How Physical Therapy Can Help Your Diabetes

| Dr. Kristen Reed

Diabetes mellitus (DM) is a group of metabolic diseases that results in elevated blood glucose levels and can result in long-term damage or dysfunction of various organs. Managing DM takes an interdisciplinary team that usually includes a physician, nurse, and dietician. Additional team members may include a pharmacist, clinical exercise specialist, podiatrist, psychologist or counselor, and a physical therapist (PT). 

As part of the interdisciplinary team, the PT has 3 main roles. These include assisting with prevention strategies, creating strategies to prevent the disabling and life-threatening complications of DM by managing day-to-day, and assisting with the management of chronic complications that have been acquired within the musculoskeletal, neuromuscular, cardiovascular/pulmonary, or integumentary systems. 

Physical activity is the primary means for blood glucose control and can prevent or delay the onset of type 2 DM as it directly affects blood glucose levels. Following exercise, cells are better able to respond to insulin and glucose uptake in the bloodstream and the effect can last up to 1 day in older adults. However, sessions must be regular and frequent. Physical activity can also improve blood pressure, and cardiovascular health, reduce the risk for mortality and improve quality of life. The PT can assist with creating an appropriate physical activity program, gradually and safely increasing the physical activity, managing the physical activity program with food intake and medications, and assisting with creating realistic and practical goals. 

The PT can also assist with the management of chronic complications that occur across body systems:

Musculoskeletal System

  • Diabetes exaggerates and adds to the impairments and functional limitations that occur with an aging musculoskeletal system
  • Common changes include:
    • Soft tissues becoming more rigid, less pliable, and less extensible leading to decreased range of motion
    • Changes to the form and function of the foot and lower body 
    • Weakness in the intrinsic muscles of the foot and the lower body can lead to a muscle imbalance
  • PT can assist by:
    • Educating on appropriate shoes to reduce the effects of DM, provide pressure distribution in the shoe, and improve overall functional mobility
    • Referring to professionals to create custom inserts or modify shoe gear
    • Determining the need for assistive devices, such as an ankle-foot orthosis, & monitoring that they are fitting appropriately to avoid breakdown of skin
    • Provide and educate on the benefits of exercise in the management of a reduced range of motion and strength
    • Assist with early recognition and treatment of complications due to high blood sugar levels and their effects on joint mobility and range of motion, especially in the foot
    • Creating a home exercise program to prevent recurrence of signs/symptoms and maintain functional outcomes

Neuromuscular System

  • Highly likely that there will be DM-related complications as well as age-related changes that affect multiple systems of the body
  • Common changes include:
    • Small-fiber neuropathy which contributes to foot ulcerations
    • Large-fiber neuropathy produces numbness, muscle weakness, and sensory ataxia, and may lead to falls
    • Neuropathy may also be associated with postural instability, leading to an increased number of falls
    • Reflexes are often diminished or absent in older persons with DM 
  • PT can assist by:
    • Designing an exercise program that takes special care to protect the feet and ensure safety
    • Addressing balance and gait problems & recommending potential assistive devices
    • Educating on pain management to improve overall comfort
    • Stabilizing the joint to minimize trauma
    • Creating an exercise program to maintain strength and reduce the risk of falls
    • Provide education on daily foot care 

Cardiovascular/Pulmonary System

  • Vascular health is negatively impacted even in a prediabetes state, before the actual diagnosis of DM 
  • Heart disease is the leading cause of DM-related deaths
  • Common changes include:
    • Abnormal blood pressure, heart rate and rhythm, respiratory rate, and heart/lung sounds
    • May have silent macrovascular complications or atypical presentation of heart disease
    • 3 major cardiac syndromes associated with DM: orthostatic hypotension (drop in blood pressure with change in position), cardiac denervation syndrome (resulting in not being able to feel typical symptoms associated with a heart attack), & abnormal cardiovascular response to exercise
    • Decreased exercise tolerance
    • Causes interruption or delay of healing processes for wounds due to decreased blood flow, increasing the risk of amputation
  • PT can assist by:
    • Educating on the benefits of a therapeutic lifestyle that includes exercise and stress reduction
    • Closely monitoring vital signs during physical activity to create a safe and beneficial program 
    • Educating on how to monitor exercise intensity when vital signs do not respond typically
    • Initiating extended warm-up and cool-down periods into the exercise program as needed

Integumentary System

  • At least 33% of people with DM will develop a skin disorder that is caused or affected by DM 
  • Common changes include:
    • Bacterial infections, fungal infections, and itching
    • Anhidrosis (lack of sweating): causing dry skin and a loss of sweat/oil production which normally helps to protect the skin
    • Areas of irritation or skin breakdown from improper insulin injection techniques
    • Problems with wound closure and healing
  • PT can assist by:
    • Looking for signs of complications with healing following surgical procedures
    • Education on proper skin care
    • Educating on regular foot inspections & what to look for with beginning tissue damage
    • If amputation occurs, instruction on the care of residual and remaining limbs, therapeutic exercise, gait training, and prosthetic training

If you are suffering from diabetes, contact Live Your Life today so that we can help with prevention management, alleviating your symptoms, and improve your overall quality of life!

Dr. Kristen Reed

Dr. Kristen Reed, DPT, GRS, CLT graduated in 2011 from the University of Minnesota-Twin Cities with a B.S. in Kinesiology degree. She went on to graduate with a Doctorate of Physical Therapy from St. Catherine University (2015) and completed the Geriatric Clinical Residency program at the University of Minnesota- Twin Cities in 2016. She has spent her career working with primarily geriatrics in the Transitional Care/ Memory Care/ Long Term Care settings. Dr. Reed loves working with geriatrics and is passionate about helping them improve their quality of life. She loves being a therapist and watching her clients reach their goals.

She is kept busy with her husband and young daughter. She enjoys spending time with friends and family as much as possible. Her favorite activities are hiking in the summer and downhill skiing in the winter.


1Scarborough P. Diabetes across the physical therapist practice patterns. APTA: Focus Physical Therapist Practice in Geriatrics. 2011; 6: 1-47. 

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