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:
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
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!
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:
As 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.
The symptoms that come with an ankle sprain include:
Grades of Injury
The 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:
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.
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.
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.
Mild 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.
Prevention 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 Message
Ankle 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.
Carly Rush - Exercise Physiologist