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“Someone once told me that God figured that I was a pretty good juggler. I could keep a lot of balls in the air at one time. So He said, ‘Let's see if you can juggle another one.’”

Arthur Ashe (1943–1993)

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Objectives

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On completion of this chapter, the student/practitioner will be able to:

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  • Discuss the signs and symptoms of diabetes and diabetic neuropathy.

  • Discuss the possible etiologies of diabetic neuropathy.

  • Explain the difference between the three classic subgroups of diabetic neuropathy.

  • Discuss, compare, and contrast the common presentations of diabetic neuropathy.

  • Discuss physical therapy intervention for diabetic neuropathy.

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Key Terms

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  • Diabetes

  • Gestational diabetes

  • Insulin

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Introduction

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Diabetes mellitus (DM), or simply diabetes, is a chronic health condition in which the body either fails to produce a sufficient amount of insulin or responds abnormally to insulin production.1 DM as a disease entity has been known for centuries. DM takes its name from the Greek for “passing through” because of one of its main symptoms—excessive urine production. During the 15th century, the word “mellitus” was added from the Latin for “honey” when it was noted that many patients with diabetes had high levels of sugar in their blood and urine.2,3 Classically, diabetes is divided into three broad subcategories: type 1 diabetes, type 2 diabetes, and gestational diabetes. The primary impairment of all three types of diabetes is a high blood glucose level, or hyperglycemia. The pathophysiology of DM is very complex because the disease is characterized by different etiologies that share similar signs, symptoms, and complications. The etiology may be primary or secondary as the result of tumor, trauma, obesity, or medication.

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Pathophysiology of Diabetes Mellitus

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The pathophysiology of the different types of DM is related to the hormone insulin, which is secreted by the beta cells of the pancreas. This hormone is responsible for maintaining a homeostatic glucose level in the blood. Insulin allows cells to use glucose as a main energy source. However, in a person with DM, because of abnormal insulin metabolism, the body cells and tissues do not make use of glucose from the blood. This situation results in an elevated level of glucose outside the cell and a high blood glucose concentration. Over time, a high glucose level in the bloodstream may lead to severe complications, such as ocular disorders, cardiovascular diseases, renal insufficiency, cerebral blood insufficiency, peripheral vascular disease, and neuropathy.4

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In type 1 DM, the pancreas cannot synthesize a sufficient amount of insulin hormone as required by the metabolic demands of the body. The pathophysiology of type 1 DM suggests that it is an autoimmune disease affecting the beta cells of the pancreas. Consequently, the pancreas secretes little or no insulin. Type 1 diabetes is more common in children and young ...

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