Introduction

Physical therapy (PT), a branch of rehabilitative health, is commonly recommended for patients who need to regain physical abilities that have been diminished by injuries. How can PT combat the effects of diabetes, which is a chronic disease that affects patients' entire systems?

Hyperglycemia: The Specifics

Diabetes is a condition in which the body's ability to process sugar is compromised, either due to insufficient manufacture of insulin from the pancreas (Type 1), or due to the body's resistance to normal insulin levels (Type 2). Since insulin is a molecule that is responsible for bringing sugar into your cells for energy, either of these abnormalities can lead to less sugar being utilized within your cells, where it’s supposed to fuel cellular function. The result is that sugar doesn’t enter your cells and builds up in your blood to an overabundance. This condition is called hyperglycemia, literally high sugar in the blood.

Why is that bad?

From Bad to Worse: Systemic Problems

Your blood stream can tolerate a certain sugar level; beyond that, a build-up of sugar in your blood can lead to cell-level damage throughout your whole system. Our bodies are designed as a complex interaction of thousands of chemical processes, but when even one of those processes becomes imbalanced, the rest of the body does not function properly. So, too high of a sugar level in your blood can be thought of as toxic to the whole system, from your nerves to your heart, and even your eyes.

Typically, PT is focused on addressing muscles and bone—musculoskeletal—problems. The reason for doing PT is to improve the actions and motions of your musculoskeletal system so that you can enjoy better function, and therefore a better quality of life. The amazing thing about PT addressing the specifics of musculoskeletal issues is that it can improve the systemic problems caused by diabetes. In other words, improving motion and musculoskeletal function will improve the disease as a whole. How can improving functional movement cause your insulin to work better? For example, your elbow doesn’t control your sugar level, right?

Ambitious Cycle

Diabetes creates a vicious cycle: hyperglycemia causes harm to your system, and then the harmed system causes the blood sugar levels to rise even more. PT, in contrast, creates the opposite—an ambitious cycle: improving the function of the whole system can reverse hyperglycemia.

Patients with diabetes commonly experience a host of physical problems, including:

• Carpal tunnel syndrome
• Skin thickening on fingers
• Inflamed tendons
• Decreased sensation in feet (neuropathy)
• Skin changes, breakdown, and ulcerations
• Joint pain
• Foot and ankle problems
• Knee arthritis
• Blood clots

Any combination of these can result in decreased function, which leads to decreased movement. PT is all about movement as a way of restoring function.

From Dysfunction to Function

John Adams, the second president of the United States, once wrote in a letter to his son encouraging him to exercise more, “Move or die is the language of our Maker in the constitution of our bodies.”

We are designed to survive best with everything working. The pain that patients with diabetes may experience from inflammation of joints and tendons, nerve damage in the feet and other extremities, and even from circulation problems due to blood vessels damaged by high blood sugar can all limit motion.

Physical therapists understand that diabetes can make you more sedentary, and the risks that presents. Less sugar burned by a sedentary lifestyle means even higher sugar level circulating in your blood stream. When the balancing act of sugar usage and storage is out of whack to begin with, it’s a double whammy. Fats get deposited in your arteries at a greater rate, threatening your heart and other organs. It is a sobering thought that the chances of having a heart attack double with diabetes.

Improved function changes all of that. Movement consumes calories, reducing blood sugar levels. Restoring mobility and movement via physical therapy is an important disruption to the vicious cycle created by diabetes. Additionally, once function is restored, a physical therapist is your educator for maintaining function with the equivalent of a personal trainer’s exercise course, but designed specifically for you, the diabetic.

Conclusion

Function is only part of the equation. An awareness of calories taken in and sugar levels, supported by the right diet and prescribed medicine, factor in. Obesity and diabetes create a perfect storm that may often lead to premature death. Many people living with diabetes can avoid this storm by heeding the advice of their care providers. In addition to physicians, nurse educators, and dietitians, physical therapists play an important role in turning a vicious cycle into an ambitious cycle. If you are managing diabetes without the benefit of a physical therapist, you’re missing a key player on your dream team.