Rehabilitation consideration

of hypoglycemic agents
Introduction
• Diabetes is a chronic metabolic disease in which the body is unable to
appropriately regulate the level of sugar, specifically glucose, in the
blood, either by poor sensitivity to the protein insulin, or due to
inadequate production of insulin by the pancreas.
• Fasting Plasma Glucose (FPG) ≥ 126 mg/dL (7.0 mmol/L) on two
occasions of testing confirms diabetes
Classification of diabetes
1.Type 1 Diabetes which is an absolute deficiency of insulin due to an
autoimmune destruction of β cells in the pancreas. This also includes
latent autoimmune diabetes of adulthood.
2.Type 2 Diabetes occurs from insulin resistance and a progressive
reduction in insulin secretion. T2D is largely attributed to physical
inactivity and excess body weight.
3.Gestational Diabetes, which is diabetes diagnosed in the second or
third trimester of pregnancy and was not present prior to the
pregnancy period.
Risk factors for T2D may include:

• Family History
• Obesity
• Sedentariness
• Increasing Age
• History of Gestational Diabetes
Acute complications of diabetes

• Hypoglycaemia
• Diabetic ketoacidosis
• Hyperosmolar nonketotic coma
Chronic complications of diabetes
Relate to the long term effects of hyperglycaemia on the vasculature and
can be divided into:
1.Microvascular complications consisting:
1. Retinopathy
2. Nephropathy
3. Neuropathy (including peripheral distal symmetric polyneuropathy, autonomic
neuropathy, proximal painful motor neuropathy and cranial mononeuropathy)
2.Macrovascular complications including:
1. Cardiovascular disease
2. Peripheral vascular disease
3. Stroke
Management of diabetes
• Pharmacological or non-pharmacological.
• lifestyle adjustments including diet and exercise are often
recommended to ensure optimal health
Classification of anti diabetics - oral
• Sulfonyl ureas
First generation – Tolbutamide, chlorpropamide
Second generation - Glibenclamide, Glipizide, Glimepride

• Biguanides – Metformin, Repaglinide

• Thiazolidinediones – Rosiglitazone, pioglitazone

• Alpha glucosidase inhibitor – Acarbose, miglitol

Mechanism of action
• Sulfonyl ureas increase release of Insulin from the pancreas
• Biguanides –
Suppress hepatic gluconeogenesis and glucose output from the liver.
Retard intestinal absorption of glucose
Enhance glucose mediated glucose disposal in muscle and fat
• Thiazolidinediones – Reverse insulin resistance by stimulating GLUT4
expression and translocation entry of glucose into muscle and fat
• Alpha glucosidase – Slows down absorption and digestion of
polysaccharides.
Major goals of diabetic rehabilitation
• Attain glycemic control
• Improve quality of life,
• Prevent or delay complications
• Empower patients with the knowledge of their condition.
• Physical activity is known to improve the uptake of glucose as an
increased blood flow to muscles enhances glucose uptake in muscle cells;
• improve the sensitivity of insulin to excess blood glucose and reduce
intra-abdominal fat - a known risk factor for insulin resistance
• Prevent cardiovascular complications.