Physical Therapy Guide to Diabetes
Diabetes is a condition in which the body does not produce enough of the hormone insulin. It can also occur when the cells in the body do not react normally to insulin. When diabetes is present, the level of sugar (glucose) in the blood becomes too high. High blood sugar can cause many health problems.
As of 2018, the Centers for Disease Control and Prevention estimated that 34.2 million Americans (10.2%), had diabetes. About 7.3 million of those people may be unaware that they have the disease. Diabetes rates are almost double for Native Americans and African Americans. Diabetes was the seventh leading cause of death in the United States in 2017. Worldwide, approximately 463 million adults were living with diabetes in 2019.
Diabetes can affect anyone at any age. Physical problems related to diabetes include weakness, loss of endurance, obesity, and balance problems. Diabetes often leads to the problem of lower physical activity (which causes many other diseases). Physical activity and exercise are effective ways to lower high-blood sugar levels. Physical therapists help people with diabetes improve or avoid related problems. They teach people how to safely add physical activity to their lives in effective and enjoyable ways.
You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is Diabetes?
Diabetes (diabetes mellitus) is a disease in which the body does not produce, or properly use, insulin. Insulin is a hormone produced by the pancreas. It allows sugar to enter cells and provide the energy needed for daily activities. When the pancreas doesn't produce enough insulin, too much sugar builds up in the blood. This sugar build up also can happen when muscle, fat, and liver cells don't properly respond to insulin. This buildup of blood sugar is called hyperglycemia. It can be toxic to cells throughout the body. When cells don't have enough sugar to use for energy, they use an abnormal amount of fats for fuel. This condition is called ketoacidosis, and may result in a person becoming undernourished.
There are three types of diabetes:
- Type 1 develops most often in children and young adults. In this type, the immune system destroys the insulin-producing cells (beta cells) of the pancreas.
- Type 2 can develop at any age and is usually preventable. The body's cells develop insulin resistance. The pancreas can't produce enough insulin to override the resistance.
- Gestational diabetes develops in women during pregnancy. It occurs more often in African Americans, Native Americans, and Hispanic Americans. It also is more likely to occur in pregnant women with a family history of diabetes.
The exact cause of type 1 diabetes is unknown. The following factors play important roles in developing type 2 and gestational diabetes:
- Poor diet.
- Lack of physical activity.
Complications of all types of diabetes can include:
- Heart disease.
- Heart attack.
- Stroke .
- High blood pressure.
- Retinopathy (eye disease) which can lead to vision problems and blindness.
- Kidney disease.
- Neuropathy (nervous system disease). This can result in foot and hand pain, inner-ear nerve damage, and balance problems.
- Peripheral vascular disease (a blood circulation disorder).
- Reduced muscle strength (frailty) and physical function.
- Skin problems, including sores, ulcers, and infections.
- Cell death (necrosis), most often in toes and feet.
- Premature death.
Signs and Symptoms
The following signs may be present in those with diabetes:
- Slow-healing sores.
- High blood pressure.
- Frequent infections of the gums, skin, vagina, or bladder.
- Unexplained weight loss.
Diabetes symptoms include:
- Increased thirst.
- Frequent urination.
- Constant or extreme hunger.
- Tingling, burning, or numbness in feet and hands.
- Blurred vision.
- Pain in joints or muscles.
- Cramping or pain in the legs, or limping while walking.
- Chronic pain.
The American Diabetes Association offers information on target blood sugar levels and other measures.
How Is It Diagnosed?
Diabetes is diagnosed by a doctor, based on a test of your blood glucose level. This test is ordered by a doctor when a person reports some of the signs and symptoms of diabetes. Your doctor also may order a test if you have other risk factors.
If you have diabetes, a physical therapist can work with you to reduce your symptoms and provide treatments based on your personal needs and goals. They will work with you on physical problems that can be helped with a personalized exercise program
How Can a Physical Therapist Help?
Physical therapists help people with diabetes take part in safe, effective exercise programs. This can help lower your blood sugar levels. Your physical therapist can help you improve your ability to move, perform daily activities, and reduce pain. Physical therapy treatments also can help heal diabetes-related skin problems faster than without treatment.
Your physical therapist will examine your record of blood glucose levels and check your skin for wounds. They also will conduct a complete assessment of your:
- Skin sensation (especially in the feet).
They will use the results of these tests to design a personalized treatment program that addresses your problems and needs. Your treatment program can help improve your:
Movement. Your physical therapist will choose specific activities and treatments to help restore normal movement. These might begin with passive movements that the physical therapist performs for you to gently move your joints. They can help you progress to active exercises and stretches that you can do yourself.
Strength. Your physical therapist can teach you the right exercises to steadily and safely restore your strength.
Flexibility. Your physical therapist will determine if any muscles are tight and help you gently stretch them. They can teach you what to do to improve your flexibility.
Endurance. Regaining your endurance is important. You may have weakness due to inactivity. Your physical therapist can teach you exercises to help you regain the energy to return to your normal activities.
Balance and coordination. Regaining your sense of balance is important to prevent falling. Coordination is also essential for daily living and work-related activities. Your physical therapist can teach you how to improve your balance and restore your coordination.
Walking ability. Your physical therapist can improve your ability to walk in comfort by adjusting your shoes or adding inserts (orthotics) to support your feet and ankles. They may teach you how to use a walker or a cane, if needed, to help you walk safely.
Pain levels. Physical therapy treatment is a safe way to treat chronic pain. Your physical therapist may use different types of treatments and technologies. They will prescribe the most effective and safe exercises for you to perform to control and reduce pain. Your physical therapist can teach you how to protect painful areas to make them less sensitive to diabetic nerve pain (neuropathy).
Blood glucose levels. Physical activity, such as prescribed exercise, can help lower your blood sugar levels. Your physical therapist can design a safe, personalized exercise program to help you control and lower your blood sugar.
Healing of sores. Your physical therapist can apply bandages, dressings, lotions, and treatments to help sores heal faster. They also may check your footwear for proper fit and overall condition. They will teach you how to perform daily foot and skin checks to prevent blisters and sores from developing.
Home exercise. Your physical therapist will teach you how to strengthen, and stretch your muscles. They also will teach you aerobic exercises to perform on your own at home. Your exercise program will be specific for your needs. Doing these exercises as prescribed can speed your recovery.
Ability to perform daily living and work activities. Your physical therapist will discuss your activity goals with you and use them to set your recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible.
Consult with a physical therapist before you begin any exercise program to address diabetes symptoms.
If Surgery Is Required
If a part of your body becomes too damaged by the effects of diabetes, you may require an amputation. Your physical therapist can prepare you for surgery and help you recover afterward. They can help you manage pain and heal faster. Your physical therapist also can help you learn how to use prosthetics. They can help you regain your walking ability and safely get back to being active as soon as possible.
Can This Injury or Condition Be Prevented?
Type 1 diabetes cannot be prevented because science has yet to determine its cause(s).
Type 2 diabetes can often be prevented by:
- Keeping your weight at a normal level in relation to your height.
- Avoiding obesity by eating a healthy diet.
- Getting regular physical activity.
A physical therapist can develop a personalized exercise plan to help you avoid type 2 diabetes. They also can help you manage diabetes if you already have it.
You can reduce your risk for developing diabetes by:
- Participating in regular exercise.
- Performing the recommended amount of physical activity each week.
- Eating a healthy diet (and being aware of and reducing sugar intake).
- Avoiding obesity or becoming overweight.
Women can reduce their risk for gestational diabetes by doing the same things that help prevent type 2 diabetes. Losing extra pounds before becoming pregnant is highly recommended.
If you have diabetes, you can limit problems by controlling your blood sugar each day. Eating right and getting enough daily physical activity are effective ways to manage diabetes.
Sores on the feet can be prevented by inspecting your feet and skin daily, wearing good fitting shoes and orthotics, and practicing good foot care. You can learn good foot care from your physical therapist.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat people who have diabetes or are at risk for developing the condition. You can find physical therapists by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for a physical therapist with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family, friends, or other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with diabetes.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
Find a PT near you!
The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions and also prepare them for a visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapist management of diabetes. The articles report recent research and give an overview of the standards of practice for treatment of diabetes both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
US Department of Health and Human Services. Centers for Disease Control and Prevention website. Accessed March 16, 2020.
American Diabetes Association. American Diabetes Association website. Accessed August 4, 2020.
Abdelbasset WK, Tantawy SA, Kamel DM, et al. Effects of high-intensity interval and moderate-intensity continuous aerobic exercise on diabetic obese patients with nonalcoholic fatty liver disease: a comparative randomized controlled trial. Medicine (Baltimore). 2020;99(10):e19471. Article Summary in PubMed.
Alenazi AM, Alshehri MM, Alothman S, et al. The association of diabetes with knee pain severity and distribution in people with knee osteoarthritis using data from the osteoarthritis initiative. Sci Rep. 2020;10(1):3985. Article Summary in PubMed.
Curran M, Drayson MT, Andrews RC, et al. The benefits of physical exercise for the health of the pancreatic β-cell: a review of the evidence. Exp Physiol. 2020;105(4):579–589. Article Summary in PubMed.
Na JS, Dittmar PC. Diabetic amyotrophy, not your typical back pain. BMJ Case Rep. 2020;13(1):e231928. Article Summary in PubMed.
Carbone S, Del Buono MG, Ozemek C, Lavie CJ. Obesity, risk of diabetes and role of physical activity, exercise training and cardiorespiratory fitness. Prog Cardiovasc Dis. 2019;62(4):327–333. Article Summary in PubMed.
Di Biase N, Balducci S, Lencioni C, et al. Review of general suggestions on physical activity to prevent and treat gestational and pre-existing diabetes during pregnancy and in postpartum. Nutr Metab Cardiovasc Dis. 2019;29(2):115–126. Article Summary in PubMed.
Nasiri-Amiri F, Sepidarkish M, Shirvani MA, Habibipour P, Tabari N. The effect of exercise on the prevention of gestational diabetes in obese and overweight pregnant women: a systematic review and meta-analysis. Diabetol Metab Syndr. 2019;11:72. Article Summary in PubMed.
Pongrac Barlovic D, Tikkanen-Dolenc H, Groop PH. Physical activity in the prevention of development and progression of kidney disease in type 1 diabetes. Curr Diab Rep. 2019;19(7):41. Article Summary in PubMed.
Sklempe Kokic I, Ivanisevic M, Biolo G, Simunic B, Kokic T, Pisot R. Combination of a structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus: a randomised controlled trial. Women Birth. 2018;31(4):e232–e238. Article Summary in PubMed.
Wróbel M, Rokicka D, Czuba M, et al. Aerobic as well as resistance exercises are good for patients with type 1 diabetes. Diabetes Res Clin Pract. 2018;144:93–101. Article Summary in PubMed.
Matos M, Mendes R, Silva AB, Sousa N. Physical activity and exercise on diabetic foot related outcomes: a systematic review. Diabetes Res Clin Pract. 2018;139:81–90. Article Summary in PubMed.
Mendes GF, Nogueira JA, Reis CE, DE Meiners MM, Dullius J. Diabetes education program with emphasis on physical exercise promotes significant reduction in blood glucose, HbA1c and triglycerides in subjects with type 2 diabetes: a community-based quasi-experimental study. J Sports Med Phys Fitness. 2017;57(6):850–858. Article Summary in PubMed.
Kluding PM, Bareiss SK, Hastings M, Marcus RL, Sinacore DR, Mueller MJ. Physical training and activity in people with diabetic peripheral neuropathy: paradigm shift. Phys Ther. 2017;97(1):31–43. Article Summary in PubMed.
Tomas-Carus P, Ortega-Alonso A, Pietilainen KH et al. A randomized controlled trial on the effects of combined aerobic-resistance exercise on muscle strength and fatigue, glycemic control and health-related quality of life of type 2 diabetes patients. J Sports Med Phys Fitness. 2016;56(5):572–578. Article Summary in PubMed.
Liubaoerjijin Y, Terada T, Fletcher K, Boulé NG. Effect of aerobic exercise intensity on glycemic control in type 2 diabetes: a meta-analysis of head-to-head randomized trials. Acta Diabetol. 2016;53(5):769–781. Article Summary in PubMed.
Tsai YJ, Yang YC, Lu FH, Lee PY, Lee IT, Lin SI. Functional balance and its determinants in older people with diabetes. PLoS One. 2016;11(7):e0159339. Article Summary in PubMed.
Pinsker JE, Kraus A, Gianferante D, et al. Techniques for exercise preparation and management in adults with type 1 diabetes. Can J Diabetes. 2016;40(6):503–508. Article Summary in PubMed .
* PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Revised in 2020 by Jill Heitzman, PT, DPT, PhD, board-certified clinical specialist in geriatric physical therapy and reviewed by Pradeep Rapalli, PT, MBA, board-certified clinical specialist in geriatric physical therapy, on behalf of APTA’s Academy of Geriatric Physical Therapy. Authored in 2011 by Andrea Avruskin, PT, DPT.