Diabetes and

physiotherapy
Case study: Mr. Yeng Yong
PROFILE
 MR. YENG/ 56/ Male/ Chinese
 Reason for admission:
 fever+ with body ache+ bone pain+ severe a/w
tired fatigue++, unable to walk, bilateral UL &
LL swelling
? cikungunya by OPD, not dengue
 Past Hx: DM type 2, uncontrolled
 Social Hx:
 Semi retired real estate agent
 Lives in JB alone, wife lives in Singapore
 Ex-badminton player

 Reason for PT
 Swollen distal (R) finger joints
 Swollen ankle/ pain VAS: 5
 Bed bound
 Increase fall risk (fell 3-4 times this year,
poorly fitted shoe)


AIMS OF PT
1.IncreaseROM
2.Ambulate pt
3.Reduce fall risk
Day 1
 Sensation & proprioception tests
 Static and dynamic joint
 Light touch
 Sharp/blunt
 Visualfield test
 Reasons:-
 Retinopathy
 Neuropathy Diabetes
 Rx: Due to pain, couldn’t ambulate pt

Day 2
 Sensation and proprioception test
 Light touch
 Static and dynamic joint test
 Sitting balance
 Static
 dynamic
 STS
 Static standing balance
 Rx: Sit to stand:- correct method
Day 3
 Swelling hasn’t reduced esp hands
 Able pain
 AROM
 UL: functional, except finger (F) & wrist (E)
 LL: functional, except ankle (DF) & (PF)
 STS
 Standingbalance
 AMBULATE: 2 metres
 PROBLEM: HYPERGLYCEMIA; glucose lvl 19.9
 BP was monitored



DAY 3 con’t
 Dry mouth 
 Thirst 
 Frequent urination
 Urination during the night
 Blurry vision 
 Dry, itchy skin
 Fatigue/drowsiness 
 Weight loss
 Increased appetite
 If hyperglycemia persists:
 Difficulty breathing

DAY 4
 Paindecreased
 Swelling on foot decreased
 Reinforced: food intake
 Glucose just before walking
 11.5
 Rx: STS
 Standing balance
 Gait training
 Education



DIABETES MELLITUS
Diabetes mellitus
 Monitoring
 Blood glucose: 3 - 6.9
 BP: 130/80 mmHg
 Lipids: < 70 mg/dL
 HR

Dm medication
 Oral hypoglycemic agents
 Metformin
 Glitazone
 Sulfonylures and miglitinides
 Insulin
 Long acting insulin
 Short acting insulin
What can we do?
 Exercise: Exercise appears to improve the insulin resistance
of peripheral tissues and alleviate the defect of insulin-
stimulated glycogen metabolism in skeletal muscle


 Education: “Education is essential as an empowerment

strategy for diabetes self-management and prevention
or reduction of complications. (Level of Evidence =
IV)”, (Glasgow, 1999).


 Assessments:
 Identify peripheral neuropathy by assessing for sensory,
autonomic and motor (S.A.M.) changes (Level of Evidence
= II – IV)
 Assess for foot pressure, deformity, gait and footwear.
(Level of Evidence = Ia – IV)
What we shouldn’t do
 Exercise induced hypoglycemia
 Precaution:
 Avoid therapy at peak insulin effect
 Eat carbohydrate snack before
 Moderate Intensive work load
 Injection site away from exercising mm
 Know signs and symptoms of hypoglycemia

Weakness
Sweating
Tachycardia
Tremor
Hunger
Nausea Headache
Hypothermia
Visual disturbances
Confusion
What we Shouldn’t do
 250-300 mg/dL
 No vigorous / prolonged exercises
> 300 mg/dL
 No exercise
 Exercise HRs shouldn’t exceed 50%/60% of
predicted max
 Special attention: H2O intake, foot care
 NEVER exercise alone
References
 http://
www.healthlinkbc.ca/kbase/topic/mini/tf4413/symptoms.htm
 Practical guide to the care of the geriatric patient- 3rd
edition
 Assessment and Management of Foot Ulcers for
People with Diabetes, practice guidelines march
2005
 Physiotherapy Effectiveness Bulletin - Health
Promotion: Physical Activity And Exercise In Selected
Populations April 2002
 Kelley, DE, and Goodpaster, BH. (2001) Effects of
exercise on glucose homeostasis in Type 2 diabetes
mellitus. Medicine and Science in Sports and
Exercise, 33(6): S495-S501
 Cardiopulmonary physical therapy, a clinical manual,
joanne watchie
