The Rise of Diabetes

What if you were told a debilitating disease you had was reversible? Yes you would have to make some simple lifestyle changes, but a life limiting, chronic, debilitating disease could be a thing of the past. You would make the necessary changes…wouldn’t you?

Diabetes affects approximately 382 million people worldwide, accounting for 8.3% of the worlds population, and continues to increase in all countries. It is estimated that the number of people with diabetes will increase to 55% by 2035 (Brussels International Diabetes Federation 2013). In Ireland 854,165 adults over the age of 40 are at increased risk of developing, or actually have type 2 diabetes. Another 300,000 adults between 30-39 are overweight and not meeting the recommended guidelines for physical activity putting them at increased risk of chronic ill health.

What is Diabetes?

The body needs insulin to transform glucose into energy. Diabetes is a metabolic disorder characterised by chronic hyperglycaemia resulting from defects in insulin secretion, insulin action, or a combination of both. If the pancreas does not produce insulin it is Type 1 diabetes. If the pancreas does not produce enough insulin or the insulin cannot be processed it is type 2 diabetes. Type 2 is the most common type accounting for 85-95% of worldwide cases. The good news is it is also the one most treatable.


Risk Factors

Several known risk factors are well established:

  • Lack of Exercise
  • Overweight
  • Unhealthy Eating
  • Family History

Of these four known risk factors three are modifiable, two directly through exercise alone, and a third indirectly. Add exercise into the mix and three of the four risk factors are eliminated (we can’t choose our family). Yet despite the evidence exercise remains an afterthought for clinical medicine (Church and Blair 2008). Just 39% of adults with diabetes are active (American Diabetes Association and ACSM 2010).

“Ask not what your country can do for you, ask what you can do for your country”.

John F. Kennedy

Benefits of exercise – the cornerstone of management for type 2 diabetes

Improved glycemic control

Physical activity causes glucose uptake into active muscles. Resistance training results in lowering fasting blood glucose for at least 24 hours post exercise. Exercise significantly improves glycemic control and reduces visceral adipose tissue and plasma triglycerides in persons with type 2 diabetes, even without weight loss (Cochrane Systematic Review 2007).

Improved insulin sensitivity

Physical activity can result in acute improvements in systemic insulin action lasting up to 72 hours post exercise. So even in the days after a bout of exercise benefits can be seen. Muscular contractions stimulate blood glucose transport via a separate mechanism not impaired by insulin resistance.

Improved body composition

Physical activity results in reduction in LDL cholesterol and increased calorie expenditure. reducing body weight (one of the risk factors) can only be a good thing.

Reduced blood pressure

Aerobic exercise reduces systolic blood pressure.

Improved general well being

The positive endorphins released during and after physical activity will leave a lasting positive effect on your mood and stress levels.

Where does physiotherapy fit?

A Chartered Physiotherapist, much to peoples surprise, does much more than “rub” things better. With knowledge of the cardiovascular and respiratory systems as well as the obvious musculoskeletal system we are perfectly equipped to prescribe exercise programmes for this population group. Giving an exercise programme based on guidelines is the correct approach but often with diabetes there are co-morbidities such as joint pain, overweight issues, and lack of knowledge that need to be taken into consideration when prescribing an exercise plan. Research suggests that a combination of resistance training and aerobic exercise, along with flexibility is most effective (Mendes et al 2016). But certain exercises involving high impact may aggravate an existing condition such as low back pain or knee pain. Tailoring a strengthening and aerobic exercise programme to meet the individual needs of the patient is key to increasing and maintaining activity levels. No one will persist with exercise if it is exacerbating another problem. But what if a patient could get all the benefits of exercise to address their type 2 diabetes and keep their knee or back pain at bay? Less hospital admissions, less medication and GP waiting times, better overall health, less cost to the country, avoidance of the medley of conditions associated with the condition. Let’s free up some of that precious time and money for conditions such as Cystic Fibrosis, Cancer, Multiple Sclerosis or Dementia. Sounds good to me.

Contact the clinic today to find out more and get your diabetes under control with the most effective pill of all – exercise!

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For more information on any of the issues addressed throughout this article please contact Rob via email at, Twitter @mccabephysio, Facebook at McCabe Physiotherapy or visit

Rob McCabe MISCP

Chartered Physiotherapist

MSc (pre reg) Physiotherapy, BSc Sport Science and Health, MSc Sports Physiotherapy, PG Dip Orthopaedic Medicine

Orchard House, Moorefield Rd, Newbridge, Co. Kildare

Click here for a link to previous blogs

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