PT Classroom - Physical Therapy Implications for the Treatment of Diabetes Mellitus ׀ by Pete Balik, MPT, CSCS


Pete Balik graduated from the University of Iowa with a Bachelor of Science in Kinesiology and a Master of Physical Therapy degree. He has been practicing since 1995 and started Active Care Rehab in 2001.He has lectured at Concordia University, and University Wisconsin Milwaukee. Pete has been certified by the National Strength and conditioning Association and USA Triathlon. He also served as the Legislative Chair for the Wisconsin Physical Therapy Association, and has been a member of the American Physical Therapy Association since 1993.His practice includes sports medicine and general orthopedic patients.

Physical Therapy Implications for the Treatment of Diabetes Mellitus


Diabetes is rapidly becoming an epidemic in the United States, epically Type II (formally called adult onset). Type II usually appears in persons over the age of 40 and is associated with physical inactivity and in persons who are overweight. Usually symptoms are not obvious at first. The symptoms associated with diabetes can include: frequent urination, excessive thirst, extreme hunger, unusual weight loss, increased fatigue, irritability and blurry vision (1). Recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes (1). However, if left untreated, diabetes can lead to blindness, kidney failure, amputation or death.

The American Diabetes Association reports that there are 23.6 million people in the United States, or 8% of the population, who have diabetes. They report that the total annual economic cost of diabetes in 2007 was estimated to be $174 billion. Medical expenditures totaled $116 billion and were comprised of $27 billion for diabetes care, $58 billion for chronic diabetes-related complications, and $31 billion for excess general medical costs. Indirect costs resulting from increased absenteeism, reduced productivity, disease-related unemployment disability, and loss of productive capacity due to early mortality totaled $58 billion (1).

A common condition associated with patients who have diabetes is peripheral neuropathy. Peripheral neuropathy is the term used for damage to the nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side-effects of systemic illness. Peripheral neuropathy is not a disease itself and is commonly diagnosed in people when no pre-existing cause is present. Less than three percent of the general population is affected by peripheral neuropathy, yet sixty percent of diabetics will develop some degree of nerve damage. However, some known causes of peripheral neuropathy include diabetes mellitus, alcoholism, radiation, and chemotherapy.

The diagnosis of peripheral neuropathy is performed based on the symptoms that the patient is experiencing at the time of the doctor’s examination. Some common symptoms that a patient may experience are sensations of decreased circulation in the extremities, such as numbness, tingling, alternating burning hot and ice cold feelings, sharp or dull pain, decreased coordination, and muscle fatigue. Furthermore, some patients have reported the feeling of wearing a stocking or glove when the patient is afflicted with peripheral neuropathy (2). Patients with peripheral neuropathy not only notice pain but may experience balance problems or difficulty walking as well. These are issues that should also be addressed in physical therapy.

Another tool which is available to some physical therapists for treating complications associated with diabetes is Anodyne Therapy. Anodyne Therapy received FDA approval in 1994 and utilizes monochromatic infrared energy (MIRE) to release nitric oxide from the patient’s red blood cells. The company says this improves nerve function and is important for making new blood vessels and healing wounds. As the company notes, “low levels of nitric oxide are common in people with diabetes and are a major factor in the poor circulation, loss of sensation, chronic falls, foot ulcers and pain of diabetic peripheral neuropathy.” Therefore, this type of therapy is a simple, safe, non-invasive treatment option for people who suffer from pain and numbness at the feet.

Numerous studies conducted have supported these findings with the use of Anodyne Therapy. In one study that was published in Diabetes and Its Complications, 2239 patients who were treated with Anodyne Therapy and then examined. From the examination they found that 67% of patients with chronic foot and leg pain had a decrease in symptoms after Anodyne. Physical and Occupational Therapy in Geriatrics also reported that 272 patients at 7 facilities demonstrated significant pain reduction and improvement in functional outcomes with Anodyne Therapy.

The patients’ history, sensation, balance, strength and flexibility are assessed before treatment is started. Anodyne Therapy treatment consists of strapping small pads to the affected areas for approximately 30 minutes. Patient may feel some warmth during the session, but no significant pain. Along with utilizing Anodyne Therapy, the physical therapist will also design an individualize exercise program for each patient to address his or her specific needs. Balance, gait, stretching exercises and patient education (ie. proper foot care) are usually incorporated to help patients improve their functional levels. Anodyne and physical therapy treatments are covered by all major insurances including Medicare, Medicaid and Title XIX. 

Aerobic and resistance exercise are also a key component of the overall treatment plan. Recent studies have shown that these forms of activities help control the blood sugar levels of patients with diabetes. One study, included 251 adults, between ages 39 and 70, who were not exercising regularly and had type 2 diabetes were divided into four groups, one performing 45 minutes aerobic training three times per week, another 45 minutes of resistance training three times per week, the third 45 minutes each of both three times per week, and the last no exercise. The study found that the group which performed both kinds of exercise had about twice as much improvement as either other group alone (3).

Another study involving 10,455 subjects found that diabetics who attended exercise classes had more significant improvements than people who focused on trying to change exercise, diet modification and medication at the same time (4).

People with diabetes can make great gains with exercise. Many of our patients need help getting started with an exercise program, because they have never been very active. As physical therapists it is essential that we not only address our patients' deficits but educate our patients regarding lifestyle changes and self management as this can drastically improve their quality of life as well.


Last revised: September 8, 2009
by Pete Balik, MPT, CSCS


3. American College of Physicians. "Both Aerobic And Resistance Exercise Improved Blood Sugar Control In People With Diabetes.", Science Daily
4. University of Missouri-Columbia (2007, June 15). Exercise Helps People With Diabetes, Study Says. ScienceDaily.

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