16 Dec Physiotherapy; A Practical Approach to the Management of Diabetic Neuropathy
In this present day especially in this thriving part of the world (Nigeria), much is known about diabetes, its complications and medical management, but there is lesser knowledge on the role of physical therapy as well as a dart in literature in the significant role of physiotherapy in the management of the complications of diabetes. One of the striking complications of diabetes is diabetic neuropathy.
It will be cheering if we have a distinctive overview of the terms diabetes and diabetic neuropathy. Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves (WHO, 2020). There are two major types; type 1 and type 2 diabetes. Type 1 can occur at any age, but affects mostly children and adolescence. When you have type 1 diabetes, your body produces very little or no insulin, which means that you need daily insulin injections to maintain blood glucose levels under control. Type 2 is common in adults and accounts for around 90% of all diabetes cases. When you have type 2 diabetes, your body does not make good use of the insulin that it produces. Another type is the gestational diabetes in which there is elevated blood glucose level during pregnancy and is associated with complications to both mother and child. It may disappear after pregnancy but child and mother are at risk of developing type 2 diabetes later in life.
Diabetic neuropathy is a type of nerve damage that occurs if you have diabetes. Increases blood glucose can injure nerves throughout your body. It’s a serious complication of diabetes that may affect 50% of people with diabetes. The cornerstone for treatment, is a healthy lifestyle (with increased physical activity and healthy diet) with consistent blood sugar management.
Four types of diabetic related neuropathy exists
Peripheral, autonomic, proximal and focal or mononeuropathy.
In autonomic neuropathy, nerves supplying the stomach, intestines, eyes, sex organs and heart can be affected, possibly causing bl
adder or bowel pro
blems, hypoglycaemia unawareness, vomiting and loss of appetite, gastroparesis and decreased sexual response.
Peripheral neuropathy, most commonly affects the legs and feet but rarely arms and hands. Signs and symptoms are usually worst at
night and include; numbness, tingling or burning sensation, cramps, hypersensitivity to touch, serious foot problems such as ulcer, bone and joint pain.
Proximal neuropathy also known as diabetic amyotrophy often affects nerves in the thighs, hips, buttocks or legs. Symptoms include; severe pain in the hip, thigh or buttocks, eventual weakness & shrinking of thigh muscles, difficulty in rising from sitting.
Focal neuropathy appears suddenly and affect specific nerves most often in the head, torso and leg. Its symptoms include double vision, bell’s palsy, eye pain, severe pain in certain areas such as low back or leg, chest or belly pain. People living with diabetes can al
so suffer other nerve related problems like entrapment syndrome, loss of balance, impaired gait and muscle loss.
As life threatening as diabetic complications can be, there is hope for people with diabetic neuropathy. Several treatments exists that can manage and improve this condition.
One of them is physiotherapy. Although many are unaware of physiotherapy as an option for individuals with diabetic neuropathy. However physiotherapy is an effective treatment option that can help restore balance and sensation that has been lost, regain muscle strength, reduce neuropathic pain, and can help regulate blood sugar levels through prescribed therapeutic exercises. A comprehensive physical activity routine includes:
– raises heart rate, works on muscles, and raises breathing rate. Examples include; stationary cycling, swimming or
water aerobics classes, brisk walking or treadmill exercise, low impact aerobic exercises.
Flexibility A.K.A stretching– helps keep your joints flexible and reduce chances of injury. Examples include; calf st
retch, plantar fascia stretch, seated
Strength training exercise– makes the muscle stronger, and more injury resistant through constant training routines. Examples are chair squat, counter calf raises etc.
Balance training exercises– this can help get the individual back to normal and overcome dizziness and unsteady gait. It’s an important element for the elderly. Examples include side leg raise, hip flexion and extension exercises, frenkel exercise, etc.
Other benefits of exercise in diabetic care include;
- Increase function of insulin (insulin sensitivity to the liver and muscle cells)
- reduction of cardiovascular complications
- reduction of need for medications
- control of obesity,
- improve mental wellness
As joerg teichmann quotes, “rest is not the answer, activity and therapy help healing most”.
Senior Physiotherapist, NRS Maitama, Abuja