The “Secret Weapon” for Fighting Diabetes

By Kateri Kane PT, DPT

If you’ve been living with either type I or type II diabetes, by now you probably know the general gist of what it is.  For those of you who don’t or those of you who have never lived with diabetes, we’ll start with a brief overview.

According to Taber’s Cyclopedic Medical Dictionary, diabetes mellitus (DM) is “a disorder of carbohydrate metabolism, characterized by hyperglycemia [excess glucose in the blood] and glycosuria [excretion of glucose in urine] and resulting from inadequate production or utilization of insulin.”  The important thing to note here is that insulin maintains the balance of your blood sugar levels; so when it’s affected, blood sugar is no longer controlled naturally by the body.  In type I DM, insulin is not produced by the body and typically occurs prior to the age of 25.  This form of DM is difficult to regulate.  Type II DM is the result of cellular resistance to insulin and the inability of the body to regulate compensatory secretions of insulin.

The key with these forms of diabetes is that they are PERMANENT.  This does NOT mean you are doomed to fall into a diabetic coma nor have your legs amputated simply because you have diabetes.  However, these are very REAL risks if you do not MANAGE your condition.

So, what is this “secret weapon” for fighting diabetes (description coined by The Hormone Foundation)?  If you haven’t guessed it yet, it’s EXERCISE!  According to several sources, exercise does all of the following in relation to diabetes:

  • Lowers blood sugar, blood pressure, and cholesterol
  • Improves circulation
  • Reduces the need for insulin and oral medications
  • Prevents weight gain and promotes weight loss (excess body fat can worsen diabetes)
  • Strengthens the heart, muscles, and bones
  • Improves strength, flexibility, and endurance
  • Improves brain function and mood
  • Lowers stress

Prior to starting an exercise program, speak to your doctor so that he/she can do any testing that may be necessary to rule out medical complications.

When you begin an exercise program, checking your blood sugar level is VERY important.  Certain general guidelines exist to help steer your level of exercise and amount of food intake prior to exercise depending on what your blood glucose level reads.  A good basic guideline is to make sure your glucose level is at least 100 mg/dL but less than 300 mg/dL before beginning exercise.  If it’s higher than 300 mg/dL, get your blood glucose under control before exercise.  Those with diabetes should exercise 30 minutes on most days of the week adding up to 150 minutes of moderate aerobic exercise and 90 minutes of vigorous activity at least.

Diabetics should take special precautions when exercising.  Wear shoes and socks and check your feet daily for sores or blisters.  Don’t exercise alone, especially if you use insulin.  Know the signs of hypoglycemia and keep hard candies with you when exercising (take food with you for prolonged activities like hiking).  Check your sugar level before and after exercise and every half hour if exercise exceeds 1 hour.  Also, make sure to stay hydrated because dehydration can mimic low sugar levels.

I hope this information helps clear up some questions or misconceptions about diabetes.  Feel free to leave any comments or suggestions.  Our next blog will be related to the benefits of laser treatment.  Find out if this treatment may help you.  Thank you for reading and stay active.

Resources:

 JCEM

One Touch

BMJ Group

http://www0.sun.ac.za/kampusgesondheid/wp-content/uploads/2010/09/Diabetes-and-exercise.pdf

Taber’s Cyclopedic Medical Dictionary

Goodman & Fuller’s Pathology: Implications for the Physical Therapist

Can Exercise Save You from Breast Cancer?

By Kateri Kane PT, DPT

Many people in this country have either known an immediate relative or a friend who has battled breast cancer.  This particular cancer is the most common cancer diagnosis in women and the second leading cause of cancer death following lung cancer.  Risk factors include:

Key Risk Factors

Additional Risk Factors

Gender (female)

History of benign breast disease

Age 60 or older

Ethnicity (whites: increased incidence; blacks: more deaths)

Age at first menstruation (increase risk if <12 years old), especially when combined with late menopause (>55 years)

Late menopause (>50 years)

Nulliparity, infertility; 1st child born after age 30

Diethylstilbestrol exposure

Age at first live birth (increased risk if >35 years)

Alcohol (?2 drinks/day of beer, wine, hard liquor)

2 or more first degree relatives (mother, sisters, or daughters) with breast or ovarian cancer

Postmenopausal weight gain (20-30 lb. or more since age 18); obesity

Male relative with breast cancer

High doses of chest radiation before age 30 (e.g. Hodgkin’s disease)

Number of previous breast biopsies (whether positive or negative)

Environmental exposures (under investigation)

High-fat diet

As least 1 biopsy with atypical (ductal or lobular) hyperplasia or radial stars

Long term use of first-generation oral contraceptives before 1975 (high does e.g. EstrAval) or recent (last 5 years) combined hormone replacement therapy

Previous personal history of breast cancer

High bone density (postmenopausal women); circulating estrogen promotes bone formation

To check out your risk, click here.

Several of these risk factors are modifiable, meaning that your lifestyle can affect your level of risk for getting breast cancer.  Many studies have been performed particularly on the effects of weight gain as a risk factor.  The American Cancer Society found that 20-30 pounds of weight gain after the age of 18 produces a 40% greater likelihood of developing breast cancer than for women who either gain only 5 pounds or have been overweight since childhood.  So what can you do to reduce your risk?  45-60 minutes of moderate-to-vigorous activity 5+ days per week is recommended.  For those of you who don’t think you have time to exercise 5 days a week, activity does not just mean exercising on the elliptical at your local gym.  Moderate to heavy yard work or house work could also be classified under this description.  The key term here is ACTIVITY.

But what if you already have breast cancer? Is exercise still recommended?  The answer is yes!  A meta-analysis, one of the most highly reliable forms of research, was performed on the effects of exercise on breast cancer patients and survivors.  This study found that women with breast cancer who participated in exercise had significant improvements in quality of life as well as physical functioning, peak oxygen consumption, and reduced symptoms of fatigue.

The take home message here is that exercise is good for both preventing breast cancer and for managing your condition if you already have it.  Different levels of activity may be recommended depending on your stage of cancer, so if you are unsure at what level of intensity you should be exercising, contact a health care professional for guidance.

Resources:

Goodman & Fuller’s Pathology: Implications for the Physical Therapist

Canadian Medical Journal

Journal of the National Cancer Institute

What Exactly Is Direct Access?

By Kateri Kane, PT, DPT

October is Physical Therapy Month, so we thought we would use this opportunity to provide some good information you might not know about the field of physical therapy.  Have you ever heard the terminology direct access in relation to physical therapy?  If not, here’s the run down.  Direct access is an individual’s freedom to acquire physical therapy treatment WITHOUT a referral from a physician.  Say for example, you twisted your ankle or started having back pain and needed physical therapy to recover.  Through direct access you are able to bypass going to a doctor’s appointment in order to get a referral for PT.

Direct access not only saves you the hassle of visiting your doctor, it can also save you money.  According to a study by Jean M. Mitchell and Gregory de Lissovoy, when comparing physician referral episodes of physical therapy. Direct Access episodes, total paid claims were 2.2 times higher for physician referral episodes.  Direct access episodes also encompassed fewer visits and thus less cost in this study. Even though your insurance may cover the majority of your physician and PT visit costs, you still have to pay your copay every visit.  These costs can add up, especially as the rates of copays increase; so the idea that you MAY have fewer PT visits and no doctor visit to pay for could be financially helpful.

Unfortunately, not EVERY state has direct access, but the majority of states do.  According to the APTA, 47 states and the District of Columbia have direct access.  Michigan, Indiana, and Oklahoma are the only states that DO NOT.  Michigan and Oklahoma allow for a PT evaluation but no treatment without a referral, while Indiana does not allow for either of these without a referral.  Despite the fact that a majority of states have direct access, each state has different rules and possible restrictions that can be viewed here.

So how exactly does direct access work?  In Pennsylvania, you are permitted to see a physical therapist that has a Direct Access certification for up to 30 days without a prescription from a physician.  If you require treatment for longer than this amount of time, then your physician will need to be contacted and sign off on a plan of care to continue with treatment.  If a therapist determines that you need further testing or that you are not an appropriate candidate for PT at the time of evaluation, he/she will refer you to your physician or a specialist.

Even though state law may allow you to see a PT through direct access, your insurance may not pay for it.  Medicare in particular allows for an initial evaluation through direct access, but will not cover any treatment without a referral from a physician.  It is important for you to be familiar with your insurance plan in order to know what is covered.  If you are unsure of your plan benefits, you may want to ask the physical therapist’s office to check into your coverage before you begin therapy.

We hope this information helps give you a better idea of what PT benefits are out there for you.  Once again if you have any comments, questions, or suggestions for future topics let us know.  Thank you and stay active.

Resources:

APTA FAQ

APTA Overview

APTA Direct Access

APTA Direct Access by State

Physther

 

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  Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website.