According to the CDC 37.3 million adults in the U.S. have diabetes. About 90-95% of these cases are type 2 diabetes. That’s about 10% of the adult population and those numbers are only expected to rise. A VERY large percentage of our patients have diabetes. On our intake forms DM II is probably one of, if not the most, checked box for comorbidities and other conditions.
So what’s our role as PTs when it comes to diabetes? Just ignore it’s there and leave it for the patient’s other providers to worry about? What can we actually do to help our diabetic patients? We might be able to do more than you think.
Musculoskeletal Rehab
Okay I know this seems obvious at first, but I bring it up because it can be especially life changing for patients with diabetes specifically. Research shows most cases of type II diabetes are preventable. Oftentimes the disease devolops through poor diet, inactivity, and obesity. Exercise or more the ability to exercise plays a big role in this.
It’s very common for a person to become inactive due to musculoskeletal pain or injury. I’ve often heard a patient say “yeah ____ happened and it all just went downhill from there.” This may have led them to become inactive which contributed to the development of their diabetes.
While there isn’t a true cure for diabetes, remission is possible with lifestyle changes including diet and exercise. Remission isn’t going to happen if the patient doesn’t start working out. A patient isn’t going to start exercising if they have significant musculoskeletal pain.
PT can be the first of many important steps for a patient with DM to turn their health around. PT can get the patient’s musculoskeletal pain under control where a new path to health is then accessible. From there a patient can make some of the necessary lifestyle changes and possibly reach remission.
Neuropathy & Balance
While some patients may be able to reach remission through lifestyle changes, some of the damage, like neuropathy, can’t be undone. Due to the numbness caused by neuropathy, many patients have issues with their balance. This puts those patients at increased risk for falls and other injuries.
It’s unlikely we’ll increase feeling in the patients feet, but we can work on reactionary balance and compensatory methods. I stress the use of reactionary balance here. Like I said, the feeling in the patient’s feet isn’t likely to come back no matter what we do. Most of the time they will have to react to losses of balance in order to avoid a fall. Make the balance work functional. I tend to focus a lot on reaching, bending, perturbations – anything to knock the patient off balance versus static standing on foam or in tandem stance.
We can also provide guidance on home modifications or assistive devices to decrease the potential for falls. Balance training that PTs provide can help keep patients with diabetes independent and reduce the risk of them getting seriously injured.
Skin Care
Closely related to neuropathy and balance training is the topic of skin care. Patients with diabetes may develop diabetic foot ulcers and not even know it because of the loss of feeling in their feet.
Where I work, we PTs do a fair amount of wound care. I have seen some diabetic foot ulcers that get BIG or go all the way to the bone. The patient will dead-ass sit there and say “I didn’t even know it was there until I noticed my sock was wet from the oozing.”
Yuck, I know, I’m grossing you out right now. I’m trying to get across just how bad these wounds can be. The sad part is it is very common for these to fester into something BAD that ultimately results in amputation. Sometimes just the toes, but sometimes it’s the whole foot which only further limits mobility and comes with a whole other set of problems.
Now, you may be thinking “But I’m not a wound care PT.” Well even if you’re not a wound care PT, you can still have a part in helping diabetic patients with skin care. The CDC recommends patients with diabetes check their feet every day. Many sources also recommend high risk individuals see a podiatrist annually or every 3-6 months.
As PTs we can educate patients and provide resources on proper foot checks. We can also educate on proper footwear to protect the feet and avoid wounds from happening in the first place.
Just like with balance, providing patients with some skincare education can prevent the patient from injuries that lead to major surgeries and further impaired mobility.
Lifestyle Modifications
A few weeks ago I wrote a blog post about why I think PTs should act as the bridge between health and healthcare. I think this is especially true when It comes to the diabetic population. Already a few times in this short blog post I’ve mentioned how much lifestyle modifications can help these patients.
The problem is many patients don’t know where to start. They often don’t know what they should be eating, how often they should be exercising, what their overall activity levels should be, or how their diabetes and comorbidities can lead to some pretty serious consequences like amputations, heart attacks, and strokes.
While we don’t need to become a diabetic patient’s personal health coach, we can be the one to at least give them basics for healthy living. We don’t need to spend hours educating on macros, but we can steer them in a good direction or towards some resources to help them learn. We don’t have to make them a personalized weekly workout routine, but we can educate them on how to start making regular exercise a part of their schedule.
Most of the time this will at least spark some small changes. Sometimes it will cause someone to seek more information and make big changes instead. These changes could make a world of difference for diabetic patients, who a have shorter life expectancy than people without diabetes. If these patients make the necessary lifestyle modifications, it could not only add years, but quality years to their life. But that doesn’t happen if someone doesn’t do at least some basic lifestyle education. Why not PTs? I do a deep dive of why I think we’re honestly the best people do this in that other blog post so make sure to check it out.
You don’t need to completely change your approach with diabetic patients. It’s likely a lot of your treatment stays the same. Due to the seriousness of the disease and the numerous comorbidities associated with diabetes, this is just a population that I think needs a little extra TLC. Do you see lots of patients with diabetes? What things do you focus on or do differently with them than some of your other patients? Hopefully I touched on some of them here. If not, drop in the comments what extra TLC you’re giving your patients with diabetes. After reading (or listening) to this is there anything you’ll now start doing? Share that in the comments as well.
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