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Diabetes and Physiotherapy

There are two main types of diabetes; insulin dependant(Type 1) and non-insulin dependant(Type 2)

 Type 1 This is an inherited autoimmune disease where antibodies are produced against the beta cells in the pancreas. This leads on to the non production of insulin which is necessary to control the blood glucose levels. The onset tends to occur in childhood and adolescence. The aim of treatment is to control glucose levels and prevent vascular complications

 Type 2 This a disease of late onset linked to both genetic and lifestyle factors. These lead to reduced insulin secretion and a resultant chronic hypoglycaemia.

 The treatment of both types of diabetes depends on the maintenance of near normal glucose levels. For those with Type 1 diabetes this requires the taking of insulin to control sugar levels, and further management through diet. Those with Type 2 diabetes only require insulin if their glucose levels are poorly controlled; the majority being controlled through diet, exercise and weight loss. For individuals with either type of diabetes, a low-fat, carbohydrate controlled diet is ideal, with an emphasis on an increased intake of complex  as opposed to simple carbohydrates.

 Physiotherapy

Physiotherapy is an essential part of the maintenance and rehabilitation of many individuals. Its value will be recognised in many areas of the human condition; not least by those that are affected by diabetes. Many physiotherapists have specialised in the provision of exercise therapy and are experts in this field and they will encounter those people with diabetes and consider their exercise therapy in light of this condition

 The target of any adult is to try and achieve at least 30 minutes of continuous moderate activity, equivalent to a brisk walk 5 or 6 times a week. Exercise is a very important factor in the treatment of diabetes and its effect must be considered in those individuals who are taking insulin.

 The diabetic sportsperson needs to have an understanding of the effect of exercise on their blood sugar levels.

 Type 1 diabetes and exercise

 Exercise helps to improve insulin sensitivity and blood lipid levels; decrease heart rate and resting blood pressure; decrease body weight and thereby reduce obesity; and reduce the risks of coronary heart disease. The type 1 diabetic will tend to live longer if they take up regular exercise

Both insulin and exercise independently help cellular glucose uptake and their actions are cumulative. So an exercising type 1 diabetic will have lowered insulin requirements. Control of blood sugar is achieved through a balance in carbohydrate intake, exercise level and insulin dose and it is very important that the diabetic monitors their glucose levels before and after the exercise session. Frequent self-monitoring should be undertaken, especially if taking up new activities, so that a balance is achieved in the diet, exercise and insulin parameters.  Individuals are encouraged to monitor their sugar levels before, during and after exercise so as to learn their patterns of response to different intensities and duration of exercise, so as to avoid any potentially life-threatening complications.

 Type 2 diabetes and exercise

 It is well recognised that exercise helps reduce the chances of developing type 2 diabetes and a regular exercise regime can reverse many of the defects in metabolism of both fat and glucose that occurs in people with type 2 diabetes. Those people controlling this type of diabetes through diet therapy alone are unlikely to need to make any adjustments for exercise.

 Musculoskeletal disorders, diabetes and physiotherapy

There are a number of musculoskeletal disorders that tend to be found more in diabetic individuals compared to the normal population. These are:

 Adhesive Capsulitis( frozen shoulder)

 This condition is characterised by pain and loss of movement in the shoulder joint. It can be aided in recovery by physiotherapy aimed at increasing mobility and decreasing pain, reducing effects of associated factors, education and advice regarding the nature of the condition and direction in graded exposure to exercise as the condition allows. Its prevalence is 11-30% in those with diabetes

 Limited joint mobility(Diabetic cheiriarthropathy)

 This is characterised by thick, tight waxy skin, mainly on the back of the hand with limited joint mobility in the fingers. Physiotherapy is directed at individual hand therapy. Prevalence is 5-50% in diabetic patients

 Dupuytren’s contracture

 This is usually seen as contracture of the fascia in the palm of the hand leading to deformation of the hand with contraction of the 4^th and 5^th digits. However the 2^nd and 3^rd digit tend to most affected in diabetics. Physiotherapy can help mobility and education. Prevalence is 20-63%

 Carpal tunnel syndrome.

 This is pain and dysaesthesia in the wrist and hand and 5-8% of diabetics also have a diagnosis of carpal tunnel syndrome. Physiotherapy assessment is often utilised in the examinations of these patients and help can be given for associated factors, when they are involved, such as neural involvement from the neck and in neural tension in the upper limb nerves.

 Tenosynovitis

 This is associated with the duration of diabetes but not age. Its prevalence is 11% in diabetics. Physiotherapy is directed at reducing pain, improving mobility as able, and education and advice.

Complex regional pain syndrome type1 (CARP 1)

 This is characterised by peripheral and central sensitisation leading to continuing pain out of proportion to the stimuli, and from vasomotor dysfunction. Physiotherapy is aimed at pain relief and mobility, as able. The use of cognitive behavioural techniques are utilised, to encourage a gradual exposure of the individuals to activity.

 Diffuse idiopathic skeletal hyperostosis (DISH)

 Prevalence of this in diabetics is 13-49% and is identified by the production of new bone especially in the thoraco-lumbar region. Ossification is seen in ligaments and tendons elsewhere, including the skull, heels and elbows. Management includes physiotherapy

 Most of the information seen here is taken from “ Clinical Sports Medicine” by Brukner and Khan. McGraw-Hill Medical 2007.  This article was written by Paul Johnson; MSc, MCSP