vary depending on the type of diabetes you ultimately develop.

Risk factors for Type 1 diabetes involve:

• Having a family history (parent or sibling) of Type 1 diabetes mellitus,
• Injury to the pancreas (like by infection, tumor, surgery, or accident),
• Presence of the autoantibodies (antibodies that mistakenly attack your own body’s tissues or organs),
• Physical stress (such as surgery or illness),
• Exposure to illnesses caused by viruses.

Risk factors for prediabetes and Type 2 diabetes involve:

• Have a Family history (parent or sibling) of prediabetes or Type 2 diabetes mellitus.
• Being a Black, Hispanic, Native American, Asian-American race or Pacific Islander.
• Having overweight/obese.
• Having high blood pressure.
• Having low HDL cholesterol (the “good” cholesterol) and great triglyceride level.
• Being physically inactive.
• Being age 45 or older.
• Having gestational diabetes or giving birth to a baby weighing great than nine pounds.
• Having polycystic ovary syndrome.
• Having a history of heart disease (HD) or stroke.
• Being a smoker.

Risk factors for gestational diabetes involve:

• Have a Family history (parent or sibling) of prediabetes or Type 2 diabetes.
• Being African-American, Hispanic, Native American, or Asian-American.
• Having overweight/obese previous to your pregnancy.
• Being over 25 years of age.

What causes diabetes?

The cause of diabetes, regardless of the type, is having very much glucose circulating in your bloodstream. However, the reason why your blood glucose levels are high varies depending on the type of diabetes.

• Causes of Type 1 diabetes: This is an immune system condition. Your body attacks and shatters insulin-producing cells in your pancreas. Without insulin to allow glucose to come into your cells, glucose builds up in your bloodstream. Genes may play a role in certain patients. A virus may trigger an immune system attack.
• Cause of Type 2 diabetes and prediabetes: Your body’s cells do not allow insulin to work as it should to let glucose into its cells. Your body’s cells have enhanced resistance to insulin. Your pancreas can not keep up and make enough insulin to overcome this resistance. Glucose levels increase in your bloodstream.
• Gestational diabetes: Hormones produced by the placenta during your pregnancy create your body’s cells more resistant to insulin. Your pancreas can not make enough insulin to overcome this resistance. Too much glucose keeps in your bloodstream.

What are the symptoms of diabetes?

Symptoms of diabetes involve:

• Increased thirst
• Weak, tired feelings
• Blurred vision
• Numbness & tingling in the hands & feet
• Slow-healing sores or cuts
• Unplanned weight loss
• Frequent urination
• Frequent unexplained infections
• Dry mouth.

Other symptoms

• In women: Dry and itchy skin, and sometimes yeast infections or urinary tract infections.
• In men: Reduced sex drive, erectile dysfunction, decreased muscle strength.
• Type 1 diabetes symptoms: Symptoms can develop quickly – over certain weeks or months. Symptoms begin when you are young – as a child, teen, or young adult. Additional symptoms involve nausea, vomiting or stomach pains, and yeast infections or urinary tract infections (UTIs).
• Type 2 diabetes & prediabetes symptoms: You may not have any symptoms at all or may not notice them since they develop steadily over so many years. Symptoms usually begin to develop when you are an adult, yet prediabetes and Type 2 diabetes are on the rise in all age groups.
• Gestational diabetes: You commonly will not notice symptoms. Your obstetrician will test you for gestational diabetes betwixt 24 and 28 weeks of your pregnancy.

What are the complications of diabetes?

• If your blood glucose level remains high over a long period of time, your body’s tissues and organs can be seriously harmed. Certain complications can be life-threatening over time.

Complications involve:

• Cardiovascular issues involving coronary artery disease, chest pain, heart attack, stroke, high blood pressure, high cholesterol, and atherosclerosis (narrowing of the arteries).
• Nerve damage (neuropathy) causes numbing and tingling that begins at the toes or fingers and then spreads.
• Kidney damage (nephropathy) can conduct in kidney failure or the need for dialysis or a transplant.
• Eye damage (retinopathy) can conduct to blindness; cataracts, and glaucoma.
• Foot damage involving nerve damage, poor blood flow, and poor healing of cuts and sores.
• Skin infections.
• Erectile dysfunction.
• Hearing loss.
• Depression.
• Dementia.
• Dental problems.

Complications of gestational diabetes:

• In the mother: Preeclampsia (high blood pressure, excess protein in the urine, leg/feet swelling), risk of gestational diabetes during future pregnancies, and risk of diabetes after in life.
• In the newborn: Higher-than-normal birth weight, decrease blood sugar (hypoglycemia), higher risk of developing Type 2 diabetes over time, and death shortly later birth.

How is diabetes diagnosed?

Diabetes is diagnosed & managed by examing your glucose level in a blood test. There are three tests that can calculate your blood glucose level: a fasting glucose test, a random glucose test, and an A1c test.

• Fasting plasma glucose test: This test is best done in the morning later an eight-hour fast (nothing to eat or drink except sips of water).
• Random plasma glucose test: This test can be done at any time without the requirement to fast.
• A1c test: This test, also known as HbA1C or glycated hemoglobin test, supply your average blood glucose level over the past two to three months. This test calculates the amount of glucose attached to hemoglobin, the protein in your red blood cells that carries oxygen. You do not require to fast before this test.
• Oral glucose tolerance test: In this test, the blood glucose level is first measured later and overnight fast. Then you drink a sugary drink. Your blood glucose level is later checked at hours one, two, and three.

Gestational diabetes tests: There are 2 blood glucose tests if you are pregnant. With a glucose challenge test, you drink a sugary liquid & your glucose level is checked 1 hour after. You do not require to fast before this test. If this test shows a greater-than-normal level of glucose (over 140 ml/dL), an oral glucose tolerance test will follow (as described above).

Type 1 diabetes: If your healthcare provider (doctor) suspects Type 1 diabetes, blood & urine samples will be collected & tested. The blood is checked for autoantibodies (an autoimmune signal that your body is attacking itself). The urine is checked for the presence of ketones (a signal your body is burning fat as its energy supply). These signs specify Type 1 diabetes.

Who should be tested for diabetes?

• If you have symptoms & risk factors for diabetes, you should be acquire tested. The earlier diabetes is found, the earlier management can start and complications can be lessened or prevented. If a blood test determines you have prediabetes, you & your healthcare professional (doctor) can effort together to create lifestyle changes (e.g. weight loss, exercise, healthy diet) to cure or delay developing Type 2 diabetes.

Additional personal testing advice based on risk factors:

• Testing for Type 1 diabetes: Test in children & young adults who have a family history of diabetes. Less typically, older adults may also develop Type 1 diabetes. Therefore, testing in adults who come to the hospital and are created to be in diabetes-related ketoacidosis is main. Ketoacidosis is a dangerous complication that can happen in people with Type 1 diabetes.
• Testing for type 2 diabetes: Test adults age 45 or older, those between 19 and 44 who have overweight/obese and have 1 or more risk factors, women who have had gestational diabetes, children between 10 and 18 who are overweight/obese and have at least 2 risk factors for type 2 diabetes.
• Gestational diabetes: Test all the pregnant women who have had a diagnosis of diabetes. Test all pregnant women between weeks 24 & 28 of their pregnancy. If you have another risk factor for gestational diabetes, your obstetrician may test you before.

How is Diabetes Treated?

Diabetes harms your whole body. To best manage diabetes, you will need to take steps to manage your risk factors, including:

• Retain your blood glucose levels as near to normal as possible by following a diet plan, taking prescribed medication, and increasing your activity level.
• Maintain your blood cholesterol (HDL and LDL levels) and triglyceride levels as close to the normal ranges as possible.
• Manage your blood pressure (BP). Your blood pressure (BP) should not be over 140/90 mmHg.

You grasp the keys to managing your diabetes by:

• Planning what you eat & following a healthy meal plan. Follow the Mediterranean diet (vegetables, whole grains, beans, fruits, healthy fats, low sugar) or a Dash diet. These diets are high in nutrition and fiber and decrease fats and calories. See a registered dietitian for assist understanding nutrition and meal planning.
• Exercising regularly. Try to exercise for at least thirty minutes most days of the week. Walk, swim or find a certain activity you enjoy.
• Achieving a healthy weight. The effort with your healthcare team to create a weight-loss plan.
• Taking medication & insulin, if prescribed, & closely following recommendations on how & when to take it.
• Monitoring your blood glucose and blood pressure (BP) levels at home.
• Keeping your appointments with your healthcare providers (doctors) and having laboratory tests completed as ordered by your doctor.
• Quitting smoking (if you smoke).

How do I check my blood glucose level? Why is this important?

• Checking your blood glucose level is important because the results assist guide decisions about what to eat, your physical activity, and any needed medication & insulin adjustments or additions.
• The most usual way to examine your blood glucose level is with a blood glucose meter. With this test, you prick the side of your finger, put the drop of blood into a test strip, & insert the strip into the meter & the meter will look at your glucose level at that moment in time. Your healthcare provider (doctor) will tell you how often you will need to check your glucose level.

What is continuous glucose monitoring?

• Advancements in technology have given us another way to monitor glucose levels. Continuous glucose monitoring uses a small sensor inserted under your skin. You do not need to prick your finger. Instead, the sensor measures your glucose and can display outcomes anytime during the day or night. Ask your healthcare provider (doctor) about continuous glucose monitors to look if this is an option for you.

What should my blood glucose level be?

Tell your healthcare (doctor) team what your blood glucose level must be. They may have a personal target range for you. In general, though, most people try to retain their blood glucose levels at these targets:

• Previous meal: between 80 and 130 mg/dL.
• About two hours later the start of a meal: less than 180 mg/dL.

What happens if my blood glucose level decreases?

• Having a blood glucose level that is decreased than the normal range (usually below 70 mg/dL) is known as hypoglycemia. This is a signal that your body gives out that you require sugar.

Symptoms you might experience if you have hypoglycemia involve:

• Weakness or shaking
• Moist skin, sweating
• Fast heartbeat
• Dizziness
• Sudden hunger
• Confusion
• Pale skin
• Numbness in mouth or tongue
• Irritability, nervousness
• Unsteadiness
• Nightmares, bad dreams, restless sleep
• Blurred vision
• Headaches, seizures
• You might flock out if your hypoglycemia is not managed.

What occurs if my blood glucose level is high?

If you have very much glucose in your blood, you have a condition known as hyperglycemia. Hyperglycemia is defined as:

• A blood glucose level greater than 125 mg/dL while in the fasting state (nothing to eat or drink for at least eight hours).
• or
• A blood glucose level greater than 180 mg/dL one to two hours later eating.

How is diabetes treated?

Treatments for diabetes depend on your type of diabetes, how well-managed your blood glucose level is, and your other existing health condition.

• Type 1 diabetes: If you have this type, you should take insulin every day. Your pancreas no longer creates insulin.
• Type 2 diabetes: If you have this type, your treatments can involve medications (both for diabetes and for conditions that are risk factors for diabetes), insulin, and lifestyle changes like losing weight, making healthy food choices, and being more physically active.
• Prediabetes: If you have prediabetes, the goal is to retain you from progressing to diabetes. Treatments are focused on treatable risk factors, like losing weight by eating a healthy diet (like the Mediterranean diet) and exercising (at least five days a week for 30 minutes). Many of the strategies used to cure diabetes are the same as those recommended to treat diabetes (see the prevention section of this article).
• Gestational diabetes: If you have this type and your glucose level is not very high, your initial treatment might be modifying your diet and getting regular exercise. If the target goal is still not met or your glucose level is very high, your healthcare (doctor) team may start medication or insulin.

Oral medications and insulin tasks in one of these ways to treat your diabetes:

• Stimulates your pancreas to create and release more insulin.
• Steady down the release of glucose from your liver (extra glucose is stored in your liver).
• Blocks the breakdown of carbohydrates in your stomach or intestines so that your tissues are very sensitive to (better react to) insulin.
• Assists rid your body of glucose through increased urination.

What oral medications are approved to treat diabetes?

• Over 40 medications have been approved by the Food & Drug Administration for the treatment of diabetes. It is behind the scope of this article to review all of these drugs. Instead, we will briefly review the main drug classes available, how they work, and present the names of certain drugs in each class. Your healthcare (doctor) team will decide if the medication is right for you. If so, they will decide which specific drug(s) are best to treat your diabetes.

Diabetes medication drug classes involve:

• Sulfonylureas: These drugs decrease blood glucose by causing the pancreas to release more insulin. Examples involve glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (Micronase, DiaBeta).
• Glinides (also called meglitinides): These drugs decrease blood glucose by getting the pancreas to release more insulin. Examples involve repaglinide (Prandin) and nateglinide (Starlix).
• Biguanides: These drugs decrease how much glucose the liver produces. It also increases how insulin works in the body and slows down the conversion of carbohydrates into sugar. Metformin (Glucophage) is an example.
• Alpha-glucosidase inhibitors: These drugs decrease blood glucose by delaying the breakdown of carbohydrates and decreasing glucose absorption in the small intestine. An example is an acarbose (Precose).
• Thiazolidinediones: These drugs increase the way insulin works in the body by allowing more glucose to enter into muscles, fat, and the liver. Examples include pioglitazone (Actos) and rosiglitazone (Avandia).
• GLP-1 analogs (also known as incretin mimetics or glucagon-like peptide-1 receptor agonists): These drugs improve the release of insulin, reduce glucose release from the liver during later meals and delay food emptying from the stomach. Examples involve exenatide (Byetta), liraglutide (Victoza), albiglutide (Tanzeum), semaglutide (Rybelsus) and dulaglutide (Trulicity).
• DPP-4 inhibitors (also known as dipeptidyl peptidase-4 inhibitors): These drugs assist your pancreas release more insulin after meals. They also decrease the amount of glucose released by the liver. Examples involve alogliptin (Nesina), sitagliptin (Januvia), saxagliptin (Onglyza), and linagliptin (Tradjenta).
• SGLT2 inhibitors (also known as sodium-glucose cotransporter 2 inhibitors): These drugs work on your kidneys to separate glucose in your body through your urine. Examples involve canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).
• Bile acid sequestrants: These drugs decrease cholesterol and blood sugar levels. Examples involve colestipol (Colestid), cholestyramine (Questran), and colesevelam (Welchol).
• Dopamine agonist: This medication decreases the amount of glucose released by the liver. An example is a bromocriptine (Cyclocet).
• Many oral diabetes medications may be utilized in combination or with insulin to achieve the best blood glucose management. Certain of the above medications are available as a combination of two medicines in a single pill. Others are available as injectable medications, for ex., the GLP-1 agonist semaglutide (Ozempic) and lixisenatide (Adlyxin).

Always take your medicine exactly as your healthcare (doctor) prescribes it. Discuss your personal questions and concerns with them.

What insulin medications are approved to treat diabetes?

There are so many types of insulin for diabetes. If you need insulin, your healthcare team will discuss the various types and if they are to be combined with oral medications. To follow is a short review of insulin types.

• Rapid-acting insulins: These insulins are taken 15 minutes previous meals, they peak (when it best lowers blood glucose) at one hour and work for another two to four hours. Examples involve insulin glulisine (Apidra), insulin lispro (Humalog), and insulin aspart (NovoLog).
• Short-acting insulins: These insulins take about 30 minutes to reach your bloodstream, reach their peak effects in 2 to 3 hours and last for three to six hours. An example is insulin regular (Humulin R).
• Intermediate-acting insulins: These insulins reach your bloodstream in two to four hours, peak in 4 to 12 hours, and work for up to 18 hours. An example is NPH.
• Long-acting insulins: These insulins work to retain your blood sugar stable all day. Commonly, these insulins last for about 18 hours. Examples involve insulin glargine (Basaglar, Lantus, Toujeo), insulin detemir (Levemir), and insulin degludec (Tresiba).
• There are insulins that are a combination of various insulins. There are also insulins that are combined with a GLP-1 receptor agonist medication (e.g. Xultophy, Soliqua).

How is insulin taken? How many various ways are there to take insulin?

Insulin is available in several various formats. You and your healthcare provider (doctor) will decide which delivery method is right for you based on your preference, lifestyle, insulin requirements, and insurance plan. Here is a quick review of available types.

• Needle and syringe: With this method, you will insert a needle into a vial of insulin, pull back the syringe, and fill the needle with the proper dose of insulin. You will inject the insulin into your belly or thigh, buttocks, or upper arm – rotating the injection spots. You may require to give yourself one or more shots a day to maintain your target blood glucose level.
• Insulin pen: This device looks such as a pen with a cap. They come prefilled with insulin or with insulin cartridges that are inserted and replaced for later use.
• Insulin pump: Insulin pumps are little, computerized devices, about the size of a small cell phone that you wear on your belt, in your pocket, or under your clothes. They deliver rapid-acting insulin 24 hours a day through a small flexible tube known as a cannula. The cannula is inserted below the skin using a needle. The needle is then removed leaving only the flexible tube below the skin. You replace the cannula every 2 to 3 days. Another type of insulin pump is attached directly to your skin and does not utilize tubes.
• Artificial pancreas (also called a closed-loop insulin delivery system): This system utilizes an insulin pump linked to a continuous glucose monitor. The monitor checks your blood glucose levels every 5 minutes and then the pump delivers the needed dose of insulin.
• Insulin inhaler: Inhalers permit you to breathe in a powdered inhaler through an inhaler device that you insert into your mouth. The insulin is inhaled into your lungs, then soaked up into your bloodstream. Inhalers are only approved for utilization by adults with Type 1 or Type 2 diabetes.
• Insulin injection port: This delivery method includes the placement of a short tube into the tissue beneath your skin. The port is grasped in place with an adhesive patch. You utilize a needle and syringe or insulin pen and inject the insulin through this port. The port is changed every certain day. The port supplies a single site for injection instead of having to rotate injection sites.
• Jet injector: This is a needleless delivery method that utilizes high pressure to send a fine spray of insulin through your skin.

Are there other treatment options for diabetes?

• Yes. There are 2 types of transplantations that might be an option for a chosen number of patients who have Type 1 diabetes. A pancreas transplant is possible. However, getting an organ transplant requires taking immune-suppressing drugs for the release of your life and dealing with the side effects of these drugs. However, if the transplant is successful, you will likely be able to stop taking insulin.
• The type of transplant is a pancreatic islet transplant. In this transplant, clusters of islet cells (the cells that make insulin) are transplanted from an organ donor into your pancreas to back those that have been destroyed.
• Another treatment below research for Type 1 diabetes is immunotherapy. Since Type 1 is an immune system disease, immunotherapy holds promise as a way to utilize medication to turn off the parts of the immune system that cause Type 1 disease.
• Bariatric surgery is another treatment choice that is an indirect treatment for diabetes. Bariatric surgery is an option if you have Type 2 diabetes, have obesity (body mass index over 35), and are considered the best candidate for this type of surgery. Much increased blood glucose levels are look in people who have lost a significant amount of weight.
• Of course, other medications are prescribed to treat any existing health problems that contribute to improving your risk of developing diabetes. These conditions include high blood pressure, high cholesterol, and other heart-related diseases.

Physiotherapy Management

• Therapeutic exercise programs comprise the major side of management. Patient education for proper foot care is an essential area of the physical therapy program for diabetic patients.

Exercise Therapy

• A sound, independently tailored exercise prescription is a cornerstone in the management of Diabetes Mellitus (DM).

Salient Points

1. It is recommended that people with Diabetes Mellitus (DM) ought to have regular aerobic exercise and strength training to reassure positive adaptations in the control of blood glucose concentration, insulin action, muscular strength & exercise tolerance.
2. Importance of various modes of exercise in patients with type 2 diabetes – increases the uptake of glucose by muscles, improves utilization, alters lipid levels, improves high-density lipoprotein, and decreases triglyceride and total cholesterol.
3. Exercise assists people to overcome disability by preventing, treating, and rehabilitating neuromuscular complications like neuropathies, skin breakdown, foot ulcers, arthritis, other joint pains, frozen shoulder, back pain, and osteoarthritis associated with Diabetes Mellitus (DM).
4. Moderate to high levels of different modes of exercise such as cardiorespiratory fitness exercises, aerobic exercise, and progressive resistance exercises are also associated with substantially decrease morbidity and mortality in men and women with diabetes.

Guidelines for a sound exercise program are as follows:

1. Do not exercise if the blood glucose level is decreased to 100 mg/dl or greater than 250 mg/dl.
2. Preferably, exercise indoors rather than outdoors to minimize the risk of integumentary and musculoskeletal trauma, as well as for the patient to have immediate access to necessary things to address hypoglycemia, hyperglycemia, or diabetic ketoacidosis.
3. Patients are highly advised to wear the medical tag for diabetics every time they come out of their house to go somewhere else.
4. Always have a carbohydrate snack at hand during each exercise session. A glass of orange juice or milk is a better pickup for a patient who is experiencing hypoglycemia.
5. Exercise at a normal temperature. Ne’er exercise in extreme temperatures.
6. For Type 1 (Insulin Dependent) patients, ne’er exercise during the peak times of insulin. Collaborate with the nurse in charge of the patient concerning the type of insulin administered.
7. Type 2 diabetics are advised to have an average of 30 minutes of exercise timing per session.
8. Always wear proper footwear & exercise in a safe & secure environment.
9. Type 1 diabetics may require to reduce insulin or increase food intake prior to the start of an exercise program. Physical Therapists must coordinate with the referring physician for this case.
10. During prolonged exercise timing, 10-15 grams of carbohydrate snack is recommended every 30 minutes.
11. Clients who are on Sulfonylureas are red flags because it can cause exercise-induced hypoglycemia. Closely coordinate with the referring physician if this was missed previous to the referral.
12. Menstruating women require increased insulin during menses, especially if they are not active.
13. There should be no short-acting insulin injections close to the muscles to be exercised within 1 hour of exercise.
14. Patients should eat two hours before exercising. If planning to exercise later meal, patients must wait 1 hour prior to starting.
15. Patients must always carry their own portable blood glucose monitor. They must check their glucose levels before and later exercise.
16. Patients are advised to drink 17 oz. of fluid after the previous exercise.
17. If blood glucose is reduced to 100 mg/dl but not less than 70mg/dl, the physical therapist may provide a carbohydrate snack and then recheck the glucose level later 15 minutes.
18. Make sure exercise does not contribute to unnecessary stress for the patient. Stress improves insulin requirements. A steady progression from aerobic and resístance exercises is the key.
19. Avoid exercising delay at night.
20. If faced with an unexpected and hard situation wherein the physical therapist is in doubt whether the patient is experiencing hyperglycemia or hypoglycemia, always give a glass of orange juice or milk or a carbohydrate snack. This is the safest action because this can relieve hypoglycemia (if it is indeed) and cannot injure if it is hyperglycemia.
21. Exercise 5 times a week as maintenance (or at least every other day) and at the same schedule/time, preferably.
22. As much as possible, the patient must not exercise alone, so that there will always be someone to assist in unexpected situations.
23. Good examples of carbohydrate snacks (10-15 grams of carbohydrates) are half (1/2) a cup of fruit juice or cola, 8 oz. of milk, 2 packets of sugar, and 2 oz. tube of honey or cake deco gel.

Can prediabetes, Type 2 diabetes, and gestational diabetes be cured?

Although diabetes risk factors like family history and race can not be changed, there are other risk factors that you do have some control over. Adopting certain of the healthy lifestyle habits listed below can improve these modifiable risk factors and assist to decrease your chances of getting diabetes:

• Eat a healthy diet, like the Mediterranean or Dash diet. Retain a food diary and calorie count of everything you eat. Cutting 250 calories per day can assist you to lose ½ pounds per week.
• Get physically active. Aim for 30 minutes a day at least 5 days a week. Begin slow and work up to this amount or break up these minutes into more doable 10-minute segments. Walking is the best exercise.
• Work to achieve a weight that’s healthy for you. Do not lose weight if you are pregnant, yet check with your obstetrician about healthy weight gain during your pregnancy.
• Decrease your stress. Learn relaxation techniques, deep breathing exercises, mindful meditation, yoga, and other assist fulfill strategies.
• Limit alcohol intake. Men should drink no more than 2 beverages containing alcohol a day; women should drink no more than one.
• Acquire an adequate amount of sleep (typically 7 to 9 hours).
• Quit smoking.
• Take medications as directed by your healthcare provider to manage existing risk factors for heart disease (like high blood pressure, and cholesterol) or to reduce the risk of developing Type 2 diabetes.
• If you think you have symptoms of prediabetes, look at your provider.

Can Type 1 diabetes be prevented?

• No. Type 1 diabetes is an autoimmune disease, meaning your body censure itself. Scientists are not sure why someone’s body would attack itself. Other factors may be involved too, like genetic changes.

Can the long-term complications of diabetes be prevented?

• Chronic complications are responsible for most illnesses and death connected with diabetes. Chronic complications usually appear later in several years of elevated blood sugars (hyperglycemia). Since patients with Type 2 diabetes may have elevated blood sugars for several years previous being diagnosed, these patients may have signs of complications at the time of diagnosis.
• The complications of diabetes have been described before in this article. Although the complications can be wide-ranging and harm many organ systems, there are many basic principles of prevention that are shared usually.

These involve:

• Extract your diabetes medications (pills and/or insulin) as prescribed by your doctor,
• Extract all of your other medications to treat any risk factors (high blood pressure, high cholesterol, other heart-related problems, and other health conditions) as directed by your doctor,
• Monitor your blood sugars closely,
• Follow a healthy diet, like the Mediterranean or Dash diet. Do not skip meals,
• Exercise regularly, at least 30 minutes 5 days a week,
• Keep a weight that is healthy for you,
• Keep yourself well-hydrated (water is your best choice),
• Quit smoking, if you smoke,
• Look at your doctor regularly to monitor your diabetes and to watch for complications.

What should I look for if I have been diagnosed with diabetes?

• If you have diabetes, the most important thing you can do is retain your blood glucose level within the target range recommended by your healthcare provider.

In common, these targets are:

• Previous meal: between 80 and 130 mg/dL.
• About two hours after the beginning of a meal: less than 180 mg/dL.
• You will require to closely follow a treatment plan, which will likely involve following a customized diet plan, exercising 30 minutes five times a week, quitting smoking, limiting alcohol, and getting seven to 9 hours of sleep a night. Every time take your medications and insulin as instructed by your provider (doctor).

When should I call my doctor?

• If you have not been diagnosed with diabetes, you should look to your healthcare provider (doctor) if you have any symptoms of diabetes. If you previously have been diagnosed with diabetes, you should contact your provider (doctor) if your blood glucose levels are outside of your chosen range, if current symptoms worsen or if you create any new symptoms.

Does eating sugary foods cause diabetes?

• Sugar itself does not directly cause diabetes. Eating foods high in sugar content can conduct to weight gain, which is a risk factor for developing diabetes. Eating more sugar than recommended — American Heart Association recommends no more than 6 teaspoons a day (25 grams) for women and 9 teaspoons (36 grams) for men — conducts to all kinds of health injuries in addition to weight gain.
• These health injuries are all risk factors for the development of diabetes or can bad complications.

Weight gain can:

• Increase blood pressure, cholesterol, and triglyceride levels,
• Raise your risk of cardiovascular disease,
• Cause fat buildup in your liver,
• Cause tooth decay.

What types of healthcare professionals (doctors) might be part of my diabetes treatment team?

• Most people with diabetes see their primary healthcare provider 1st. Your provider (doctor) might refer you to an endocrinologist/pediatric endocrinologist, a physician who specializes in diabetes care.
• Other members of your healthcare team may involve an ophthalmologist (eye doctor), a nephrologist (kidney doctor), a cardiologist (heart doctor), a podiatrist (foot doctor), a neurologist (nerve and brain doctor), a gastroenterologist (digestive tract doctor), registered dietician, nurse practitioners/physician assistants, diabetes educator, pharmacist, personal trainer, social worker, mental health professional, transplant team & others.

How often do I need to see my primary diabetes healthcare professional (doctors)?

• In general, if you are being treated with insulin shots, you should look to your doctor at least every three to four months. If you are treated with pills or are managing diabetes through diet, you should be looking at least every four to six months. More frequent visits may be needed if your blood sugar is not managed or if complications of diabetes are worsening.

Can diabetes be cured or reversed?

• Although these are seemingly simple questions, the answers are not so simple. Depending on the type of your diabetes and its personal cause, it may or may not be possible to reverse your diabetes. Successfully reversing diabetes is more commonly known as achieving “remission.”
• Type 1 diabetes is an immune system disease with a certain genetic component. This type of diabetes can not be reversed with traditional treatments. You require lifelong insulin to survive. Providing insulin through an artificial pancreas (insulin pump plus continuous glucose monitor and computer program) is the most advanced way of retaining glucose within a tight range at all times – most closely mimicking the body. The closest thing to the prevention of Type 1 is a pancreas transplant and a pancreas islet transplant. Transplant candidates must join strict criteria to be eligible. It is not an option for everyone and it requires taking immunosuppressant medications for life and dealing with the side effects of these drugs.
• It is possible to reverse prediabetes and Type 2 diabetes with a lot of effort and motivation. You had to reverse all your risk factors for disease. To do this means a combination of decreasing weight, exercising regularly, and eating healthy (for example, a plant-based, low carb, low sugar, healthy fat diet). These efforts should also decrease your cholesterol numbers and blood pressure to within their normal range. Bariatric surgery (surgery that makes your stomach smaller) has been shown to achieve remission in certain people with Type 2 diabetes. This is an important surgery that has its own risks and complications.
• If you have gestational diabetes, this type of diabetes closed with the birth of your child. However, having gestational diabetes is a risk factor for creating Type 2 diabetes.
• The good news is that diabetes can be successfully controlled. The extent to which your Type 1 or Type 2 diabetes can be managed is a discussion to have with your healthcare provider (doctor).

Can diabetes kill you?

• Yes, it is possible that if diabetes remains undiagnosed and unmanaged (severely high or severely low glucose levels) it can cause devastating injury to your body. Diabetes can cause heart attack, heart failure, stroke, kidney failure & coma. These complications can conduct in your death. Cardiovascular disease in particular is the conducting cause of death in adults with diabetes.

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