Physiotherapy, Exercise & Diabetes

Physiotherapy is a healthcare discipline concerned with promoting health and preventing disease by examining, diagnosing, treating, and rehabilitating impairments and disabilities that affect people of all ages (children - adult) through variety of treatment methods such as manual techniques, exercises, electrotherapy, hydrotherapy, heat therapy and cold therapy.

Diabetes is a chronic condition affecting people of all ages and walks of life. The disease can cause a number of long term complications, resulting in disability, reduced quality of life, and premature death.

Exercise plays an important role in diabetes. Physiotherapists are experts in exercise prescription for people with chronic illnesses and are therefore able to provide advice on physical activity and promote self-management practices. Physiotherapists also assist with the management of complications associated with diabetes.

Exercise and Diabetes

Everybody benefits from regular exercise. In diabetes it plays an important role in keeping you healthy. The use of exercise in managing diabetes is well documented. How exercise can help:

  • lnsulin to work better which will improve your diabetes control
  • To control your weight
  • Lower your blood pressure
  • Reduce your risk of heart disease
  • Reduce stress

Diabetes can be controlled by lifestyle modifications which include intensive exercise rather than pharmacological therapy. Physiotherapists can help people by planning an individualized exercise program. This exercise program helps to control the glucose level in blood and achieves optimal weight.

Physiotherapy can reduce the frequency of cardiovascular events and improves the life expectancy. It also helps to improve the metabolic movements of the body in absence of weight loss. In addition to physical exercise, the use of alternate therapies such as yoga can help to achieve optimal cardio-respiratory health. Physiotherapists can suggest specific exercises for the people with coexisting complications and caution certain movements that might be detrimental to their health. Effective counseling for physical exercise can ensure both cardio-respiratory and musculoskeletal fitness. For example, an isotonic exercise like jogging helps a person to control high blood pressure and diabetes. But a repeated foot trauma associated with jogging may cause Sensory neuropathy or Charcot’s foot.


Most of the people suffering from diabetes have musculoskeletal complications like frozen shoulder, back pain or osteoarthritis. People with poorly managed type 1 diabetes have a syndrome of limited joint mobility. Diabetic amytrophy is a type of neuropathy that has muscle wasting and weakening in the thighs. Carpal tunnel syndrome and sciatica are the other neurological conditions that occur in people suffering from diabetes.
In all these conditions, physiotherapy plays a major role in returning people to their normal life. The physiotherapist uses a combination of active and passive exercises, and mechanical and electrical aids to promote musculoskeletal and neurological functions.


Isotonic Exercise

Physiotherapy offers various non-pharmacological techniques for pain relief such as Transcutaneous electrical nerve stimulation (TENS) and Interferential therapy (IFT).
Transcutaneous electrical nerve stimulation (TENS) involves electrical nerve stimulation through the skin and sends painless current to the specific nerves. This mild electrical current generates heat that helps to relieve stiffness and pain by improving mobility.

Interferential therapy (IFT) uses the strong physiological effects for the low frequency of electrical stimulation of nerves.

TENS and IFT are considered as gold-standard therapies for neuropathic pain relief. They have proven benefits in the management of painful diabetic neuropathy, resistant foot ulcers, and edema (build-up of fluid in tissue). TENS are most effective against burning and stabbing pain but are less effective against sensitive skin and restless leg syndrome.

TENS and IFT are adopted as primary treatments for painful neuropathy as they are safe and have fewer drug interactions. Other methods such as ultrasonic therapy and hot wax are used for specific conditions of people with both diabetes and other conditions.



Prosthesis Leg

Physiotherapy helps to prevent and manage foot problems. Many numbers of foot complications can be reduced by teaching the importance of correct gait and posture along with the basic principles of off-loading. For people with typical diabetes-related foot problems, the usage of crutches or foot splints can ensure off-loading and early healing.

People who are unfortunate to undergo an amputation can be helped with post-operative pain relief, limitation of disability, rehabilitation, and the optimum use of a prosthesis. Similarly, rehabilitative measures are available for people who are recovering from heart attack, stroke, peripheral vascular surgery, other traumas, and other surgical interventions.


Physiotherapy interventions are usually delivered on a one-to-one basis. It will provide a contemporary approach to chronic medical care. The time spent with the physiotherapist during treatment can strengthen the bonding and enhance communication between them.
The need for physiotherapy services continues to grow as the number of people with diabetes continues to rise with the existing diabetes population. A team of diabetes care with the specialized physiotherapists helps to improve the health and well-being of people with diabetes.

Rehabilitation is needed to strengthen muscles, reduce pain, restore movement and return to best function. At Optima Health Physio Consult, we will work closely with you and your family to assist you helps you return to normal activities and to improve your quality of life. Certified physical therapists perform a comprehensive assessment and develop an individualized treatment plan to address your specific needs. Commonly used techniques during rehabilitation include stretching, joint mobilization, strength training, mobility training, gait training, and pain management. 

Whether the goal is to return to work, function more independently at home or in the community or get back on the field, our physiotherapists  at Optima Health Physio Consult will offer treatment, guidance, education and support to you. 


Staying Fit For Life

If you have diabetes, you have probably been told that exercise is especially good for you and can help you to manage your disease. What are some of the positive changes that regular exercise can bring you?

Benefits Of Regular Exercise

1. Lowers blood sugar levels and improves the way your body uses insulin

2. Improves cholesterol levels, lowers bad (LDL) and raises good (HDL) cholesterol

3. Decreases blood pressure and makes your heart stronger

4. Increases muscular strength and stamina

5. Helps control weight

6. Increases flexibility and improves balance

7. Boosts energy levels

8. Improves self-esteem and sense of well-being

9. Reduces stress

10. Helps you to look and feel great!

Tips For Exercising Safely And Planning For Safe Exercise

  • See your doctor and your physiotherapist for a thorough checkup before beginning an exercise program.
  • Start slowly and increase time and distance gradually.
  • Avoid exercise outdoors in extreme heat or cold
  • Check feet regularly for blisters or injuries.
  • Carry ID that identifies you as a person with diabetes.
  • Do not exercise when you are ill.
  • Keep a record of your blood sugars for your doctor so you can review the effects of exercise on your diabetes. 

Before Exercise

  • Wear loose comfortable clothing and appropriate, well-fitting shoes.
  • Exercise with a partner. It will keep you both on track.
  • Wait about 1 hour after eating before exercise.
  • Check blood sugars before and after exercise.
  • Take along a source of fast-acting carbohydrate like glucose tablets in case your blood sugar becomes low (below 70 mg/dl) while exercising.
  • Drink plenty of water, before, during and after exercise.
  • If you have type 1 diabetes and your blood sugar is over 250 mg/dl then check for ketones before exercise. Do not exercise if you find ketones.
  • If you have type 2 diabetes and your blood sugar is over 350 mg/dl before exercise, you blood sugar could go up or down with exercise. Be sure to check your blood sugar again after exercise. 

If you suffer from diabetes and want to learn more about how exercise can help you, it is important that you have your condition assessed by a physiotherapist.

Now, let me talk more on diabetes...

What is Diabetes?

Diabetes affects the way your body uses carbohydrates (starches, fruit, and milk), protein and fat. Diabetes occurs when the pancreas does not make insulin at all (Type 1 Diabetes) or when the body cannot properly use the insulin that the pancreas does create (Type 2 Diabetes). If either of these should occur, sugar (the body's main energy source) builds up in the blood, starving the cells for energy. In time, this can damage the eyes, kidney, nerves or heart, producing a life-threatening situation.

Warning Signs of Diabetes - Hyperglycemia

Some warning signs of high blood sugar include:

  • Excessive thirst
  • Excessive urination, especially at night
  • Feeling very tired most of the day
  • Cuts or sores that are slow to heal
  • Blurry vision from time to time
  • A tingling feeling or no feeling in the hands and feet
  • Experiencing more infections than usual
  • Sexual problems
  • Acanthosis nigricans, a darkened pigmentation of the skin folds (i.e., neck, elbows, behind the knees or the groin areas)

Check your blood sugar frequently if you have any of the signs of high blood sugar noted above.

Warning Signs of Hypoglycemia with Diabetes

Once diagnosed and in treatment, you may have some or none of the warning signs of low blood sugar:

  • Sweating
  • Hunger
  • Headache
  • Shaky
  • Tired/sleepy
  • Grouchy/Irritable
  • Rapid heartbeat
  • Poor concentration
  • Numbness or tingling around mouth or tongue

Types of Diabetes

Type 1 Diabetes: Previously called IDDM or Juvenile Onset Diabetes

Type 1 diabetes is an autoimmune disease, similar to thyroid disease, lupus or rheumatoid arthritis and approximately 10 percent of people with diabetes are diagnosed with this type. Islet Cell Antibodies (ICA) destroy the beta cells of the pancreas. These ICAs are often present at the time of diagnosis.

There is typically a family predisposition to Type 1 diabetes due to specific tissue types that run in families.

Facts About Type 1 Diabetes Include

  • Must administer insulin: inject, inhale or pump insulin to live
  • Pancreas produces little or no insulin
  • Usually develops in individuals before the age of 30
  • In children, symptoms may occur suddenly with frequent urination, thirst, extreme hunger and fatigue, rapid weight loss and very high blood sugar levels (onset of symptoms in adults is more gradual, often being mistaken for Type 2 diabetes)
  • If untreated, can progress to ketoacidosis and coma
  • Can occur throughout the life span


Type 2 Diabetes: Previously called NIDDM or Adult Onset Diabetes

Type 2 diabetes occurs when the body cannot properly use the insulin that the pancreas creates and approximately 90% of people with diabetes are diagnosed with this type. In addition, the pancreas produces insulin in insufficient quantities for the demands of the body.

Facts About Type 2 Diabetes Include

  • Happens more gradually
  • More frequently occurs after the age of 30 but increasing numbers of children and adolescents are being diagnosed
  • 80 to 90 percent of individuals who get Type 2 diabetes are overweight
  • Individual may have new or no symptoms
  • Treatment Depends On The Individual Person And May Include
  • Dietary modification and/or weight management
  • Increased activity
  • Medication
  • Lifestyle changes
  • Blood pressure and lipid management
  • Combination of all these items
Major Metabolic Problems Include
  • Insulin resistance in the muscle, liver or fat cells
  • Increased glucose production in the liver
  • Impaired insulin secretion from the pancreas

Other Metabolic Derangements Include

  • High blood pressure
  • High lipid levels
  • Obesity
  • High insulin levels

Risk Factors

  • Overweight
  • Family history of diabetes
  • Hispanic, African-American or Native American
  • 10-16 years of age or over 30 years of age
  • Prior history of large babies or diabetes during pregnancy (gestational diabetes)
  • Inactive lifestyle
  • High blood pressure
  • HDL cholesterol less than 35 mg/dl and/or triglycerides greater than 250 mg/dl


Gestational Diabetes

Gestational diabetes is the type of diabetes that occurs only during pregnancy. It affects seven percent of all pregnancies in the United States and 11 percent in San Antonio where there is a high incidence of obesity and diabetes among the Hispanic population. This carbohydrate intolerance of variable severity is usually detected between 24-28 weeks of pregnancy, and tends to resolve once the baby is born. It is extremely important to control elevated blood sugars in both types of diabetes to reduce complications in the mother and the baby.

Risk Factors Associated With Gestational Diabetes Include

  • African American, Hispanic/Latino American, American Indian
  • Family history of diabetes
  • Obesity
Diabetes & Pregnancy

Pregnancy and new motherhood are times of great excitement, worries and many changes for any woman. If you have diabetes and are pregnant, your pregnancy is automatically considered a high-risk pregnancy. High risk means you need to pay special attention to your health. Special care and attention are the keys to a successful pregnancy.


Diabetes Statistics

The Facts About Diabetes

According to the most recent estimates, diabetes remains the 7th leading cause of death in the United States. People with diabetes are at higher risk for heart disease, stroke, blindness, kidney failure, extremity amputations and other chronic conditions. Some complications, especially microvascular (eye, kidney, and nerve) disease, can be reduced with good glucose control.

Early detention and treatment of complications can prevent progression, so it is essential to monitor with eye exams, urine tests and foot exams. Because the risk of cardiovascular disease increases in diabetic and pre-diabetic patients, it is especially important to check blood pressure, improve nutrition and encourage smoking cessation. Health care provides working together with people diagnosed with diabetes and their support network can reduce the occurrence of any complications.

More Facts About Diabetes

Diabetes by Race/Ethnicity

  • 15.1 % American Indians/Alaska Natives
  • 12.1% Hispanics
  • 10.2% White
  • 17.0% Black
  • 8.0% Asians 

Diabetes by Gender

  • 12.3% Men
  • 10.6% Women 

Date reported: 2015 | Sources of Information:

American Association of Diabetes Educators
American Diabetes Association 
Centers for Disease Control and Prevention
Health Collaborative 
Texas Diabetes Council

Optima Health Physio Consult