According to the Centers for Disease Control, almost 26 million children and adults are living with diabetes (about 8% of the population). Of these, an estimated 19 million have been diagnosed, whereas there are 7 million who are unaware that they have the disease. Also, about 79 million people have "pre-diabetes," a condition in which blood sugar (glucose) levels are abnormal, but are not yet considered diabetic. Up to 30% of pre-diabetics will develop full-blown diabetes.

In diabetes, the body does not produce or properly use insulin. Produced by the pancreas, insulin is a hormone needed to allow glucose (sugar) to enter the cell and provide the energy necessary for daily activities.

Although the exact cause of diabetes is unknown, factors such as obesity and lack of exercise play important roles in type 2 diabetes. Diabetes can result in such conditions as:

• Heart disease
• Stroke
• High blood pressure
• Blindness
• Kidney disease
• Nervous system disease ("neuropathy")
• Peripheral vascular disease
• Amputations
• Skin problems, including ulcers and infections
• Reduced muscle strength and physical function

In a condition called "pre-diabetes" or "insulin resistance," blood sugar levels are normal or only moderately elevated and often are accompanied by elevated insulin levels but have not yet reached the diabetic stage. With pre-diabetes, you have a greater risk not only for diabetes but for heart attacks and strokes.

5 Physical Therapy Modalities for Diabetes

1. Therapeutic exercise: Physical activity, along with diet and medication, is a cornerstone of treatment for diabetes—and physical activity is a cornerstone for prevention of diabetes. Based on your health status, your physical therapist will prescribe aerobic and resistance exercises based on your needs.
2. Ultrasound: About 25% of people with diabetes will suffer from skin ulcers, particularly on the foot, because of the loss of sensation and circulation in the legs, according to past research. A recent study published in The Journal of Investigative Dermatology found that ultrasound therapy reduced healing time for skin ulcers by one-third.
3. Transcutaneous electrical nerve stimulation (TENS): A potential consequence of peripheral neuropathy in people with diabetes is severe, unremitting pain. A study published in The Journal of the American Physical Therapy Association found that the use of a TENS device drastically reduced pain caused by diabetic neuropathy, with patient’s reporting a cessation of pain by day 24 of treatment.
4. Gait Training: Peripheral neuropathy is a common complaint of diabetes. Peripheral neural damage in turn will cause balance impairments in diabetic patients. Research shows that balance training using wobble and balance boards can improve significantly stability indices in diabetic patients with neuropathy.
5. Monofilament Test: 1 in 4 patients with Diabetes will develop problems with their feet. People with diabetes are 25 times more likely to lose a leg then people without the condition. Patients with diabetes should have regular foot and footwear inspections using the Semmes Wienstein Monofilament Test. Monofilament test are a patient’s first line of defense against foot complications.

Diabetes is a known problem within our society. People with Type 2 Diabetes and Pre-Diabetes are advised to “exercise” and “lose weight”. While this advice is helpful, the increased risks and side effects of diabetes make it necessary for patients to use the expertise of physical therapists when looking to take control of their diabetes and improve their own health and well-being.