By Debbie Childerhose, BPE, BHSc (PT)
You are working in an out-patient orthopaedic clinic and you have a new patient that discloses she has been recently diagnosed with Diabetes Mellitus-Type 2(DMT2).  She is 51 years old and you have been treating her for tendonitis of her shoulder.  Reviewing her past medical history reveals she is on medications for high cholesterol and for high blood pressure.  She also has family history of a mother suffering a myocardial infarction at the age of 48 year old. She tells you she is not happy taking so many medications.
What are the impact on this women’s health, now that she has been diagnosed with DMT2? Her cardiovascular health, her neurological health and her musculoskeletal health?  
Having a diagnosis of DMT2 will put this women at a high risk of having a heart attack. Women with DMT2 are seven times more likely to have a cardiovascular event than another of the same age without DMT2. It also affects her cholesterol and blood pressure profile as well. And her family history is positive if the health concern happened before the age of 65 year old. 
DMT2 also has a profound effect on the neurological system as well and can be affecting her memory. Like, remembering to take her medications at a certain time or in doing some of her exercises. Also, poor sugar control leads to neuropathies of feet or legs which can increase the risk of pain or falls.
DMT2 indicates poor glucose control and this can cause musculoskeletal issues that are present to be persistent as the tendons aren’t healing in a healthy environment. Insulin-dependent diabetes are 8 times more likely to suffer from rotator cuff tendonitis. 
Consider talking to the patient at her visits about:
  1. What is she doing in knowing what her blood glucose levels are? Research shows that if patients are taking their blood sugars at regular intervals, they have better control.
  2. Talk about what the healthy range of blood sugars should be before she is doing the aerobic component to her exercise prescription.  This will strengthen her heart health.
  3. If you are not aware of Diabetes care, suggest the patient attend a clinic that has a PT who is a Certified Diabetes Educator, or a Diabetes Exercise program where they have the expertise on DM care. 
  4. Guidelines for DM care are online and were last updated in 2013. There is a great section on what exercise parameters are for people living with Diabetes.  If the patient isn’t performing these, you are in a great position as their physiotherapist to help get on board with their exercise routine. 
These patients need to see that exercise in their lifestyle is so important to their overall health. Improved blood sugar levels will strengthen their heart, increase and maintain their memory and help to alleviate some of the musculoskeletal complaints that they are suffering from.   Physiotherapists are in an ideal position to offer that education and guidance in managing these patients in the health care team. 
From the CDA 2013: 
“You should know:
  • Physical activity can be as powerful as glucose-lowering medication… with fewer side effects.2
  • Physical activity levels of Canadians have fallen dramatically over the last 40 years.
  • Fitness level is one of the strongest predictors of all-cause mortality in people with diabetes.1
  • Low physical fitness is as strong a risk factor for mortality as smoking.1
  • Most people with diabetes or those at risk for diabetes do not meet the Canadian Diabetes Association’s guidelines for aerobic and resistance exercise:
  • Your patients have the power to improve their blood glucose control by actively exercising 5 days a week and engaging in resistance training.
  • Regular physical activity, in conjunction with healthy eating and weight control, can reduce diabetes incidence by 60%.2
We must do more to encourage regular physical activity and exercise for our patients!