By Megan Storey | November 2, 2020
Diabetes mellitus (DM) is a chronic condition that affects the body’s ability to breakdown (or metabolise) the food we eat into energy, for use by the trillions of cells that make up the human form. Diabetes is a global problem, and while it affects both men and women, there is one type that affects women only – gestational diabetes. Last year, over 460 million people were living with a DM diagnosis worldwide. In the next decade, this figure is expected to rise to approximately 580 million people. The disease comes at a great cost to healthcare services, and to life. In 2019 alone, global healthcare costs for DM reached $760 billion, and a total of 4.2 million people died from complications of this disease. The key to living with this disease, as with all diseases, is to understand the disease and how it affects the body.
The main characteristic of DM is high blood sugar (aka hyperglycaemia). Sugar in the form of glucose is the body’s primary source of energy. The body gets glucose by breaking down carbohydrates from foods we eat (i.e. breads, grains, fruits and vegetables). Glucose is then distributed to all of the cells around the body via the blood. In order for our cells to reap the benefit of glucose, they require the help of a hormone called insulin to grab the glucose and take it into the cell. We get insulin from the pancreas, an organ found tucked away behind our stomach. In DM, there is a problem with the production of insulin in the pancreas. It either is not produced at all, or not enough good quality, usable insulin is produced. Without insulin, glucose in the bloodstream builds up and up, the body is not able to get the energy it needs, and this is a huge problem.
Types of DM
There are three main types of DM:
- DM type 1: This form of the disease is caused by an autoimmune response of the body. In simple terms, the body’s defence system sends in the cavalry and destroys the insulin producing cells in the pancreas. People with DM1 are required to inject a synthetic form of insulin regularly throughout the day using either a needle or pump mechanism.
- DM type 2: By far the most common form of DM. One of three mechanisms exist… 1) The pancreas doesn’t produce enough insulin. 2) The insulin produced is ineffective. 3) The cells of the body do not respond to insulin in the correct way. In many cases, DM2 can be managed effectively by making lifestyle changes and without the need to have to inject synthetic insulin. However, some people require medication and may eventually need the help of insulin injections to effectively manage the condition.
- Gestational DM: Ladies… this one is just for us! Gestational DM may develop during pregnancy. The good news is that most cases will automatically resolve once your little bub is born. In this form, the blame doesn’t lie with the pancreas not producing insulin. Instead, hormones produced by the placenta during pregnancy block the effect of insulin, and the cells are not able to take up glucose. The pancreas will try to produce more insulin to fight the effect of these hormones, but as pregnancy progresses, hormone production ramps up and your poor little pancreas is sometimes unable to keep up. The result is gestational DM.
Signs and symptoms
Uncontrolled blood sugar levels can lead to the development of immediate symptoms including:
- Excessive thirst and hunger
- Increased urination
- Tiredness and fatigue
Over a prolonged period, if blood sugar levels are poorly managed, it can result in damage to blood vessels throughout the body. Common long-term effects of uncontrolled diabetes include:
- Damage to nerves that affect the limbs, including the hands and feet
- Kidney disease and failure
- Heart attack
- Ulceration of the skin that take a long time (or are unable) to heal
- Skin infections
- Weight and mood changes
During pregnancy, the mothers blood sugar levels are closely monitored, especially if the mother is at high risk of developing gestational DM. Those at greater risk include overweight, older women, and those with a family history of DM. Uncontrolled gestational diabetes can lead to a baby with a high birth weight, and needing help to stabilise their own blood sugar levels immediately following birth.
Although much of the diagnosis and medical management of DM will be handled by your doctor, we as physiotherapists have a very important role to play. Exercise is a key player in the management of type 2 diabetics especially. Exercise helps to improve how efficient your insulin works, which helps you to control your blood sugar levels. Exercise will also help with weight management, reducing the risk of cardiovascular problems such as heart attack and stroke. If implemented in a controlled way, there is good evidence suggesting exercise, as well as a super clean and controlled diet, can reduce the impact, delay and even prevent the onset of DM type 2. As well as helping you implement a healthier lifestyle overall, we can also help in the following ways:
- Screening your body for signs of nerve and blood vessel related problems
- Educating you on what to look out for regarding skin issues
- Screening you for associated conditions, including frozen shoulder, carpal tunnel syndrome and other musculoskeletal problems
- Reminding you to get your eyes tested
- Screening and monitoring for signs of depression (which is strongly associated with DM)
Our main goal, whether you are pregnant or otherwise, is to encourage you to be active on a daily basis and provide education on what is important to you from an individual perspective. If you need some help to get your head around diabetes, and especially the role of exercise for its management, then please get in touch today.