By Kanikkai Steni Balan Sackiriyas, PT, DSc.
Physical therapists as autonomous practitioners need to stay abreast with the basic knowledge of common medical conditions such as diabetes and its implication on health and activity. Continuously screening and monitoring for signs and symptoms and risk factors of diabetes are crucial to the safety of our patients. Also, modifying or stopping exercise programs according to the patient’s blood glucose level is key to providing safe intervention.
Diabetes is a widespread problem affecting millions of people worldwide, with a total estimated cost of $327 billion ($237 billion direct costs and $90 billion in reduced productivity) in the United States in 2017 (American Diabetes, 2018) and can impact physical therapy services. The process of turning what we eat into useable energy is continuously occurring in our body. A lot of us do not realize the amount of work our digestive system undergoes as it prepares, process and converts the food we eat into energy for our body. Our body prepares the digestive system before we even put food in our mouth. In other words, our body adjusts our digestive tract and starts to secrete the hormones and enzymes as soon as we begin to feel hungry or sometimes even when we smell food. The body needs to break down a complex diet that includes carbohydrates, fat, and protein into simpler or smaller food units. One of the byproduct during digestion is glucose or monosaccharide. Glucose is a “simple sugar” – a byproduct of digestion – circulated in the blood and transported all over in the body and provides energy to the cells of the body such as brain and muscle (Berg JM, 2002) (NIDDK). However, any sustained increase or decrease in the normal blood glucose levels can have harmful effects on our body such as fatigue, extreme hunger, frequent urination, poor circulation, irritability, anger, depression, and decreased healing.
The normal healthy human body maintains an average fasting blood glucose level in a close range between 70 mg/dL to 100 mg/dL (Medlineplus) majorly through hormonal regulation, which is controlled by several key processes and organ working in harmony. The pancreas is one such organ that tightly regulates the glucose levels, through its production of hormones such as glucagon and insulin. The glucagon increases the glucose level in the blood and the insulin decreases glucose level in the blood (Roder, Wu, Liu, & Han, 2016), (Stephen L. Aronoff, 2004). Both of these hormones (glucagon and insulin) use a negative feedback system. The negative feedback system means the end product of one stimulates the other. In this situation, the increase in insulin decreases blood glucose levels which then triggers glucagon production that increases glucose levels in the body (Roder et al., 2016).
In diabetes, the body loses its natural control on the blood glucose level balance as a result of defects in the beta cells’ insulin production, decreased sensitivity or action to insulin or both (American Diabetes, 2010). A fasting glucose level of 126 mg/dL and higher in the blood is usually diagnosed as diabetes (Medlineplus). There are mainly two types of diabetes: Type 1 and Type 2 with type 2 being the common. Regardless of the type of diabetes, the high glucose level in the blood leads to several health risks such as poor circulation, diabetic foot ulcer, diabetic retinopathy, neuropathy, kidney disease, amputation, stroke, and even death.
According to experts, the safe range for exercise and physical activity in Type 2 diabetes is 100 to 300 mg/dL (American Physical Therapy). Close monitoring or stopping of exercise is advised if blood glucose level ranges <100 mg/dL or >300mg/dL. Stop exercise when blood glucose level is <70 mg/dL. Closely monitor and try a 10 to 15 mins of exercise with a blood glucose level that is >300mg/dL in patients who takes oral blood glucose medications. Continue the exercise and recheck blood glucose every 10 to 15 mins when the blood glucose drops. On the other hand, stop the exercise if the blood glucose level rises >300mg/dL. For patients with a blood glucose level of >300 mg/dL who takes insulin, ketones should be checked before initiating the exercise. Exercise can be continued with close monitoring of blood glucose if no ketones present. However, avoid any activity if ketones are present (American Physical Therapy).
In conclusion, understanding the patient’s blood glucose level and the time and site of the insulin administration before starting and exercise program is key to administering a safe physical therapy intervention. Also, timely collaboration with other health care team members is critical in the prevention and management of diabetes and may reduce medical costs and save the lives of the people with diabetes.
American Diabetes, A. (2010). Diagnosis and classification of diabetes mellitus. Diabetes Care, 33 Suppl 1, S62-69. doi:10.2337/dc10-S062
American Diabetes, A. (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41(5), 917-928. doi:10.2337/dci18-0007
American Physical Therapy, A. Diabetic Precautions to Exercise Retrieved from http://www.apta.org/uploadedFiles/APTAorg/Practice_and_Patient_Care/Patient_Care/Physical_
Fitness/Members_Only/PocketGuide_Diabetes.pdf
Berg JM, T. J., Stryer L. (2002). Each Organ Has a Unique Metabolic Profile. In Biochemistry. New York: W H Freeman.
Medlineplus. (2/22/2018). Retrieved from https://medlineplus.gov/ency/article/003482.htm
NIDDK. Blood Sugar Also called: Blood glucose. Retrieved from https://medlineplus.gov/bloodsugar.html
Roder, P. V., Wu, B., Liu, Y., & Han, W. (2016). Pancreatic regulation of glucose homeostasis. Exp Mol Med, 48, e219. doi:10.1038/emm.2016.6
Stephen L. Aronoff, K. B., Barb Shreiner, Laura Want. (2004). Glucose Metabolism and Regulation: Beyond Insulin and Glucagon. Diabetes Spectrum, 17(3), 183-190. doi:https://doi.org/10.2337/diaspect.17.3.183