Diabetes

--Tell me more about diabetes

Diabetes is a serious and complex illness that occurs when the body is unable to use blood glucose effectively for energy, resulting in high levels of blood sugar. The hormone insulin is essential for the conversion of glucose into energy, but in diabetes, insulin production is either not sufficient or what is available does not work properly. If unmanaged, diabetes results in damage to body organs via: heart disease and stroke, disorders of circulation (leading to gangrene and amputation), nerve damage, kidney disease, vision disorders and impotence. Diabetes may reduce life expectancy by 10–20 years and is the biggest challenge to the Australian health system, with 280 new diagnoses daily to a cost of an estimated $14.6 billion annually.

Type 1 diabetes is usually diagnosed in childhood and thought to be due to destruction of insulin producing cells.

Type 2 diabetes is the most common form and is classified a modifiable lifestyle disease associated with high blood pressure, abnormal blood fats and a classical ‘apple-shaped’ body.

Gestational diabetes occurs during pregnancy and usually goes away after the baby is born.

While there is no single cause for the development of type 2 diabetes, there are well-known risk factors which are:

• increasing age
• gender
• family history
• ethnic backgrounds
• polycystic ovarian syndrome in women are unchangeable risk factors for diabetes.

Modifiable risk factors include:

• an unhealthy diet
• not enough exercise
• and as a consequence, increased weight, especially around the waist.

Diabetes develops gradually over time. Some signs and symptoms include frequent urination, increased thirst, tiredness, slow healing, blurred vision, dizziness, mood swings and skin infections. Although diagnosis of diabetes is through a blood test (examining blood glucose you can check your risk by using the AUSDRISK Assessment tool, a simple questionnaire devised for Australians that will calculate your risk of developing type 2 diabetes.

--I have a family history of diabetes–should I be worried?

Having a close family member with type 1 or 2 diabetes is a known risk factor for developing the condition. If you are over 50, male, have a family member with diabetes, have high blood pressure, are overweight and don’t exercise much, you are at high risk of developing type 2 diabetes. Your risk can be reduced significantly by changing your lifestyle choices: physical activity needs to be at least 30 minutes of moderate intensity exercise daily and your diet should include a variety of nutritious foods. If, however, you have any of the signs and symptoms of diabetes, such as excessive thirst, frequent urination, tiredness, skin infection or slow healing, a medical examination is recommended.

--How does exercise affect diabetes?

The benefits of exercise in preventing and treating diabetes are widely recognised. Exercise has a direct effect on diabetes by lowering blood glucose levels and body fat, but also indirectly assists in the management of the complications of diabetes by improving cardiovascular fitness (reducing heart disease and stroke). Many other conditions are common in older adults with diabetes—these include osteoarthritis, osteoporosis, peripheral vascular disease, impaired mobility, elevated falls risk and cognitive impairment. Tailored exercise programs have been found to be beneficial in the management of all these conditions.

It is never too late to begin exercising—the people who show the greatest benefit are those whose diabetes is most poorly controlled. There are many perceived barriers to exercise, but, with careful planning by a physiotherapist, a suitable exercise program can be designed and safely implemented.

--I have ulcers on my feet—what exercise is best for diabetics?

Any type of exercise that gets you moving is useful in the management of diabetes. Several studies have shown that a combination of aerobic exercise, such as walking or cycling, and resistance exercise, such as weights or exercise bands, adding up to a minimum of 210 minutes per week, is ideal for maximum benefit. Co-existing conditions, such as arthritis, stroke or peripheral vascular disease, may prevent a combined exercise program, but either type of exercise has been found to be effective in management of diabetes.

Exercise that is beneficial includes walking, swimming, exercise bike, dancing, Tai Chi, golf, water aerobics/hydrotherapy, or strength training. Incidental exercise, such as using stairs instead of the lift, parking the car further from the shops, walking the dog, or vigorous housework, is all helpful in achieving 30 minutes per day.

The complications of diabetes can provide barriers to regular exercise. Foot ulcers are a serious problem, and exercise that does not place too much stress on the feet is essential. This may include riding an exercise bike, resistance training, Tai Chi or walking in well-fitting footwear. It is important to inspect your feet before and after exercise for signs of damage.

--How can physiotherapy help with diabetes?

Physiotherapy, including individualised exercise programs, is a highly effective treatment modality in the prevention, management and in the rehabilitation of possible complications of diabetes.

Prevention

Evidence from research projects in Australia, and other parts of the world, has proven that lifestyle changes, including increased physical activity, can prevent or delay the onset of type 2 diabetes. Physiotherapists have detailed knowledge of appropriate exercise prescription to assist in the prevention of diabetes, and are also skilled in managing co-existing conditions often associated with diabetes risk, such as arthritis, osteoporosis and heart disease.

Management

Management of blood sugar levels in diabetes is essential to prevent the many serious complications that can arise. Physiotherapists can deliver a well-designed, varied and monitored exercise program, consisting of aerobic and resistance exercise, that is suitable for the individual and will also result in improvements in quality of life.

Treatment of Complications

Heart attack, stroke, poor circulation in the limbs, sometimes leading to amputation and nerve damage, are all serious medical conditions leading to loss of physical function. Physiotherapy has a crucial role to play in the rehabilitation process following any of these events to optimise the physical functioning of the sufferer while continuing to manage their diabetes. The complications of diabetes affect balance and postural control, resulting in an increased risk of falls. Physiotherapy intervention can prevent falls and should form part of any intervention formulated to manage complications of type 2 diabetes.

Barriers to exercise

Physiotherapists have heard every excuse as to why people can’t exercise: ‘I’m too busy’, ‘It’s too expensive’, ‘I’m too old, fat or tired’, ‘I have too many things wrong’, ‘I don’t feel like it’, ‘I have no one to go with’). These excuses are just that—they are perceived barriers which, with planning and support from your physiotherapist, can easily be overcome. Individuals are never too old or too unfit to start to exercise; the key is to gain clearance from your doctor, then start slowly and gradually increase your intensity.

--How effective is physiotherapy for diabetes?

Physiotherapy in the prevention, management and treatment of complications of diabetes has been well-researched and proven to be a highly effective intervention. Several studies have shown that diabetes can be prevented or delayed by lifestyle changes. In people with a diagnosis of diabetes, blood sugar levels have been shown to be lowered by exercise in numerous studies, and the Exercise and Sport Science Australia position statement (2012) recommends 210 minutes of exercise per week and no more than two consecutive days without exercise. The effectiveness of physiotherapy intervention following stroke, heart attack and amputation has been accepted for many years, and physiotherapy provides the cornerstone of rehabilitation for these conditions. More recently, much evidence indicating the effectiveness of physiotherapy intervention in the reduction of falls has emerged, and physiotherapists are now considered to play a crucial role in the prevention of falls in people with diabetes.

--What can I do at home?

Although there are many options for exercise in the community, a varied and effective exercise program is easy to devise at home. Brisk walking (in well-fitting shoes) is suitable for almost everyone—walk to the shops for the paper, take the dog for a walk or go with a friend. For resistance exercise, you can use hand weights, resistance bands or your own body weight—squats, lunges, push-ups and step-ups require no equipment and are free. ‘TV exercises’ (when the ads come on) like standing up and sitting down, ankle pumps or leg lifts, are good examples. ‘Kettle exercises’, such as squats, lunges or heel raises at the kitchen bench, while you are waiting for the kettle to boil, use a combination of strength and balance exercises. Use every opportunity you can to be active—it all adds up.

If you would like to invest in some exercise equipment, an exercise bike or simple pedal set is a good option. A pair of hand weights or resistance bands is an inexpensive-but-effective piece of exercise equipment that won’t take up too much space at home.

--What services are available for diabetics?

Diabetes Australia is the national body for people affected by all types of diabetes and those at risk. Through leadership, prevention, management and research, Diabetes Australia is committed to reducing the impact of diabetes. It works in partnership with diabetes health professionals, and educators, researchers and healthcare providers, to minimise the impact of diabetes on the Australian community. 

National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered by Diabetes Australia. The NDSS delivers diabetes-related products at subsidised prices, and provides information and support services to people with diabetes. 

The National Disability Insurance Scheme (NDIS) rollout is underway, with projected completion by 2019. The impact of the NDIS on people with diabetes will be based on individual assessment. Provisions currently under the health system will not be moved to the NDIS, but people who qualify for disability funding will be able to choose providers and manage their services under the NDIS.

People with diabetes are able to access allied health services to help manage their chronic condition through the Medicare Chronic Disease Management Plan implemented by their GP. This entitles the individual to Medicare benefits for up to five allied health services in a calendar year.