What is Diabetes ?
More than 51 million people in India are afflicted with diabetes, and the figure is likely to touch 80 million by 2030. It is no wonder then, that India has been tagged as the ‘Diabetes Capital of the World.
Physiotherapists treat a wide range of conditions and injuries. Many people believe that physiotherapists only treat sports injuries and help rehabilitate patients after surgery. While this is a big part of what physiotherapists do, they also help in a number of other ways that you might not have expected.
Diabetes carries a heavy burden on patients, the healthcare system, and society. Over the next decade, diabetes rates will rise from population growth, an aging population, and declining mortality rates. However, diabetes can be prevented, treated, controlled, and the risk lessened via various health and lifestyle interventions including physiotherapy. Physiotherapists can assess, diagnose, treat, and manage musculoskeletal (MSK) manifestations and complications of type 2 diabetes. They can also counsel patients and provide advice on appropriate and effective exercise, physical conditioning, and active, healthy living.
Types of Diabetes
- Diabetes Mellitus (T1DM or 'Juvenile Diabetes')
- Diabetes Mellitus (T2DM or 'Adult-onset Diabetes')
Diabetes facts
Physical activity is a crucial intervention to prevent and manage type 2 diabetes. Thirty minutes of moderate physical activity/day plus a 5-7% reduction in body weight cuts type 2 diabetes risk by 58% (and 71% for those over age 60).
The benefits of physical activity in people with type 2 diabetes include improved glycemic control, reduced cardiovascular complications, and a 30-50% reduction in mortality. Supervised physical activity programs are more effective than general exercise counseling, home-based exercises, or flexibility exercises. Complications or co-morbidities including cardiovascular disease, obesity, joint pain, neuropathies, skin breakdown, and amputation present barriers to regular physical activity.
Diabetes Nerve Disease (Neuropathy)
Diabetic nerve disease (neuropathy) is the damage caused to the nerves of the body due to high blood sugar levels from diabetes. Those who have long term, uncontrolled high sugar levels are at high risk of developing weak nerves in all the vital organs of the body (Autonomic Neuropathy) like brain, heart, stomach, bladder, intestines, lungs, etc. When the extremities, especially the leg and foot nerves are affected, it is called Peripheral Neuropathy.
Symptoms
- Loss of sensation in toes, feet, arms, and legs; you may not feel the pain if you have a small blister or cut and may find it difficult to distinguish between hot and cold temperatures;
- Very few contraindications
- Deep pain in feet and legs;
- Tingling and burning sensation in arms and legs;
- Sluggish digestion causing diarrhea, constipation, and bladder problems;
- Sexual problems – difficulty in achieving and sustaining an erection long enough to complete the sexual act (erectile dysfunction) in men; vaginal dryness and inability to achieve orgasm in women;
- Changes in skin color;
- Fast heart rate;
- A sudden drop in blood pressure when you stand up after sitting or lying down;
- Dizziness and nausea.
Recommended tests
Diabetic Peripheral Neuropathy Filament test & Biothesiometry to detect nerve damage in early stages;
How do Physiotherapists help in treating Diabetes?
Did you know physiotherapists can help with type 2 diabetes Seeking the help of a physiotherapist may not be your first thought if you have diabetes, but you may be surprised to learn what physiotherapists can do to help you manage the disease? Physical activity helps manage diabetes by improving glycemic control and reducing cardiovascular complications. But getting started is not always easy or straightforward. People with diabetes often have other conditions like cardiovascular disease, joint pain, skin breakdown, nerve pain (neuropathy) or leg ulcers that can make physical activity challenging.
Physiotherapists Treatment in helping patients with diabetes
Prescribing a safe and graduated exercise program: if you are overweight, have joint pain, or have the cardiovascular disease it’s important to start with medically supervised exercises that consider these complications. A physiotherapist can provide suitable activities that are safe and gradual.
Providing specific treatment for joint pain: if you have knee, back, or foot pain that limits your mobility, a physiotherapist can assess the problem and determine if a specific rehabilitation program will help the joint pain and allow you to get moving again.
Assisting with pain management: if you suffer from nerve pain caused by diabetic neuropathy, the physiotherapist can assess if electrical stimulation, desensitization, or targeted exercises will help manage the pain.
Educating you on good footwear: a physiotherapist can assess and advise you on appropriate footwear if you have ulcers or blisters on your feet and show you how to adjust your walking technique to reduce pressure on the feet.
Providing skin and wound care: some specialized physiotherapists can help if you suffer from leg ulcers. Physiotherapists involved in wound care can debride the wound, apply compression bandaging to help circulation, consider if electrical stimulation or laser therapy will help, and provide advice on appropriate exercises and activities.
Health promotion – Support diabetes prevention including physical activity and healthy eating programs for all ages, removal of high sugar foods/drinks from schools, adequate food labeling, and smoking prevention and cessation.
With a strong medical background, physiotherapists work closely with physicians and other healthcare providers involved in your care. Many physiotherapists do not require a doctor’s referral. To find a physiotherapist that treats diabetes
Eat low fat foods like
Dairy and dairy-like products: Low-fat (1%) or fat-free (skim) yogurt, cottage cheese, or milk Sorbet, sherbet, gelatin ices, and low-fat or fat-free frozen yogurt Fish, meat, and poultry: Egg whites or egg substitutes; Crab, white fish, shrimp, and light tuna (packed in water); Veal, chicken and turkey breast (without skin), and lean cuts of other meats (look for “loin” in the name) – braise, roast, or cook them without adding fats; Extra-lean ground beef such as ground round, or ground turkey breast (check the labels)
Veggie burgers; Grains, cereals, and pasta; Hot (oatmeal or grits) and cold cereals (except granola types); Low-fat crackers; Soft tortillas – corn or whole wheat; Toast, English muffins, or bagels with jelly or honey (no butter); Pretzels, soda crackers, or plain bread; Fruits and vegetables
Fruits and fruit juices, applesauce; Vegetables and vegetable juices (again, watch out for fat in sauces you may add)
Snacks and sweets: Danish pudding and fruit pie fillings; Vanilla wafers and ginger snap cookies.
Gelatin; Angel food cake; Puddings made with skim milk
Baked chips, tortilla or potato; Low-fat microwave popcorn; Hard and jelly candies
Broth type soups with a vegetable base; Sauces, pudding, or shakes made with skim milk; Salsa
Light margarine and mayonnaise; Reduced-calorie or fat-free salad dressings
• Eat high fiber and small amounts of fruit
• Eat 5-6 small meals throughout the day. Eating small meals puts less demand on the pancreas
Diabetic Foot and Wound Healing & Hyperbaric Oxygen Therapy (HBOT)
Sometimes, foot ulcers and non-healing wounds result in gangrene and may necessitate amputation of limb..
Treatment Procedure
Hyperbaric Oxygen Therapy (HBOT) which refers to using pressurized pure oxygen to treat conditions such as wounds that won’t heal in patients with diabetes or radiation injury.
