How Physical Therapy Can Help You Manage Diabetes
Based on research studies from the CDC (Centers for Disease Control), almost 30 million individuals (children as well as adults) have diabetes–that amounts to roughly 9.3% of the population. However, only an estimated 21 million of these people have actually been diagnosed. That means that around 8.1 million people in the US have no idea that they are diabetic. And close to 86 million people living in the US have pre-diabetes. This is where blood sugar (glucose) levels are abnormally high but are not yet considered diabetic.
What Exactly Is Diabetes?
If you have been diagnosed with diabetes, it means your body is not properly using or producing insulin. Insulin is a hormone that is needed to let glucose (sugar) enter the cell and provide the energy needed for daily activities, and is produced by the pancreas. When adequate amounts of insulin are not produced by the pancreas, or when the liver, muscle, and fat cells don’t respond properly to insulin, glucose builds up in the blood (hyperglycemia). This can be very toxic to your cells. Also, due to the decreased glucose uptake in the cells, they can use an abnormal amount of fats for fuel (ketoacidosis) and can become undernourished.
When talking about diabetes it is important to distinguish between the 3 main types:
Type 1 diabetes – This develops most often in children and young adults. Here, the immune system destroys beta cells (insulin-producing cells) of the pancreas
Type 2 diabetes –This can develop at any age and can be largely preventable. Here, the cells of the body actually become resistant to insulin, and the pancreas is unable to produce enough insulin to override the resistance.
Gestational diabetes - This develops in women during pregnancy. It also occurs more frequently in Hispanic Americans, African Americans, and American Indians (as well as women with a family history of diabetes). It is also associated with inactivity and obesity.
Although it is not exactly known what causes diabetes, we do know that factors such as lack of exercise and obesity play significant roles in Type 2 diabetes. Diabetes can result in conditions such as:
High blood pressure
Peripheral vascular disease
Skin problems, including infections and ulcers
Decreased muscle strength and physical function
What Are The Signs And Symptoms Associated With Diabetes?
Symptoms of diabetes include:
High blood pressure
Constant or extreme hunger
Unexplained weight loss
Frequent infections, such as skin, gum, bladder, or vaginal infections
The onset of Type 1 diabetes can happen fairly suddenly. What’s important to realize is that, if you have ketoacidosis, your cells are using excessive amounts of fats for fuel and can be undernourished to the point that you could lapse into a diabetic coma unless you receive insulin. The onset of Type 2 diabetes, in contrast, usually develops much more slowly–and it’s possible you may not even experience any symptoms.
What Are The Recommended Measurements For Adults With Diabetes?*
Preprandial plasma glucose (before a meal) 70-130 mg/dl (5.0-7.2 mmol/l)
Postprandial plasma glucose (after a meal) <180 mg/dl (<10.0 mmol/l)
Blood pressure <130/80 mmHg
LDL <100 mg/dl (<2.6 mmol/l)
Triglycerides <150 mg/dl (<1.7 mmol/l)
HDL >40 mg/dl (>1.1 mmol/l) men,>50 women
* Based on American Diabetes Association*
How Can Physical Therapy Help Those With Diabetes, Or May Be Susceptible To Diabetes?
Physical activity is the basis for the prevention of diabetes, and along with diet and medication, the foundation for treatment of diabetes. If you’re already a diabetic, then you should know that you must control your blood glucose (sugar), lower your cholesterol and blood pressure, maintain a healthy weight, and exercise to lower your risk of stroke and heart disease. Regular physical activity can also reduce your need for medications, especially if you are pre-diabetic. The American Diabetes Association recommends 30 minutes of moderate exercise at least 5x/week and should include both aerobic and strength workouts. Your Physical Therapist should conduct a thorough evaluation, including a detailed medical history and list of medications, and create an individualized exercise program tailored specifically for you.
How Physical Therapy Can Help You To Manage Your Weight, Reduce Your Risk Of Heart Disease, And Lower Your Blood Sugar Levels
Based on the present status of your health, your Physical Therapist should include aerobic exercises in your program to meet your individual goals. This should include both moderate and vigorous aerobic exercise. Moderate-intensity aerobic exercise is where your breathing rate and heart rate both increase–even though you may sweat, you should still be able to carry on a conversation. This might include swimming, brisk walking, gardening, and ballroom dancing. Vigorous aerobic exercise is where you breathe rapidly and you can only speak in short phrases. You definitely perspire, and your heart rate increases substantially. This might include jogging, hiking uphill, martial arts, and fast dancing. Your Physical Therapist should recommend physical activity at least 3x/week, with no more than 2 consecutive days without physical activity.
If you are a Type 2 diabetic then your Physical Therapist should prescribe resistance exercises, which utilize weights or elastic bands (unless you have another medical issue that makes them unsafe). The goal is to try and do them 3 days/week. Your Physical Therapist should determine a safe starting point, including the amount of weight and number of repetitions.
Your Physical Therapist should also help you to manage exercise precautions. Some of these include:
If you have Type 1 diabetes in addition to hyperglycemia (high sugar levels) and your blood glucose is > 250 mg/dl, you need to check your urine for ketones before initiating exercise. Ketones are created when the body breaks down fat for energy (ketoacidosis). If no ketones are found you may exercise with caution. If ketones are found you should not exercise vigorously. If you have Type 2 diabetes you should not have to postpone exercise for high blood glucose if you are feeling well and are also well hydrated.
If you take insulin or medication that helps the body to produce more insulin, you should eat carbohydrates before exercise if your blood sugar is less than 100mg/dl. You may also need to speak with your Physical Therapist re: when it’s appropriate to take medications in relation to when you exercise.
If you suffer from diabetic retinopathy (eye disease) your Physical Therapist should create an exercise routine that addresses the activity limitations as recommended by your eye doctor (e.g., no heavy weights).
If you have diminished sensation in your lower legs and feet from peripheral neuropathy you are still able to perform weight-bearing exercises. Recent studies have shown that these issues do not increase the risk of skin breakdown. Careful daily inspection of the feet in individuals with diabetes is very highly recommended.
Make sure to consult your Physical Therapist to assist you with physical activity if you have any of the following:
Numbness or tingling in the feet
Calluses or sores (ulcers) on your feet
Pain in your joints or muscles
Pain or limping with walking
Had a stroke
Used an assistive device such as a cane, walker, or crutches
Any questions pertaining to the best exercises that are right for you
What Happens When You Have Complications?
If you neglect to manage your diabetes properly, it can cause problems in nerves and blood vessels, often in the legs. If blood flow to the legs is decreased you can experience cramping pain while walking or lead to skin breakdown on the legs or feet (ulcers). If nerves are affected, you can experience tingling in the feet, which may progress to complete numbness. This is extremely critical because the numbness can mask any damage to the joints or skin because you don’t feel the pain in the normal way. These issues can affect your daily activities, limit your ability to exercise, and can also negatively affect your overall health. If any of these problems occur, notify your Physical Therapist so they can:
Evaluate and care for skin ulcers that are slow to heal
Help decrease your cramping pain during walking
Use special tests to check the sensation in your feet
Instruct you in how to protect your feet if they have lost sensation
Improve your walking ability by adapting shoes or orthoses
If you or anyone you know is affected by diabetes, be proactive, and don’t wait to take action. Call my office at once at (302) 691-9055 or visit my website at www.wildermanphysicaltherapy.com to schedule your FREE 30-minute consultation to see how Physical Therapy can help.