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Type 2 Diabetes Mellitus (T2DM) is a chronic condition developed as a result of varying levels of insulin resistance which causes hyperglycaemia (elevated blood glucose levels [BGL’s]). People who are at risk of developing T2DM with slightly lower levels of insulin resistance and hyperglycaemia are often diagnosed with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), both of which are known as Pre-diabetes. T2DM is a progressive disorder in the sense that it generally develops over several years before the damage and symptoms begin to really take shape. During this time, insulin resistance begins whereby the insulin starts to perform worse and worse, resulting in the ineffective management of BGL’s (i.e. too much glucose building up in the bloodstream). This insulin resistance then results in the pancreas working tirelessly to produce even larger amounts of insulin to try to achieve a certain degree of BGL management. Over time, the cells in the pancreas responsible for producing insulin start to wear out and destroy themselves, meaning that significantly less insulin is being produced. Generally, people have lost 50-70% of their insulin producing cells by the time they are diagnosed with T2DM.
Are you at risk? The cause of T2DM remains largely unknown, however, it is associated with several modifiable risk factors. i.e. lifestyle factors and behaviours that we can willingly change to improve our health. Modifiable risk factors that can contribute to the development of T2DM include:
These include:
The link to that is: DID YOU KNOW? 280 Australians develop diabetes every day. That’s one person every five minutes! What are the signs and symptoms of this disease? National Diabetes week was last week, and the campaign for 2019 was “it’s about time”. T2DM (and diabetes in general) is often diagnosed several years after the disease has already taken shape in the body, and unfortunately, unmanaged diabetes can result in the development of many other serious health issues such as heart disease, kidney failure and even blindness. The slogan “it’s about time” was to reinforce the idea that we need to put our health first and take the time to learn about the symptoms of diabetes, as well as visit our GP or relevant health professional for a check-up, so that we can prevent more complicated health issues from developing.
These symptoms can sometimes be passed off as a ‘sign of getting older’, and while yes, the presence of these symptoms doesn’t necessarily mean you have diabetes and really could just be a result of getting older, it isn’t going to hurt to visit your GP and double check. Prevention is always better than cure! What can mismanagement or late diagnosis of this disease lead too? As mentioned, unmanaged diabetes can lead to various other health complications. Here are some facts from the Diabetes Australia website about diabetes and the risk of other health complications.
Diabetes Australia. (2015). Preventing Complications. Retrieved from https://www.diabetesaustralia.com.au/preventing-complications Most of these health complications can be prevented by early diabetes diagnosis and management, which is why it is imperative that you check in with your GP or relevant health professional if you are at risk, or concerned about your risk of developing diabetes. The sooner you know and work towards managing your diabetes, the easier it will be to prevent your health from deteriorating. What treatment is available for this disease? Currently there is no cure for T2DM. As such, we often use the term “managing” when talking about diabetes. Depending on how early the diabetes is diagnosed, management can be done through lifestyle modifications including a healthy diet, regular physical activity/exercise and monitoring of BGL’s. Diet and exercise play critical roles in helping to reach/maintain a healthy body weight and managing BGL’s, with exercise improving the overall effectiveness of insulin in lowering BGL’s. Regular BGL monitoring provides a snapshot of how well your treatment and lifestyle changes are working, and can help you or your health professional decide whether other changes are necessary. People with T2DM generally need to measure their BGL’s several times a day using a blood glucose meter. As mentioned, exercise improves the effectiveness of insulin in the body by increasing the amount of glucose used by muscles as an energy source. This can significantly lower BGL’s and put people at risk of experiencing a hypo (hypoglycaemia/low BGL’s), which is why it can be extremely important for people with T2DM to monitor their BGL’s before and after exercise. On top of personally checking their BGL’s, people with T2DM should be regularly monitored by a General Practitioner or credentialed Diabetes Educator. They will often use tests to measure your fasting BGL’s and HbA1c (glycated haemoglobin – used to give an indication of long-term glucose management) as a way of viewing how well your diabetes is being managed. The goal of diabetes management is to keep BGL’s as close to the healthy range of between 4 to 6mmol/L (fasting), which will minimise the risk of both short and long-term health complications. As diabetes is a progressive condition, meaning it worsens over time, it may also be necessary to take tablets to help manage BGL’s. If insulin levels drop too low, it may also be necessary to start taking insulin in combination with tablets for proper diabetes management. Requiring medication as treatment is a normal process due to the natural progression of the disease. It’s important to remember that medications are only one piece of the puzzle and should be used together with healthy eating and regular exercise! How can NExT help? As we have mentioned, exercise plays a big role in helping to manage BGL’s by improving the effectiveness of insulin in the body. On top of this, exercise helps improve other areas of your health such as maintaining a healthy body weight, improve blood pressure and cholesterol levels, and minimising the risk of other health complications such as heart disease. As an Exercise Physiologist, Carly is trained in how to best exercise people with diabetes, with the knowledge and skills to be able to take into account any other health complications that you may have. Carly is able to take your blood glucose measurements before and after exercise to ensure you are having a good response to your exercise program, and is able to tailor it to best suit your needs. I hope this blog post has helped you gain a better understanding of Diabetes, and how important it is to check your risk of developing this condition! If you have any suggestions of conditions, injuries or general topics that you'd like us to cover in our upcoming blog posts, please feel free to leave us a comment, or send us a message via email, facebook or instagram. Better yet! Why not book in a session with one of us so we can talk about everything directly? We don't bite, I promise!
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Back pain. We’ve all had it at one stage or another, and can range from a small, annoying niggle to a searing pain that keeps you bed-ridden for days. It’s frustrating, painful, and often the result of something very trivial that leaves you thinking “you cannot be serious?!” As always, prevention is better than cure, so to prevent you from asking this question, here are five ways to help you protect your back and continue to be able to do the things you love. Rule #1: Limber Up Yes, rule #18 from Zombieland has been promoted with a bullet to rule #1 here, and despite Woody Harrelson’s lion comments, limbering up is very important. Before any task involving your back, whether it is lifting, bending, pushing, pulling, gardening or even sitting at your work desk all day, a simple stretching and warm-up routine can help loosen your muscles and joints to help prevent injury. The following 7-step routine may help to loosen and relax your back, aiding in the prevention of activity-related injuries. 1. Cat and Camel  Perform with slow, deep breaths for 5 repetitions. Image courtesy of whyiexercise.com 2. ‘Do the Twist’  Hold this position for 30secs. Repeat on the other side. Image courtesy of westvalley.edu 3. The ‘Merv Hughes’  Hold this position for 30secs. Repeat on the other side. Image courtesy of au.pinterest.com 4. Heel to bottom  Hold this position for 30secs. Repeat on the other side. Image courtesy of popsugar.com.au 5. Toe Touch  Hold this position for 30secs. Image courtesy of thotdoc.org 6. ‘Let me see your hips SWING’
Swing legs outward and across your body repeatedly for 30secs each side, then back and forward for 30sec each side. Images courtesy of workoutlabs.con 7. Windmills  Gently perform in a fluid motion at around 1 second per count. Perform 10 repetitions. Image courtesy of armyprt.com This routine can be done before any planned exercise, before you sit at your desk all day, or even first thing in the morning as a way to help energise your day. Rule #2: Do You Even Lift?  Image courtesy of freemusclebuildingtips.com No, I don’t mean hitting the gym until you turn into Wolverine, though there are many health benefits to weight training, including injury prevention, but that is best saved for another blog. I’m talking about lifting properly. Many times people bend too far, twist through their back or carry heavy, bulky items on their own. Turning by using your legs, squatting to pick up items and lifting heavy loads with other people are all ways to protect your spine from injury. PRO TIP: Always remember to use lifting equipment to help you if it is on hand.... it is there to help!  Image courtesy of efoza.com Rule #3: Shouldering the load People carry bags for many different purposes: school, work, fashion or just generally taking items from one place to another that would look ridiculous if you tried to juggle it in your hands… unless you are a professional juggler then, by all means, disregard this rule! But if the world of circus performance is not for you, then the right bag can make all the difference. Ideally, a backpack works best, as the load is even throughout your back, providing balance. Notice it is called a backpack, not a shoulderpack. Too many people wear their backpacks only on their shoulders, treating the waist and chest straps as nothing more than a waste! However, these straps, when properly adjusted, can help to improve your posture when carrying your backpack, saving your spine from undue stress.  This backpack guide works well for adults too! Image courtesy of wellnessmediaresources.com If you are carrying a satchel or a bag that only goes over one shoulder, try to limit the items you put in your bag to the necessities only, and purchase a lightweight bag. Also, train yourself to comfortably carry your bag on both shoulders so the same side isn’t under pressure all the time. Alternatively, an airport-style luggage bag with wheels that you can push or pull along can remove a great deal of stress from your back, helping you to transport heavier items with minimal pressure through your spine. Rule #4: Learning how to Sit Down OK. I’m not suggesting you’ve forgotten how to sit down. Everyone knows how to do that, and if it is on a couch or watching a movie it can be quite relaxing. But how we sit down, particularly at our desks, is often the cause of a world of tightness and pain arising from poor posture. Whether this is when you’re hard at work or casually browsing through videos on YouTube, the wrong seated posture can leave your back sore and sorry. Below is a simple diagram to help you set up your desk both at work and at home.  Image courtesy of fitness.stackexchange.com As well as following the diagram, remember to take breaks to stand, walk around, have a drink and do the Merv Hughes, Toe Touch, Windmill and Hip Swing exercises every 45-60mins. This breaks up your day, helping to prevent your posture from creeping forward under the effect of our friend gravity. At work you could even ask your manager or human resources department if they provide ergonomic assessments, to help tailor your work environment specifically to you. Rule #5: Put your Best Foot Forward Feet. The tyres of the body. Many of us try to work towards that magical '10,000 steps per day' mark, not realising the stress we are putting on our spine if we do this in the wrong footwear. Yes, it’s lovely to strut around in stilettos, easy to slip on some flats, and relaxing to bum around in some thongs, but, long-term, heels and shoes with a lack of support can lead to back pain. I’m not saying to ditch these shoes altogether, but having a supportive pair or two for when you’re on your feet the most can help to reduce stress through your back. Visiting a shoe store and having a professional recommend a shoe type for your foot can help. Talking to a podiatrist or osteopath if you have a history of foot pain or injuries can also help, providing orthotics, exercises and advice on footwear to suit your needs.  The perfect fit is so important! Image courtesy of au.pinterest.com
So, remember: limber up, lift correctly, choose the right bag, sit up straight and make sure your shoes are the perfect fit. This will help you on your way to save your spine, keeping you able to do the things you love. At NExT Osteo and Rehab, both Liam and I have worked extensively with a large range of different conditions and illnesses, as well as a variety of different injuries through our work with local sporting groups! This new blog series, “Spotlight Sunday”, is where we want to share with you some information about the different types of injuries, and illnesses, that we often see and work with. And what better topic to start off with than the common, but dreaded, ankle sprain!  Almost everyone will experience an ankle sprain (better known as a rolled or twisted ankle) at least once in their lifetime, which is why it is one of the most common injuries seen by health professionals worldwide. It can be awfully painful, and quite frankly really annoying to deal with, and unfortunately most people that do an ankle once, will oftentimes do it again! In this post, we’re going to run through some information about the anatomy, symptoms, treatment and prevention of ankle sprains! (If reading isn’t your thing, you can always search for “ankle sprain” videos on YouTube which will give you a brief overview). Also referred to as a torn ligament, a sprain is damage to one or more ligaments in a joint, generally caused by trauma or the joint being overstretched/going beyond its normal range of motion. A ligament is a tough fibrous band of tissue that holds two bones together to form and stabilise a joint. The most common ways to sustain this injury include:
AnatomyAs mentioned before, a sprain is damage to a ligament of a joint, in this case, the ankle joint. In the ankle, we have two different sets of ligaments that form the joint: The lateral (outside) ligaments, and the medial (inside) ligaments.
Our medial ligaments are much stronger than our lateral ligaments, which is why people often damage their lateral side and experience that “rolling out” feeling when they sprain their ankle. The “rolling out” movement is generally a combination of the foot pointing downwards (known as plantar-flexion) and then twisting inwards (known as inversion), which is why you may hear your treating health professional call it a lateral ankle sprain or an inversion ankle sprain. SymptomsThe symptoms that come with an ankle sprain include:
Grades of InjuryThe grades of injury are a way of defining how much damage has been done to the ligament fibres. For sprains, there are three different grades: Grade I A grade I sprain is known as a mild sprain and means that there is only slight stretching and very small (microscopic) tearing of the ligament. Generally, this type of sprain has some mild tenderness and swelling around the ankle, but the stability and movement of the ankle is fairly intact. Grade II A grade II sprain is a moderate sprain and means that there is partial tearing of the ligament. Generally, this type of sprain has more tenderness and swelling around the joint, with some instability. Grade III A grade III sprain is a severe sprain and means that there is a complete tear (rupture) of the ligament. Generally, there is significant tenderness and swelling around the ankle, which substantial instability. Sometimes people who have a grade III sprain may feel less pain than someone with a grade I or grade II sprain, as the pain often comes from the further pulling on the tear which cannot occur when the ligament has been ruptured.  TreatmentMild sprains can be treated at home using the RICER method (rest; ice; compress; elevate; refer), which helps reduce pain, bruising and swelling at the injury. Over the counter pain relief medication can also be used if necessary. The rules of “No HARM” should also be applied to an ankle sprain injury for the first 48-72 hrs (depending on the grade of injury). No HARM stands for:
Like I mentioned before, if you are unsure of the extent of your ankle sprain injury, it’s a good idea to seek out the opinion of a relevant health professional. If you were injured at a sporting event, seek out a qualified sports trainer for some immediate advice. If there is no sports trainer or you were injured outside of a sport, then seek out the opinion of your physio or osteo who can also provide you with some treatment for your injury. This also applies if you find that your symptoms are not getting better after a few days, or that your symptoms are getting worse. All three of these professions will be able to gauge the grade of injury based on your symptoms, and looking at the combination and severity of those symptoms as well as their location. If they believe you may have a more serious injury, you might need to undergo an ultrasound to assess the damage. Generally, more severe strains will be treated by your physio and osteo by helping to manage your pain and symptoms, and improving your ankle stability, strength and balance through exercise. It is very rare for someone with an ankle sprain (even a grade III) to require surgery, with it often being a last resort. PreventionPrevention is better (and easier) than curing, and is a big reason why it’s important to keep an adequate level of fitness and conditioning for the type of sport, occupation or lifestyle that you have! While sport is a great and fun way of keeping in shape, it’s just as important to make sure your body can safely handle the demands of the sport before you start getting involved so that your body is less likely to be injured. The same applies for physically demanding jobs! With ankle’s specifically, you want to be mindful about your lower leg strength and endurance, as well as your balance, mobility and agility, as these are the 5 key factors that keep your ankle stable. Working on these areas during your regular exercise routine is a great way of helping to minimise your risk of rolling an ankle. If you have already sprained your ankle and want to prevent it from happening again, the same rules apply! You need to build up the strength, endurance, balance, mobility and agility associated with your injured ankle so that you are back at the same level you were before. This is important even if you’ve only suffered a mild sprain! Once you are back at that same level, it’s okay to be getting back into your normal sport or job, however, you still need to be working on further improving your ankle stability and strength from there on out. Remember, prevention is better than cure! If you are unsure about what exercises you should be doing, have a chat with your physio, osteo or your exercise physiologist for some advice and a relevant exercise program. If you’ve done your rehab exercises, want to get back into your normal routine, but still feel a little unsure about your ankle, then an ankle brace or strapping tape applied by a qualified professional can be used to help prevent further injury and provide support for your ankle. HOWEVER, this is a short-term fix! Dependence on a brace or tape to support our ankle can lead to further weakness of the joint in the long run. A strong “muscle brace” is the best brace you can give yourself, and that can only be achieved through keeping up your exercises. Take Home MessageAnkle sprains are a common injury that happen to nearly everyone at least once in their lifetime. While most ankle sprains can be treated at home using RICER, if you’re unsure about what to do, or think your injury is more severe, then seek out the treatment of your physio, osteo or exercise physiologist who will be able to help you get a better idea of the extent of your injury as well as provide you with some treatment and an exercise program to help manage your injury.
If you would like more information about how best to deal with your injury, why not book in a session with Liam or I at NExT Osteo and Rehab? With Liam and I both having a background working with a variety of local sporting groups, we’re equipped with the knowledge on how to get you back to a functioning level appropriate for your sport. We also offer taping sessions for those short term strapping fixes. Wherever you are at with your injury or health, just remember to keep taking that NExT step. While we often appreciate the cooling drops in temperature during winter, what we don’t always appreciate is the subsequent spikes in colds and illnesses that come with it. From sore throats, sniffly noses and the aches and pains, it can be particularly difficult to do your everyday activities, let alone stick to your exercise routine (regardless of how desperately we want that “summer body”). What can be even more difficult is knowing if it’s even okay to be exercising if you’re starting to come down with a bug. Some people say “lie down and rest”, while others say “go ahead and sweat it out”. So the question is: “Can I exercise when I’m sick?” The answer to this is yes (kinda). It is okay to exercise if you’re sick, depending on the type of illness and symptoms you have!  Generally speaking, if your symptoms are above your neck, it’s probably okay to exercise. These symptoms include:
This is just a general guide, and not necessarily something set in stone. See how you are feeling and decide whether you want to move forward with exercising.
If you’re feeling up for some exercise still… that’s great! However, there are still some things that should be taken into consideration so that you don’t end up making yourself feel worse. 1. Lower the intensity of your workout Even if you’re feeling well enough to exercise, it’s probably still a good idea to do a less intense workout than normal. A high intensity workout is only going to put more stress on your body, meaning your immune system is going to have to work double time to help fight off your bug, as well as help your body recover from your session. (We describe a high intensity workout as something that is going to make you breathless or feeling very fatigued) Some examples of low intensity exercise that you can do are:
2. Make sure you get enough sleep Getting an adequate amount of good quality sleep is important all year round, but especially when your body is fighting a bug. Our immune system uses the time we are asleep to help our body recover from injury and illness… so if you’re feeling a little under the weather, make sure you aren’t sacrificing those precious hours of needed sleep for a late night Netflix binge! 3. Stay hydrated We tend to associate dehydration with summer and hot temperatures, but oftentimes dehydration can be just as bad during winter! When temperatures get cooler, we don’t feel as thirsty which can result in us drinking less water than our body needs. So even if you’re exercising on a particularly chilly morning and don’t feel thirsty, make sure you’re still keeping your fluids up! 4. Know when to rest The way your body will respond to your bug and symptoms will change daily, especially when you throw exercise into the mix. Listening to your body and knowing when it might be time to take a step back and have a rest day is important. If you start feeling worse or new symptoms pop up, having a day off to let your body recover is not the end of the world!
At the end of the day, you will know your body better than anyone else, and the decision on whether to exercise while sick is entirely up to you. What I want you to know is that it’s okay to push yourself a little bit if you’re feeling up to it, but it’s also okay to take some time off to let your body catch up if you need too. Whatever you do, just make sure you take that NExT step into looking after your health.
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AUTHORSCarly Rush - Exercise Physiologist Archives
January 2021
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