It can be surprising to many people that one of the questions their physiotherapist will ask them when assessing an injury is ‘do you have diabetes’. This may seem more like an issue for your doctor than your physiotherapist! The reason why your therapist is asking is that diabetes can actually have quite a large effect on healing times of body tissues. At times, injuries can take up to twice as long to heal properly in patients with diabetes and your physiotherapist will need to update their training and rehabilitation programs to factor this in.

How does this happen?

From what most people know about diabetes, it seems strange that it would affect healing times. However, the more you understand about the processes that cause diabetes the more sense it makes. It all comes down to blood flow. Our veins and arteries are made of flexible and elastic tissues that expand and contract when necessary to allow the optimum amount of blood flow to an area. Sometimes is it better for tissues to have less blood flow and other times they require more. This flexibility of the blood vessels is essential for controlling and modulating the amount of blood to an area at any given time. When someone has diabetes, they have an excess of glucose in their blood. This occurs because the body is unable to regulate insulin, which is used to break down glucose and provide the body with energy. This can be due to an autoimmune disorder that affects the cells that make insulin (Type I) or insulin resistance due to dietary choices (Type II). Over time, this excess glucose sticks to the blood vessel walls and they can become harder, losing their elasticity and ability to change size rapidly. Primarily this will affect the ability of the blood vessel to expand reducing the amount of blood flow available to the tissues. Diabetes can also affect the health of the nerves in they body, particularly in the hands and feet. This can result in poor sensation, which means that the person may not realize when the injury is being further injured.

Does exercise help my diabetes?

As physiotherapists we prescribe exercises as part of your rehabilitation. Everybody benefits from regular exercise. If you have diabetes, or are at risk of diabetes it plays an even more important role in keeping you healthy.
For a person with diabetes exercise helps:

• Insulin to work better, which will improve your diabetes management
• You control your weight
• Lower your blood pressure
• Reduce your risk of heart disease
• Reduce stress.

Regular exercise is an important part of your diabetes management. If you are on insulin, it will help your insulin to work more efficiently and assist with your blood glucose control. However, if your diabetes is poorly controlled (i.e. fasting blood glucose levels greater than 14 mmol/L and urinary ketones) then it is best to avoid exercise until your blood glucose has settled. Exercise in these circumstances can actually elevate blood glucose and increase ketone production.

What does this mean for recovery times?
While not everyone with diabetes will have this issue, it is something that needs to be made known to your physiotherapist so they can be aware of the possibility. These changes are more likely to occur after having diabetes for a long period of time and if it is poorly managed. Ask your physiotherapist for more information on how diabetes may be affecting your recovery and for tips to ensure the best outcomes possible.