Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Diabetes Mellitus Type 1


Related Terms

  • Brittle Diabetes
  • High Blood Sugar
  • Insulin-Dependent Diabetes
  • Juvenile-Onset Diabetes
  • Type 1 Diabetes

Differential Diagnosis

  • Drug-induced glucose intolerance
  • Glucose intolerance
  • Hormonal disorders
  • Insulin resistance
  • Kidney disease (benign renal glycosuria)
  • Pancreatic disease (pancreatitis, cystic fibrosis)
  • Prader-Willi syndrome
  • Salicylate poisoning
  • Type 1 glycogen storage disease
  • Type 2 diabetes mellitus

Specialists

  • Cardiologist, Cardiovascular Physician
  • Endocrinologist
  • Family Physician
  • Nephrologist
  • Neurologist
  • Ophthalmologist
  • Orthopedic (Orthopaedic) Surgeon
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

Factors that might influence the length of disability include stress, poor dietary habits, lack of compliance with treatment, excessive physical exertion, and the type and degree of complications. If the individual's job requirements demand physical exertion, prevent eating at regularly scheduled times, or prevent frequent glucose monitoring and/or insulin administration, the duration may be affected. Surgical intervention for resulting complications, or dialysis for treatment of kidney failure, can affect the length of disability as well as the recovery response. The development of infections, or their recurrence, can greatly influence the length of disability.

Medical Codes

ICD-9-CM:
250.01 - Diabetes Mellitus Type I
250.03 - Diabetes Mellitus without Mention of Complication; Type I [Juvenile Type], Uncontrolled
250.11 - Diabetes with Ketoacidosis; Diabetic: Acidosis without Mention of Coma, Ketosis without Mention of Coma; Type I [Juvenile Type], not Stated as Uncontrolled
250.13 - Diabetes with Ketoacidosis; Diabetic: Acidosis without Mention of Coma, Ketosis without Mention of Coma; Type I [Juvenile Type], Uncontrolled
250.21 - Diabetes with Hyperosmolarity; Hyperosmolar (Nonketotic) Coma; Type I [Juvenile Type], Not Stated as Uncontrolled
250.23 - Diabetes with Hyperosmolarity; Hyperosmolar (Nonketotic) Coma; Type I [Juvenile Type], Uncontrolled
250.31 - Diabetes with Other Coma; Diabetic Coma (with Ketoacidosis), Diabetic Hypoglycemic Coma, Insulin Coma NOS; Type I [Juvenile Type], Not Stated as Uncontrolled
250.33 - Diabetes with Other Coma; Diabetic Coma (with Ketoacidosis), Diabetic Hypoglycemic Coma, Insulin Coma NOS; Type I [Juvenile Type], Uncontrolled
250.41 - Diabetes with Renal Manifestations; Type I [Juvenile Type], not Stated as Uncontrolled
250.43 - Diabetes with Renal Manifestations; Type I [Juvenile Type], Uncontrolled
250.51 - Diabetes with Ophthalmic Manifestations; Type I [Juvenile Type], not Stated as Uncontrolled
250.53 - Diabetes with Ophthalmic Manifestations; Type I [Juvenile Type], Uncontrolled
250.61 - Diabetes with Neurological Manifestations; Type I [Juvenile Type], not Stated as Uncontrolled
250.63 - Diabetes with Neurological Manifestations; Type I [Juvenile Type], Uncontrolled
250.71 - Diabetes with Peripheral Circulatory Disorders; Type I [Juvenile Type], Not Stated as Uncontrolled
250.73 - Diabetes with Peripheral Circulatory Disorders; Type I [Juvenile Type], Uncontrolled
250.81 - Type I (Insulin Dependent Type) Diabetes Mellitus with Other Specified Manifestations, Not Stated as Uncontrolled
250.83 - Type I (Insulin Dependent Type) Diabetes Mellitus with Other Specified Manifestations, Uncontrolled
250.91 - Diabetes with Unspecified Complications; Type I [Juvenile Type], not Stated as Uncontrolled
250.93 - Diabetes with Unspecified Complications; Type I [Juvenile Type], Uncontrolled

Overview

Type 1 diabetes mellitus (type 1 diabetes) is a chronic autoimmune metabolic disorder that affects multiple organ systems, characterized by abnormally high levels of a simple sugar (glucose) in the blood (hyperglycemia). Type 1 diabetes (formerly called insulin-dependent diabetes or juvenile-onset diabetes) results when the body's immune system has destroyed the insulin-producing beta cells in the islets of Langerhans (also called islet cells) of the pancreas, and the body fails to produce the hormone insulin that normally regulates glucose. Individuals with type 1 diabetes require daily doses of insulin to prevent serious multisystem complications that can lead to premature death. The majority of cases of type 1 diabetes are diagnosed during childhood or adolescence, although adults in their late thirties or early forties can also develop a less aggressive form of this disease.

Insulin is a hormone produced in an organ near the stomach called the pancreas; it is required by the body to allow the entry of glucose into cells and convert carbohydrates, fats, and protein from food into energy. In individuals with type 1 diabetes, the pancreas does not produce insulin. Without insulin, glucose cannot be transported from the blood to the body's cells, so it accumulates in the blood, resulting in hyperglycemia. When the levels of unused glucose in the blood exceed the resorption capacity of the kidneys, glucose is excreted in the urine (glycosuria), and it causes the kidney to excrete more water (osmotic diuresis), which results in large quantities of urine (polyuria). Polyuria leads to dehydration and activates the thirst mechanism, resulting in the consumption of large quantities of fluid (polydipsia). The lack of entry of glucose into cells, despite high concentrations of glucose in the blood, causes paradoxical cell privation of glucose, which is interpreted by the body as a need to eat and triggers increased food intake (polyphagia). Women with type 1 diabetes show a higher prevalence of bulimia nervosa.

It is believed that type 1 diabetes is triggered in genetically predisposed individuals by an infectious or environmental agent that damages the beta cells of the pancreas, mistaking molecules in the beta cells for a foreign protein. When beta cells are destroyed, individuals with type 1 diabetes need to receive exogenous insulin (not produced by the body) to reduce excess levels of blood glucose, to prevent a harmful acidic state (ketosis, also called diabetic ketoacidosis or DKA) that results when defective carbohydrate metabolism produces excess ketone bodies, and to correct the defective metabolism of fats and proteins.

Peripheral vascular disease is a common comorbidity with diabetes mellitus type 1 and often is associated with significant impairment of the circulation to the legs and feet. This circulatory compromise often causes symptoms such as pain in the legs and feet during walking (intermittent claudication). Peripheral circulatory disorders in diabetics are often further complicated by tingling skin (paresthesias) and decreased sensation in the limbs (peripheral neuropathy), and increased susceptibility to infection. Together with vascular disease, these factors can result in foot infections and ulcerations (diabetic foot) that sometimes lead to gangrene and amputation of all or part of the affected extremity.

Incidence and Prevalence: Approximately 19 individuals per 100,000 younger than age 20 are diagnosed with type 1 diabetes each year (Dabelea); approximately 125,000 people younger than age 20 are living with type 1 diabetes (Liese). Most diabetes among youth aged 9 and younger is recognized as type 1 (Dabelea). As youth progress in age, the proportion of type 2 diabetes increases especially among minority youth. In adults, type 1 diabetes accounts for about 5% of all cases of diabetes ("2011 National Diabetes Fact Sheet"). The incidence of type 1 diabetes is increasing by 2% to 5% worldwide as well as in the US (Dabelea; Vehik; Maahs).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Autoimmunity is a major risk factor for type 1 diabetes; individuals who have other autoimmune diseases such as Graves' disease, Hashimoto's thyroiditis, and Addison's disease are at greater risk of developing the disease (Kordonour; Kakleas). Mumps, rubella, and Coxsackie B4 viruses are believed to be possible triggers for beta cell destruction by the immune system (Ramondetti).

Age is also a significant risk factor for type 1 diabetes, which is the most frequently diagnosed metabolic disease in children ("2011 National Diabetes Fact Sheet"].

The disease is slightly more common in young girls compared to young boys in the US (Dabelea). The incidence of type 1 diabetes varies by gender and geography in that areas with lower incidence tend to have more females diagnosed and areas with higher incidence have more males diagnosed (Maahs).

Type 1 diabetes is more common among non-Hispanic whites than among black Americans or Hispanic Americans, and is less common among Asian Americans (Liese). About 215,000 people younger than 20 years old had diabetes type 1 or 2 in the US in 2010 ("2011 National Diabetes Fact Sheet").

Genetic predisposition increases the risk for type 1 diabetes. Even though an identical twin of an individual with this disease has close to a 50% chance of developing type 1 diabetes, it is believed that a genetic predisposition and certain environmental exposure are together responsible for the development of the disease. Environmental exposure to toxic chemicals or cell-killing substances (cytotoxins) or exposure to cow's milk in infancy may increase risk.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms may develop suddenly or gradually over days to weeks and vary widely from person to person. Classic symptoms include excessive thirst and water intake (polydipsia), excessive urination (polyuria), and excessive food intake (polyphagia). Other common symptoms are weight loss despite normal or increased food intake, fatigue, headaches, muscle wasting, muscle cramps, vision changes, visible weight loss from loss of body fluids, anxiety, nausea, vomiting, and diarrhea and/or constipation. The individual may report pain in the upper right quadrant of the abdomen. Neurologic symptoms may include numbness and tingling in the hands and feet.

Physical exam: Physical findings vary with the suddenness and severity of onset of the disease. Some findings include signs of dehydration such as low blood pressure (hypotension); weak, rapid pulse; dry mucous membranes (especially in the mouth); and blurred vision. Individuals with this disease tend to be thin, usually with little body fat at the time of diagnosis. However, heavy individuals can also have type 1 diabetes. Deep and rapid breathing, a fruity odor to the breath, and altered mental status may indicate diabetic ketoacidosis (DKA), a common complication of this disease. The upper right quadrant of the abdomen may be distended and tender or painful on palpation as a result of acute fatty liver or pancreatitis associated with DKA. Altered mental status may be noted if DKA is present.

Tests: A random blood glucose level and fasting blood glucose level are typically elevated. A 2-hour-after-eating (postprandial) blood glucose level is also usually elevated. In addition, an elevated glycosylated hemoglobin (Hb), HbA1c, is often used to confirm the diagnosis. The individual's susceptibility to developing diabetes type 1 is increased by the presence of human leukocyte antigens HLA-DR3 and HLA-DR4; about 95% of patients with type 1 diabetes are found to have these antigens; however only about 5% of those with the antigens actually go on to develop clinical disease (Maahs; Virtanen). Approximately 40% to 50% of disease in familial clusters is accounted for by genetic variation in the HLA area. The remaining risk is made up of many diverse genes each having a small impact on susceptibility. Recent temporal trends suggest fewer HLA associated cases, which is suggestive of an increased influence of environmental factors among youth (Maahs). A urine dipstick will measure glucose and ketones (acetone) in the urine (both are usually positive). Other blood tests will reflect kidney function, as well as dehydration and the effects on other blood chemistries (e.g., blood urea nitrogen, albumin, serum electrolytes). Periodic determination of cholesterol levels is recommended. Further testing is usually not needed to make the diagnosis, although tissue typing for human leukocyte antigens (HLA)-DR3 and HLA-DR4, considered specific markers for susceptibility to type 1 diabetes mellitus, may be helpful. Autoimmune disease association may also be determined by baseline thyroid function tests (for Hashimoto's thyroiditis) and measurement of morning cortisol levels (for Addison's disease) and autoantibodies (for celiac disease). Islet cell destruction may be confirmed by testing for the presence of glutamic acid decarboxylase (GAD) antibodies in pancreatic tissue.

Periodic testing of HbA1c, which measures the amount of glucose bound to a protein called hemoglobin (found in red blood cells), can give an estimate of plasma glucose control over the preceding 1 to 3 months and may help the physician adjust the individual's insulin requirements. The insulin and C-peptide test may be performed to determine if any insulin is still being produced by the body, which can guide treatment using replacement insulin.

Source: Medical Disability Advisor



Treatment

Type 1 diabetes is treated with injections of insulin to maintain a stable blood glucose level. The type of insulin is based on the body's response to the insulin; the amount and frequency of dosage is determined by the blood glucose level. The individual learns how to monitor blood glucose levels, and the physician sets guidelines to regulate the insulin dosages based on the blood glucose level reading. The individual also learns how to administer insulin, along with the importance of complying with treatment. Insulin injections may be administered by vial-and-syringe methods, smaller convenient pen devices, or continuous subcutaneous insulin infusion (CSII) through a portable pump. There is also 24-hour insulin available that need only be injected once in a 24-hour period. Diet, exercise, and stress reduction techniques also assist in regulating blood glucose levels. Included in education is the importance of daily foot care and the need for early treatment of even minor scratches or wounds.

In some individuals, insulin injections, diet, exercise, and stress reduction might not be sufficient to control their glucose levels. For these individuals, the use of an insulin pump is sometimes considered. The insulin pump is a mechanical device, about the size of a pager, which administers insulin according to the schedule prescribed by the physician but is programmed by the individual. The pump delivers a small amount of insulin continuously throughout the day, providing a basal level much like the pancreas would do if it were working properly. In addition, the pump is programmed to deliver larger amounts of insulin (bolus doses) before each meal, according to the type and size of meal eaten. Therefore, the individual must continue to monitor blood sugar frequently, up to 4 to 6 times daily, for optimal control. This schedule applies to all individuals with type 1 diabetes mellitus, regardless of how the insulin is given. Implantable insulin pumps are also available that integrate glucose sensing meters into a feedback-loop system, allowing insulin to be delivered according to monitored interstitial fluid glucose levels. These implantable devices operate without requiring the individual to calculate and program them; however, their use currently is reserved for patients with severe brittle diabetes unresponsive to CSII, especially those with unpredictable and/or severe hypoglycaemia. One of the drawbacks of these appliances based in interstitial fluid glucose measurement is that there may be a delay between the detection of changes of blood glucose and the response; truly non-invasive glucose monitoring systems are expected in the near future.

Research continues on ways to deliver insulin other than injection, for example, through inhalation or by the oral route. Several insulin inhalation devices have been introduced since 2006 but have been discontinued due to lack of acceptance by diabetic consumers and physicians; costs were high compared to injectable insulin methods or pumps, and results were not seen as superior to these methods (Walsh). Various methods for inhaled insulin devices are currently being tested.

Physical exams at least twice a year (preferably 4 to 5 times a year) are needed to evaluate the stability of disease, as well as to permit early treatment for any complications or progressive symptoms. A glycosylated hemoglobin test is useful to the physician and individual in assessing glucose control and provides information to guide the physician in adjusting the individual's insulin requirements. Individuals will need at least annual dilated retinal exams. Complications can be prevented or minimized when the individual and family members receive education about symptoms of hyperglycemia, acidosis, and hypoglycemia.

For certain individuals, such as those with severe hypoglycaemia with unawareness, a pancreatic transplant may be considered. In the future, a transplantation of pancreatic islet cells may be an option.

Source: Medical Disability Advisor



Prognosis

The outcome depends on individual compliance with treatment and the development and progression of complications. With blood glucose control and attentive self-care, the outcome is potentially good. Individuals with type 1 diabetes mellitus have a slightly shorter life expectancy than healthy individuals due to the prevalence of complications.

Source: Medical Disability Advisor



Complications

Complications of type 1 diabetes mellitus can occur even when the disease is effectively controlled. They include increased susceptibility to infections, damage to the nervous system (diabetic neuropathy), kidney disease (diabetic glomerulosclerosis), visual problems from diseased blood vessels in the eye (diabetic retinopathy, glaucoma), macrovascular disease (stroke, peripheral arterial disease and coronary disease) due to hardening of the arteries (atherosclerosis), excessive fat in the blood (hyperlipidemia), foot problems due to poor circulation (diabetic foot), decreased blood pH (ketoacidosis), excessive weight gain, hyperosmolar hyperglycaemic state (HHS) formerly called hyperosmolar non-ketotic hyperglycaemic coma (HONK), and death. Impotence is common among men with diabetes.

Diabetes increases the risk of developing high blood pressure (hypertension) and elevated cholesterol levels (hypercholesterolemia), which may lead to an increased risk of heart attack and stroke.

Women attempting to conceive should closely monitor and control blood glucose levels prior to conception to reduce the risks of birth defects in the developing embryo.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work accommodations may include a flexible schedule to allow for sick days and frequent breaks for small meals or insulin injections; for some a reduced work week may be necessary. A private place, with facilities for hand washing and disposal of glucose testing strips and syringes, may be needed to allow for monitoring glucose levels and administering insulin. Limitations may be placed on continuous physical exertion, working in extreme temperatures or moist areas, working at unprotected heights, and working in isolated areas alone. As the disease progresses, work requiring visual acuity, fine dexterity, prolonged walking, or heavy labor may need to be limited.

Risk: Most onset of type 1 diabetes occurs before entering the workforce. For more information, refer to the discussion of stress and diabetes in "Disease and Injury Causation," page 242.

Capacity: Individuals with very irregular diabetes control may be precluded from driving, flying, working at unprotected heights, or holding safety sensitive positions. For more information on the qualifications for driving, refer to "Work Ability and Return to Work," page 137.

Tolerance: A conducive work environment where time is available to an employee to measure blood glucose and administer insulin may be able to remove any perceived barriers to return to work.

Source: Medical Disability Advisor



Maximum Medical Improvement

In the absence of severe secondary complications (such as MI, stroke, renal failure), MMI can be determined within 90 days, depending on the complexity of the treatment regimen required.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have a family history of diabetes?
  • Does individual complain of polydipsia, polyuria, weight loss despite normal or increased food intake, fatigue, headaches, muscle wasting, muscle cramps, vision changes, visible weight loss from loss of body fluids, anxiety, nausea, vomiting, diarrhea, and/or constipation? Does individual have polyphagia or anorexia?
  • Did physical exam reveal hypotension, weak rapid pulse, or dry mucous membranes (especially the mouth)?
  • At the time of diagnosis, was individual thin with little or no body fat?
  • Does individual's breath have a fruity odor to it? Was breathing deep and rapid?
  • Was urine testing done for glucose and ketones? Comprehensive blood sugar testing (glucose tolerance)? Was a complete blood chemistry profile performed?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Were injections of insulin given?
  • Does individual monitor blood sugar regularly?
  • Has individual received training regarding diet, exercise, and stress reduction? Daily foot care? Early treatment of minor scratches or wounds?
  • Was individual compliant with treatment regimen?
  • Is individual a candidate for an insulin pump?

Regarding prognosis:

  • Can individual's employer accommodate any necessary restrictions?
  • Is individual's diabetes being managed effectively?
  • Does individual have any conditions that may affect ability to recover?
  • Have any complications developed, such as infections, diabetic neuropathy, diabetic glomerulosclerosis, diabetic retinopathy, glaucoma, atherosclerosis, peripheral vascular disease, hyperlipidemia, foot problems, ketoacidosis, excessive weight gain, or coma?
  • Are extremities affected by peripheral vascular disease? Has gangrene developed? Has individual lost all or part of a limb due to amputation?
  • Is individual impotent?
  • Does individual have psychological problems related to dealing with a chronic disease?
  • Have individual and family members been educated about recognizing signs of hyperglycemia, diabetic ketoacidosis, and hypoglycemia?

Source: Medical Disability Advisor



References

Cited

"2011 National Diabetes Fact Sheet." CDC. 2011. Centers for Disease Control and Prevention. 30 May 2013 <http://www.cdc.gov/diabetes/pubs/factsheet11.htm>.

Dabelea, D. , et al. "Incidence of diabetes in youth in the United States: the SEARCH for Diabetes in Youth Study." Journal of American Medical Association 297 (24) (2007): 2716-2724.

Kakleas, K. , et al. "Factors for thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus." Upsala journal of Medical Sciences 114 (4) (2009): 214-220.

Kordonouri, O. , et al. "Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey." Diabetes Care 25 (8) (2002): 1346-1350.

Liese, A. D. , et al. "The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study." Pediatrics 118 (4) (2006): 1510-1518.

Maahs, D. M. , et al. "Epidemiology of type 1 diabetes." Endocrinology and Metabolism clinics of North America 39 (3) (2010): 481-497.

Ramondetti, F. , et al. "Type 1 diabetes and measles, mumps and rubella childhood infections within the Italian Insulin-dependent Diabetes Registry." Diabetic Medicine 29 (6) (2012): 761-766.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Vehik, K. , et al. "Increasing incidence of type 1 diabetes in 0- to 17-year-old Colorado youth." Diabetes Care 30 (3) (2007): 503-509.

Virtanen, S. M. , and M. Knip. "Nutritional risk predictors of beta cell autoimmunity and type 1 diabetes at a young age." Journal of the American College of Nutrition 78 (6) (2003): 1053-1067.

Walsh, John. "Will Inhaled Insulin Really Take Your Breath Away?" Diabetes Network. 2009. Diabetes Services, Inc. 3 Jun. 2013 <http://www.diabetesnet.com/diabetes_treatments/insulin_inhaled.php>.

Source: Medical Disability Advisor






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