Considerations When You Visit a Diabetic Patient for Manual Therapy

Diabetes is a condition where the body lacks insulin or has an impaired response to insulin, and affects over 9% of the population. Insulin is the hormone that enables the body to use glucose for energy. With a lack of insulin or a response to it, blood sugar levels can rise dangerously high.
 
It is important to be aware of your patients’ medical conditions before implementing any manual therapy treatment. Previous medical conditions or illnesses may affect your treatment plan and impact your diagnosis of the problem. When treating diabetic patients, take the following considerations into account.

Check for proper footwear. 

​Improper footwear can throw off the body's alignment, cause foot pain, and increase the risk of injury to the joints. Proper footwear is especially crucial for diabetic individuals. Diabetic neuropathy in the feet is the most common complication of diabetes. Neuropathy is damage to the peripheral nerves. It can impact weight-bearing, increase the risk of ulcers, cause foot shape to change, and increase the risk of infection. 

Thus, diabetic patients are advised to stay away from tight or uncomfortable footwear that may trigger adverse effects. As their manual therapist, always double check to make sure your patients are wearing appropriate footwear before exercise, especially if they have diabetes.

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Always be aware of insulin levels

​Do not exercise if your patient’s blood sugar levels are less than 100 mg/dl or higher than 250mg/dl.
 
Make sure to help or remind your diabetic patients to measure their blood sugar before exercise. Blood sugar levels less than 100 mg/dl can cause hypoglycemia. Blood sugar levels over 250mg/dl can create a high level of ketones in the blood, increasing the risk of ketoacidosis. Ketoacidosis and hypoglycemia can become life-threatening conditions. Make sure your patient's blood sugar levels between 100 mg/dl and 250 mg/dl before exercising.

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Advise your patients to eat at least 2 hours before their manual therapy treatment.

Ensuring your patients with diabetes eat 2 hours before their exercise or manual therapy session will make sure their blood sugar levels are within normal limits. If the session goes longer than 20 minutes, try to have a carbohydrate snack on hand, just in case. If their blood sugar levels become too low, hypoglycemia may occur. 

Hypoglycemia can cause fatigue, weakness, dizziness, confusion, loss of consciousness, and even, death. It is common in diabetic clients due to overdosing on their insulin medication or forgetting to eat their meals after their insulin injections. If any of these symptoms occur, offer your patient orange juice or a high glucose snack. If symptoms persist, contact a doctor.
 
Always do your research if you are unsure about a patient's medical condition. Certain precautions may be necessary due to their medical history.

References:
​https://www.cdc.gov/diabetes/data/statistics/statistics-report.html 
https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-and-exercise/art-20045697