Manage Your Diabetes with Physical Therapy

Dr. Nelli Ban, PT, DPT
Physical Therapy and DiabetesCadence Physical Therapy

People with type II diabetes require intensive treatment to help them control their blood sugar levels. While medicine helps keep your blood sugar level as normal as possible, proper blood sugar control involves lifestyle adjustments, particularly food and exercise. Proper nutrition, exercise, and medication work together to bring your blood sugar under control. If insulin doses or carbohydrate consumption are not adjusted with activity, those using insulin or insulin secretagogues (oral diabetes tablets that cause your pancreas to generate more insulin) are at risk for hypoglycemia.

Unfortunately, many people have developed medical issues that make exercise difficult by the time they are diagnosed with type II diabetes. Patients may likely have two or more comorbidities; they may have obesity issues, have started to develop or have already developed full-blown diabetic neuropathy, or have metabolic syndrome. As a result, expecting people with diabetes to start exercising on their own might not be safe or effective. This is where Physical Therapy can help you control your diabetes.

Diabetes and other chronic disorders, including cardiovascular disease and osteoarthritis, are routinely treated with physical activity, which is commonly prescribed by physical therapists. Physical therapists can also check for diabetes risk factors and complications and adjust traditional musculoskeletal exercise prescriptions as needed.

Diabetes-related musculoskeletal problems are common. Patients with diabetes are four times more likely to have musculoskeletal complications of the shoulder and hand (such as adhesive capsulitis, Dupuytren's contracture, and flexor tenosynovitis) than those without diabetes. Individuals with diabetes are also more likely to experience low back pain. As nonenzymatic advanced-glycation end products (AGEs) accumulate, collagen tissues with poor turnovers, such as tendons, skin, and discs, become thicker and stiffer, increasing the risk of contracture and musculoskeletal damage and Limited Joint Mobility (LJM).


Physical activity is an effective “medicine” for diabetes and other chronic diseases. Because physical therapists are movement experts, they have the knowledge and expertise necessary to safely and effectively prescribe physical activity and supervise exercise in medically complex patients.

Physical activity recommendations and precautions may vary by diabetes type:

Most persons with type 1 or type 2 diabetes should strive for at least 150 minutes of moderate- to vigorous-intensity aerobic exercise per week, according to the American Diabetes Association (ADA). The weekly exercise should ideally be spaced out over at least three days, with no more than two days going by without doing something active.

  • Before exercising, make sure your blood sugar is less than 250 mg/dl, whether you have Type 1 or Type 2 diabetes. People with Type 1 diabetes are more likely to develop diabetic ketoacidosis or hypoglycemia, which can lead to a diabetic coma. This is due to the fact that persons with Type 1 diabetes require insulin at all times and have a larger range of blood glucose levels than those with Type 2. Warm up for five minutes before exercising and cool down for five minutes afterward.
  • A short maximum sprint can help to counteract a drop in blood sugar levels. Sprinting before exercise may prevent blood glucose levels from decreasing for 45 minutes after exercise; sprinting afterward may prevent a drop for at least 2 hours. This approach can be used at any time during an exercise session. Although sprinting will have a limited effect if you have excessively high insulin levels or a muted hormonal response, it is still useful as a short-term method of increasing glucose levels or keeping them from decreasing too quickly.
  • If your blood glucose is low, do your resistance training first, then your aerobic exercise to maintain your glucose elevated for the first part of your session. If your glucose levels are high, to begin with, start with easy to moderate aerobic training to lower them before moving on to resistance training, which will keep your glucose levels more steady or rise slightly (depending on intensity).
  • DEHYDRATION CAN SPIKE YOUR BLOOD SUGAR. Drink plenty of water before, during, and after exercise to prevent dehydration. Take at least 6 to 8 glasses of water a day if you exercise intensely, especially for those involved in endurance training.


Physical therapists can create plans of care for people of all ages and abilities tailored to their needs, challenges, and goals. Whether it’s lowering blood sugar levels or dealing with diabetes complications, PTs can help a patient identify a safe and effective physical activity plan for faster recovery and prevention of injury. A good physical therapist can help you with the right set of exercises that are a vital part of type 1 and type 2 diabetes treatments. Physical therapists should aim to treat not only the symptoms of your condition but to establish the underlying cause and help prevent a recurrence.


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