Role of Physiotherapy in Diabetes

Diabetes mellitus - a clinical syndrome characterized by polydypsia, polyphagia and polyuria. The prevalence of diabetes is rising all over the world due to population growth, aging, urbanisation and an increase of obesity and physical inactivity. Unlike in the West, where older persons are most affected, diabetes in Asian countries is disproportionately high in young to middle-aged adults. The International Diabetes Federation (IDF) estimates the total number of people in India with diabetes to be around 50.8 million in 2010, rising to 87.0 million by 2030.

Preventing diabetes
The Diabetes Prevention Project demonstrated that lifestyle modification, including intensive exercise, is more effective in preventing diabetes than pharmacological therapy, and highlighted the role of trained professionals in motivating people to follow lifestyle interventions.

Physiotherapists are able to help people, to plan an individualized exercise programme in order to maintain good blood glucose control and achieve optimal weight.

Furthermore, physiotherapy leads to metabolic improvements even in the absence of weight loss, reducing the frequency of cardiovascular events and improving life expectancy. Effective exercise counseling ensures both cardiorespiratory and musculoskeletal fitness. This helps people with diabetes improve their quality of life, and contributes to overall control of blood glucose. The use of alternative therapies, such as yoga, can contribute to the achievement of optimal cardio-respiratory health.

Physiotherapists can help people to maintain good blood glucose control and achieve optimal weight.

While most any exercise is healthy for people with diabetes, let's look at some specific types of exercise and their benefits:

Strength Training and Type 2 Diabetes
The latest findings show that exercise such as strength training has a profound impact on helping people manage their diabetes. In a recent study 16 weeks of strength training produced dramatic improvements in sugar control that are comparable to taking diabetes medication. Additionally, the study volunteers were stronger, gained muscle, lost body fat, had less depression, and felt much more self-confident.

Aerobic Fitness and Type 2 Diabetes
Any activity that raises your heart rate and keeps it up for an extended period of time will improve your aerobic fitness. Aerobic exercise helps decrease the risk of type 2 diabetes and helps those with diabetes to better manage their blood sugar levels. Besides the health benefits, exercise is fun and boosts your mood. It's hard to feel stressed when you're walking on a treadmill or swimming laps in a pool.

Type 2 Diabetes and Exercise Tips
·To reduce the risk of hypoglycemia if you have diabetes, follow a regular routine of exercising, eating your meals, and taking your medicines at the same time each day.
·Prolonged or strenuous exercise can cause your body to produce adrenaline and other hormones that can counteract the effects of insulin and cause your blood sugar to rise. If you are participating in strenuous exercise (exercising at your maximum capacity) or prolonged exercise (lasting for several hours or more), your insulin and/or oral diabetic medicine or your calories may need to be changed. Talk to your health care provider about how to adjust your medicine.
· Be careful exercising when your medicine is reaching its peak effect.
· Depending on the time of exercise, reducing your dose of either long-acting insulin or short-acting insulin may be necessary. Your doctor can recommend how to make this adjustment.
· Exercise with someone who knows you have diabetes and knows what to do if you have a low blood-sugar reaction.
· Wear a medical identification tag (for example, MedicAlert) or carry an identification card that states you have diabetes.
· Check your sugars before, during and after exercise and always carry a small carbohydrate snack such as a fruit or fruit drink since low blood sugars can occur.
Pain relief

Physiotherapy offers various effective non-pharmacological approaches for pain relief. Transcutaneous electrical nerve stimulation (TENS) involves electrical nerve stimulation through the skin, sending a painless current to specific nerves. The mild electrical current generates heat that serves to relieve stiffness, improve mobility, and relieve pain.

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

TENS and IFT are considered gold-standard therapies for the relief of neuropathic pain, and have proven benefits in the management of painful diabetic neuropathy, edema (build-up of fluid in tissue) and resistant foot ulcers. TENS has been shown to be most effective against burning and stabbing pain, but comparatively less efficient for the relief of painfully sensitive skin and restless legs syndrome.

Other modalities, such as ultrasonic therapy and hot wax, are useful for specific conditions in both people with diabetes and people without the condition.

Physiotherapy can play an important role in preventing and managing foot problems.

Understanding the importance of correct gait and posture, along with the basic principles of off-loading when required, can prevent or stabilize a number of foot complications. In people with tropic ulcers, for example, which are typical in people with diabetes-related foot problems, the effective use of crutches or foot splints can ensure early healing.