Role of Physiotherapy in Diabetes

A Malaysian physiotherapist teaching the basics of physiotherapy at a workshop. Photo - durrah03 via Flickr under Creative Commons License

Written by Rina Desai - Special to Times of Oman

Diabetes is a problem with your body that causes blood glucose (sugar) levels to rise higher than normal. This is also called hyperglycemia. Type 2 diabetes is the most common form of diabetes. 

Diabetes is a silent killer. It can cause life-altering complications like blindness, kidney disease, amputation, heart disease stroke etc.

The good news is that diabetes can be controlled by maintaining a balanced diet and exercise. As a physiotherapist I treat variety of conditions which are secondary to diabetes such as chronic vascular infection, fatigue etc.

As exercise plays a major role to control diabetes type II, it is easy to see why physiotherapy is so important. Exercise helps control blood glucose and lipid levels, promotes circulation to peripheral tissues and improves heart's health.

When evaluating a patient with diabetes, a physiotherapist conducts a vascular and neurological assessment including sensation and skin integrity. Any change in color of skin, a break down may lead to open wounds and infection. Patient education plays a key role in controlling diabetes

Following are the nutrition and diet tips for diabetics:
• Do not eat items with refined sugar, for example carbonated drinks, processed foods like hot dogs, spaghetti, ice cream, jams, jelly, frozen pizza etc.
• Eats foods with high complex carbohydrates for example potatoes, beans, cucumbers, pears, strawberries, onions, tomatoes
• Eat low fat foods like 
Dairy and dairy-like products: Low-fat (1%) or fat-free (skim) yogurt, cottage cheese, or milk
Sorbet, sherbet, gelatin ices, and low-fat or fat-free frozen yogurt

Fish, meat, and poultry: Egg whites or egg substitutes; Crab, white fish, shrimp, and light tuna (packed in water); Veal, chicken and turkey breast (without skin), and lean cuts of other meats (look for "loin" in the name) – braise, roast, or cook them without adding fats; Extra lean ground beef such as ground round, or ground turkey breast (check the labels)

Veggie burgers; Grains, cereals, and pastas; Hot (oatmeal or grits) and cold cereals (except granola types); Low-fat crackers; Soft tortillas – corn or whole wheat; Toast, English muffins, or bagels with jelly or honey (no butter); Pretzels, soda crackers, or plain breads; Fruits and vegetables
Fruits and fruit juices, applesauce; Vegetables and vegetable juices (again, watch out for fat in sauces you may add) 

Snacks and sweets: Danish pudding and fruit pie fillings; Vanilla wafers and ginger snap cookies
Gelatin; Angel food cake; Puddings made with skim milk

Baked chips, tortilla or potato; Low-fat microwave popcorn; Hard and jelly candies

Broth type soups with a vegetable base; Sauces, pudding, or shakes made with skim milk; Salsa
Light margarine and mayonnaise; Reduced-calorie or fat-free salad dressings

• Eat high fiber and small amounts of fruit
• Eat 5-6 small meals throughout the day. Eating small meals puts less demand on pancreas

Exercise tips:
• Do not exercise if blood glucose levels are higher than 250 or lower than 70
• Check your glucose level after exercising as exercising helps drop blood glucose levels
• Since nervous system is often affected in Diabetes, patients do not always experience chest pain or typical symptom of heart attack. Common symptoms in this case are nausea, extreme tiredness and shortness of breath
• Check your shoes before exercise and feet after exercise. The shoes should be clean on the inside to prevent any friction to foreign material. If feet are discolored or reddened after exercise that may be an indication that blood circulation is being prevented
• Drink plenty of water before, during and after exercise 
• Try not to exercise for longer period with legs in hanging position
• Examples of helpful exercises: Aerobic activity at moderate intensity basically means exercising at a level that raises your heart rate and makes you sweat. This includes a multitude of sports, for example fast paced walking, light jogging, bike riding, rowing, tennis, badminton etc.
• For long duration and/or high intensity exercise sessions, plan extra carbohydrate snacks during the activity. Additional carbohydrates are suggested after 30 to 60 minutes of exercise 
• Always carry a fast-acting carbohydrate food such as glucose tablets when exercising in case blood sugar drops too low and hypoglycemia symptoms develop during exercise
• Wear a form of ID, which identifies you as having diabetes, particularly if you are exercising alone so that others may help you appropriately the event something unexpected happens

Exercising with a physiotherapist ensures professional supervision as well as safe progression of exercises keeping your metabolic demands in mind. At the first suspicion of diabetes, change of life style, food habits and exercising can prove to be life changing.

Rina Pandya-Desai is a physiotherapist working in Rehab Center, located in Shatti Al Qurum in Muscat, Oman. She is a member of American Physical Therapy Association and holds a physiotherapy license issued by the Ministry of Health, Government of Oman. Rina can be contacted on


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Thank you for the insightful article Dr.Rina.I have begin implementing the suggestions provided by you for better health of my diabetic parents.