Diabetes mellitus (DM)

Question 1

main issue in diabetes is a problem with

Answer 1

the body’s production and/or utilization of the

hormone insulin

Question 2

long-term complications of DM are severe including

Answer 2

cardiovascular, renal and retinal
disease
most common cause of peripheral neuropathy

Question 3

DM characterized by

Answer 3

elevated levels of glucose in the blood (hyperglycemia) and in the urine
(glycosuria)

Question 4

a wide range of medications used to treat DM by (3 methods)

Answer 4

o some replace insulin
o some increase insulin sensitivity
o some increase insulin secretion

Question 5

generally _______ is more worrisome for the therapist than ________

Answer 5

• hypoglycemia

- hyperglycemia

Question 6

Hypoglycemia (lead to insulin shock) symptoms include

Answer 6

Stomach pains
Nervousness
Hunger
Sweating
Weakness
Continuing headaches
Tachycardia
Palpitations
Confusion
Moist and pale skin
Convulsions

Question 7

Hyperglycemia (lead to diabetic coma) symptoms include

Answer 7

Thirst
Polyuria
Fatigue, confusion, reduced levels of 
consciousness
Headaches
Blurred vision
Nausea and vomiting
Constipation
Dehydration

Question 8

Insulin is normally released from the

Answer 8

pancreatic beta cells

Question 9

normal blood glucose level is

Answer 9

80-90 mg per 100 mL of blood

Question 10

the aim of administering exogenous insulin is to

Answer 10

to normalize levels of blood glucose

Question 11

many sources of insulin are derived from extraction from

Answer 11

the pancreas of the animal, (beef and pork insulin)

• widely used but can cause some allergic reactions
• synthetic form is also available

Question 12

insulin would be broken down in the ______if taken orally, so ______ ______ is
preferred

Answer 12

GI tract

subcutaneous injection

Question 13

common areas for injection include:

Answer 13

o abdominal wall (fastest onset of action)
o lateral arm
o around the waist and hips
o thigh

Question 14

External Insulin Pumps are devices

Answer 14

that can be programmed to automatically release insulin
- they are worn externally and connected to the patient’s bloodstream via a catheter
- they are about the size of a deck of cards, weigh about 3 ounces and can be worn on a
belt or in a pocket

Question 15

Insulin
Examples: Toronto,
NPH, lente, ultralente

Answer 15

- allows glucose to 
enter cells, which 
decreases blood sugar
- occurs by insertion of 
glucose transporters 
(GLUT) into the cell 
membrane

Question 16

Massage Therapy

Guidelines Insulin

Answer 16

- follow guidelines 
when working around 
injection sites or 
implanted devices. 
Working with old 
fibrous injection sites 
may be beneficial but 
likely consultation 
should be undertaken 
due to impaired tissue 
healing
- peripheral 
neuropathy is common

Question 17

oral hypoglycemic drugs are used to lower blood glucose levels

Answer 17

o sulfonylureas
o biguanides
othiazolidinediones
o alpha-glucosidases

Question 18

Sulfonylureas

(Glipizide, glyburide) MoA

Answer 18

-increases insulin 
secretion by the 
pancreas (only effective 
for Type II)
-

Question 19

Sulfonylureas
(Glipizide, glyburide) Notable Adverse
effects

Answer 19

• hypoglycemia
• rarely: paresthesias
  and skin rashes

Question 20

Sulfonylureas
(Glipizide, glyburide) Massage Therapy
Guidelines

Answer 20

Hypoglycemia- as for 
insulin above. If 
patient is experiencing 
paresthesias, then 
care must be taken 
during stretching and 
deeper tissue work.
=NSAIDs can increase 
the serum 
concentration of 
sulfonylureas, thus 
increasing likelihood of 
hypoglycemia

Question 21

Biguanides

(Metformin) MoA

Answer 21

- decrease release of 
glucose by liver, 
decrease intestinal 
absorption of glucose, 
increase insulin 
sensitivity in peripheral 
tissues (only effective 
for Type II)

Question 22

Biguanides
(Metformin) Notable Adverse
effects

Answer 22

fatigue and 
weakness
- nausea and vomiting, 
bruising, flatulence, 
lactic acidosis (see 
HIV med section for 
definition)

Question 23

Biguanides
(Metformin)
Massage Therapy
Guidelines

Answer 23

\: deep 
techniques may be a 
bad idea due to 
increased risk of 
bruising. Fatigue may 
necessitate shorter 
treatments. Diabetic 
neuropathy is common

Question 24

Thiazolidinediones
(Rosiglitazone,
pioglitazone) MoA

Answer 24

increase sensitivity to 
insulin, beneficial 
cardiovascular lipid 
profiles (only effective 
for Type II)

Question 25

Thiazolidinediones
(Rosiglitazone,
pioglitazone) Notable Adverse
effects

Answer 25

• edema
• headache
• anemia
• fatigue

Question 26

Thiazolidinediones
(Rosiglitazone,
pioglitazone) Massage Therapy
Guidelines

Answer 26

\: peripheral 
edema may be poorly 
amenable to 
massage- if causing 
significant concerns, 
then may need 
medical review. Same 
for headache

Question 27

Alpha-Glucosidase
Inhibitors
(Precose) MoA

Answer 27

• decreases absorption
  of glucose by the
  intestine

Question 28

Alpha-Glucosidase
Inhibitors
(Precose) Notable Adverse
effects

Answer 28

Fluatulence

Question 29

Alpha-Glucosidase
Inhibitors
(Precose) Massage Therapy
Guidelines

Answer 29

main concern is diarrhea, bloating, gas,

-encourage washroom before Tx