Diabetes, Movement, and the Factors That Change Care - A Physical Therapy Guide to Risk, Exercise, Foot Health, and Better Provider–Patient Connection for the Patient Managing Diabetes
Clinical Note for Readers
This article is educational and written for physical therapists, healthcare providers, and curious patients. It does not replace medical care, diabetes medication management, nutrition therapy from a registered dietitian, wound care orders, emergency care, or state-specific legal guidance.
Physical therapists should practice within their professional scope, jurisdictional scope, personal competence, facility policy, payer requirements, and state practice act. PTs can screen, educate, prescribe therapeutic exercise, monitor response to movement, communicate with the medical team, and refer when findings suggest care is needed outside physical therapy.
✨ Too Long Didn’t Read (TL;DR) / Summary
Diabetes is not “just a blood sugar problem.” It affects energy, movement, sensation, circulation, healing, balance, confidence, and the everyday tasks that make people feel like themselves.
In the United States, diabetes and prediabetes are common. Current CDC data estimate that 40.1 million people in the U.S. have diagnosed or undiagnosed diabetes, and 115.2 million U.S. adults have prediabetes.
There are several types of diabetes.
Type 1 diabetes is usually related to autoimmune destruction of pancreatic beta cells and insulin deficiency.
Type 2 diabetes is commonly related to insulin resistance with progressive loss of adequate insulin secretion.
Prediabetes means blood glucose is elevated but not yet in the diabetes range.
Exercise is a major part of diabetes prevention and management. For many adults with or at risk for type 2 diabetes, movement can improve glucose control, cardiovascular health, strength, balance, quality of life, and confidence.
Physical Therapists are essential members of the diabetes care team because diabetes changes how people move, heal, load tissue, tolerate activity, and participate in life.
For physical therapists, the goal is not simply to say, “Exercise more.” The goal is to help the patient answer: “What movement is safe for me, what is worth doing, and how do I build a routine I can actually keep?”
🧾 General Information
Diabetes in real life: more than a lab value
Picture this: a patient with known diabetes walks into your clinic and says any of the following:
“I’m tired all the time.”
“My feet feel weird.”
“I’m scared to exercise because my blood sugar drops.”
“My doctor said I need to move more, but my knee hurts.”
“I have a wound that finally closed, and I’m afraid it’s going to come back.”
“I know what I’m supposed to do. I just don’t know how to make it fit my life.”
That is the space where physical therapy can be powerful.
Diabetes can affect the cardiovascular system, kidneys, eyes, nerves, skin, muscles, tendons, joints, and blood vessels. In physical therapy, this may show up as reduced endurance, slower wound healing, altered sensation, increased fall risk, pain, weakness, difficulty walking, balance changes, limited joint mobility, or fear of loading the foot after a wound.
Diabetes care is not only about numbers. It is about helping people stay connected to the life those numbers are supposed to protect.
Type 1 diabetes, type 2 diabetes, and prediabetes
Type 1 diabetes is commonly caused by autoimmune beta-cell destruction, which usually leads to insulin deficiency. Those with type 1 diabetes often require insulin and must pay careful attention to their blood glucose response before, during, and after activity.
Type 2 diabetes is more common and often develops from insulin resistance combined with the body’s inability to produce enough insulin over time. It is influenced by many factors, including genetics, age, physical inactivity, body composition, sleep, stress, nutrition, medications, social determinants of health, and access to care.
Prediabetes means blood glucose is higher than normal but not yet in the diabetes range. It is not a personal failure. It is a clinical warning light. The good news: For many people, early lifestyle intervention can delay or prevent progression to type 2 diabetes.
Common diabetes testing numbers patients may hear
Patients may ask PTs about lab values. PTs should avoid diagnosing diabetes from labs unless that is within applicable law, training, and role. But PTs can help patients understand why follow-up matters.
Common diagnostic ranges include:
A1C
Normal: below 5.7%
Prediabetes: 5.7%–6.4%
Diabetes: 6.5% or higher
Fasting plasma glucose
Normal: below 100 mg/dL
Prediabetes: 100–125 mg/dL
Diabetes: 126 mg/dL or higher
2-hour oral glucose tolerance test
Normal: below 140 mg/dL
Prediabetes: 140–199 mg/dL
Diabetes: 200 mg/dL or higher
A helpful PT phrase:
“I can’t diagnose diabetes from this number, but I do want to make sure the right provider reviews it with you. Let’s talk about who manages your labs and whether you already have follow-up scheduled.”
That keeps the conversation helpful, accurate, and in scope.
Why exercise matters in diabetes
Exercise is often described as medicine, but for many patients that phrase can feel vague.
A more practical explanation is this:
When people move, working muscles use glucose. Over time, regular activity can improve insulin sensitivity, cardiorespiratory fitness, blood pressure, lipid profiles, strength, body composition, mood, and function.
For type 2 diabetes, research supports both aerobic and resistance training. Aerobic exercise helps with cardiovascular and metabolic health. Resistance training helps preserve and build muscle, which is one of the body’s most important glucose-handling tissues.
Keep in mind: the best plan is not always the one with the most movements, the most exercises, or the one that takes the most time.
It is the plan the patient understands, trusts, performs (as consistently as possible), and can progress safely.
“Move more” is not an exercise prescription
Many patients with diabetes have already been told to “exercise more.”
That advice may be accurate, but it is rarely complete.
A physical therapy-informed plan should consider:
What type of diabetes does the patient have?
Does the patient use insulin or medications that may affect glucose response?
Does the patient have neuropathy, retinopathy, kidney disease, cardiovascular disease, Peripheral Arterial Disease (PAD), foot deformity, or a current/recent wound?
What is the patient’s current activity level?
What activities matter to the patient?
What does the patient believe is safe or unsafe?
What barriers exist at home, work, finances, transportation, footwear, weather, pain, or confidence?
How will the plan be progressed?
How will the patient know when to pause and contact another provider?
Exercise prescription should be individualized by frequency, intensity, time, type, volume, and progression.
Your relationship with your patient matters here. People are more likely to follow a plan when they feel heard, respected, and included.
A practical movement framework
For many adults, the general target is a combination of aerobic activity, resistance training, balance work, flexibility, and less sedentary time.
A practical PT conversation may sound like:
“Let’s build a plan that helps your blood sugar, but also helps you climb stairs, carry groceries, get off the floor, protect your feet, and feel steadier when you walk.”
Aerobic exercise
Examples include walking, cycling, swimming, dancing, water aerobics, seated stepping, or upper-body ergometry (UBE).
For many patients, walking is the easiest starting point. For others, walking may not be ideal because of foot wounds, severe neuropathy, PAD symptoms, joint pain, balance concerns, or unsafe environments. In those cases, the best choice may be cycling, aquatic exercise, seated conditioning, or supervised exercise.
Resistance training
Examples include sit-to-stands, step-ups, rows, carries, wall push-ups, bands, machines, free weights, or bodyweight strengthening.
Resistance training should be progressed gradually. For some patients, the first goal is not “heavy lifting.” It is showing up consistently, learning safe effort, and building confidence.
Balance and fall-risk work
Diabetes-related neuropathy, vision changes, weakness, and medication factors can increase fall risk. Balance training, gait training, footwear education, assistive device training, and home safety conversations may be essential.
Reducing sedentary time
A patient who cannot tolerate a full workout may still benefit from shorter movement breaks. Standing, gentle walking, seated exercise, mobility work, and light activity can be a meaningful starting point.
A simple patient-facing phrase:
“We are not chasing perfection. We are building repeatable wins.”
Foot health: where PTs can make a major difference
The foot deserves special attention in diabetes care.
Diabetes can contribute to peripheral neuropathy, PAD, altered skin health, deformity, pressure points, ulceration, and even increase amputation risk.
Physical therapists may support foot health through screening, education, gait assessment, footwear discussion, offloading support, wound-care collaboration, assistive device training, balance training, and safe return-to-activity planning.
Patients should be encouraged to check their feet daily, especially if they have neuropathy, previous ulceration, deformity, PAD, or reduced protective sensation.
A practical patient script:
“Your feet are not fragile, but they do deserve attention. We want to build strength and walking tolerance while also respecting skin, circulation, sensation, and healing.”
Diabetes, PAD, and walking pain
PAD and diabetes often overlap. PAD may cause intermittent claudication. Intermittent claudication is leg pain, aching, or discomfort that increases during walking or exercise and decreases with rest.
Supervised exercise therapy can improve various aspects of walking including distance, time, and pain as well as and quality of life for people with intermittent claudication.
But this is not a “just push through it” situation. The program should be medically appropriate, monitored, and individualized. Patients with wounds, severe symptoms, cardiovascular concerns, or changing symptoms should be connected with the appropriate medical team.
Diabetic foot ulcers: after the wound closes, the work is not over
A newly closed diabetic foot ulcer may look “healed,” but the tissue is still adapting.
The PT-specific diabetic foot ulcer clinical practice guideline emphasizes that, after ulcer closure, reloading the foot should be gradual and monitored. In many cases, protection and offloading are especially important during the first 3 months after closure.
This is where physical therapy can help patients avoid the frustrating cycle of:
wound closes → activity increases too fast → skin breaks down again → activity stops → strength and confidence decline.
A better cycle is:
wound closes → reloading plan begins → footwear is monitored → step count and standing time progress gradually → skin is checked daily → function returns safely.
Diabetes medications and exercise: stay alert, stay collaborative
PTs should ask about medications because medications affect exercise tolerance, glucose response, hydration, appetite, dizziness, fatigue, and safety.
PTs should not adjust diabetes medications unless they are licensed and authorized to do so - in most cases in the US, this is primarily done in a military setting, where PTs have these privileges. Medication changes belong with the prescribing provider.
Patients using insulin or medications that increase hypoglycemia risk may need individualized guidance from their diabetes care team about glucose monitoring, carbohydrate planning, insulin adjustment, and activity timing.
A good PT phrase:
“Because exercise can affect blood glucose, I want to make sure your plan matches your medical plan. I won’t/cannot adjust your medication, but I can help you track how your body responds and work with you to communicate concerns to your other providers.”
When to see another provider or physician
A physical therapist should refer, coordinate, or recommend medical follow-up when symptoms or findings suggest the patient needs care beyond PT.
Examples include:
New or worsening chest pain, shortness of breath, fainting, or concerning cardiovascular symptoms
New neurological symptoms such as facial droop, sudden weakness, sudden confusion, or sudden vision changes (EMERGENCY)
Signs of severe hypoglycemia or hyperglycemia
Vomiting, fruity breath, confusion, rapid breathing, or concern for diabetic ketoacidosis
New foot wound, drainage, spreading redness, warmth, odor, fever, or rapidly worsening pain
A wound that is not healing as expected
New or worsening rest pain in the legs or feet
Sudden color or temperature change in the foot
Loss of protective sensation that has not been medically evaluated
Blood pressure, heart rate, glucose response, or symptom behavior that raises safety concerns
Medication side effects affecting participation, such as dizziness, nausea, unusual fatigue, or repeated lows
Unexplained weight loss, severe fatigue, increased thirst, frequent urination, or blurred vision
Nutrition concerns that require individualized medical nutrition therapy
Any finding that does not fit the expected musculoskeletal or functional presentation
The referral message does not need to be dramatic. It needs to be clear. Try something along the lines of:
“I’m seeing something today that deserves medical follow-up. I want to keep you moving, but I also want to keep you safe. Let’s loop in the right provider.”
👩⚕️ For Providers 👨⚕️
1. Stay in scope, but do not stay silent
Physical therapists are movement specialists. We are also front-line observers.
We may notice the wound that is not healing, the dizziness after exercise, the absent protective sensation, the blood pressure concern, the unexplained fatigue, or the patient who has not seen a primary care provider in years.
Our role is not to take over diabetes management.
Our role is to screen, educate, prescribe appropriate movement, monitor response, document clearly, and communicate when another provider needs to be involved.
2. Ask better intake questions
Try adding these to your intake:
What type of diabetes have you been diagnosed with?
Who manages your diabetes care?
When was your most recent A1C, if you know it?
Do you monitor blood glucose? If yes, how?
Do you use insulin, sulfonylureas, GLP-1 medications, SGLT2 inhibitors, metformin, or other diabetes medications?
Have you had recent hypoglycemia (or low blood sugar)?
Do you have neuropathy, PAD, kidney disease, retinopathy, heart disease, or a history of foot wounds?
Do you check your feet for wounds? If so, how often?
What shoes do you usually wear for activity?
What physical activity feels safe to you right now?
What activity are you avoiding because of diabetes, pain, fear, fatigue, or uncertainty?
3. Use exercise prescription as a way to get the patient back to life
A diabetes exercise plan should not feel like a punishment for having diabetes.
It should feel like a bridge back to capability.
Instead of saying:
“You need 150 minutes per week.”
Try:
“That may be our long-term target, but let’s start with a dose your body can handle this week. Then we’ll build from there.”
Instead of saying:
“You need to lose weight.”
Try:
“Let’s focus on what your body can do: walking farther, standing longer, getting stronger, improving balance, protecting your feet, and making activity easier to repeat.”
Instead of saying:
“Just walk every day.”
Try:
“Walking may be helpful, but first I want to understand your feet, circulation, balance, pain, glucose response, and confidence.”
Build your plan from there. That is the difference between advice and care.
4. Try Prescribing exercise using FITT-VP
Use the FITT-VP framework:
Frequency: How often?
Intensity: How hard?
Time: How long?
Type: What mode?
Volume: Total weekly dose?
Progression: How and when will it change?
For type 2 diabetes, supervised and individualized exercise can improve glycemic control and cardiometabolic outcomes. Exercise plans should consider the patient’s disease status, tolerance, preferences, resources, and response.
For some patients, the first step is a 5-minute walk after meals.
For others, it is supervised resistance training twice per week.
For another patient, it is seated cycling because a plantar foot ulcer cannot tolerate weight-bearing.
Use your clinical reasoning to find what best suits the person in front of you.
5. Respect intensity, but don’t let it be the “end all, be all”
Higher-intensity training may be appropriate for some patients, but many people with diabetes are sedentary, medically complex, fearful, painful, or under-supported.
The supplied exercise literature highlights that exercise volume, type, supervision, personalization, and adherence may matter more than chasing intensity alone.
A patient who performs moderate exercise consistently may outperform a patient who attempts an intense plan for 2 weeks and quits.
Consistency is not boring. Consistency is metabolic power.
6. Screen the diabetic foot
A diabetes-informed PT screen may include:
Skin inspection, including between toes
Callus, redness, blister, wound, drainage, temperature, swelling, dryness, or deformity
Protective sensation, commonly with a 10-g monofilament when available
Vibration sense, commonly with a 128-Hz tuning fork when appropriate
Dorsalis pedis and posterior tibial pulse assessment when trained and appropriate
Ankle, foot, and toe range of motion
Strength of ankle and foot musculature
Balance, gait, transfers, and footwear
History of ulceration, amputation, PAD, neuropathy, kidney disease, or falls
If an active wound, infection concern, vascular concern, or loss of protective sensation is identified, communicate with the appropriate provider.
7. For active diabetic foot ulcers, protect the wound and preserve the person
When a patient has an active plantar diabetic foot ulcer, the plan must protect healing tissue while preserving cardiovascular health, strength, mobility, and independence.
Depending on the patient and medical plan, options may include:
Non-weight-bearing or reduced-weight-bearing exercise
Seated aerobic exercise
Upper-body ergometry
Cycling if appropriate and not loading the wound
Strength training that avoids excess plantar pressure
Assistive device training
Balance and fall-prevention strategies
Offloading education and adherence support
Coordination with wound care, vascular, podiatry, orthotics/prosthetics, primary care, endocrinology, or surgery
The person still needs movement.
The wound needs protection.
The PT helps negotiate both.
8. After diabetic foot ulcer closure, reload slowly
Newly closed skin is not the same as mature, resilient skin.
After diabetic foot ulcer closure, consider gradual tissue reloading, footwear break-in schedules, daily skin checks, step-count monitoring, standing-time progression, and continued offloading when appropriate.
Watch for:
Redness that lasts
New callus
Blistering
Abrasion
Drainage
Warmth
Swelling
Skin temperature changes
Pain changes, if sensation is intact
Avoidance behaviors or fear of walking
A patient-friendly phrase:
“A closed wound is good news. Now we need to help the skin gain tolerance for loading gradually.”
9. For PAD and intermittent claudication, supervised exercise matters
Patients with PAD may need structured, monitored exercise rather than vague walking advice.
PTs can help with:
Walking program design
Symptom monitoring
Alternative conditioning when foot wounds limit walking
Strength training
Education about safe activity
Functional mobility
Collaboration with vascular providers
Return-to-activity planning after revascularization
For intermittent claudication, supervised exercise therapy can improve walking outcomes and quality of life.
10. Track outcomes that matter beyond glucose
Consider measuring:
30-second sit-to-stand
Five-times sit-to-stand
Timed Up and Go
Gait speed
Six-minute walk test
Step count or standing time
Single-leg balance
Functional reach
Patient-Specific Functional Scale
PROMIS Physical Function
Footwear tolerance
Skin response to loading
Rate of perceived exertion
Recovery response after exercise
Symptom response during and after activity
Patient confidence with meaningful tasks
Patients may arrive focused on blood sugar or weight.
PTs can help them also track capacity.
11. Use communication that builds trust
Diabetes care can come with shame, fear, burnout, and information overload.
Better questions create better care:
“What have you already tried?”
“What has made exercise difficult?”
“What do you worry might happen if you move more?”
“What would make this plan feel realistic?”
“What is one activity you miss?”
“What would make this worth the effort?”
“Who else is helping you manage your diabetes?”
“What do you wish providers understood about your day-to-day life?”
A simple closing script:
“My job is to help you move safely, build strength, protect your feet, and stay connected with the right team. We’ll make the plan together.”
That is The Joint Connection approach.
Evidence matters. Movement matters. But connection is often what makes both of them work.
Key Clinical Takeaways
Diabetes will affect movement, sensation, circulation, and healing - not just blood glucose.
Exercise is a core part of diabetes prevention and management, especially for type 2 diabetes and prediabetes.
“Exercise more” is not enough.
Both aerobic and resistance training matter.
Physical therapists should screen for diabetes-related complications that directly affect movement and safety.
Foot screening is essential in diabetes-informed physical therapy.
A closed diabetic foot ulcer is not the same as fully resilient tissue.
Patients with diabetes and peripheral artery disease may need supervised, structured exercise—not vague walking advice.
PTs should understand diabetes medication considerations without stepping outside scope.
Referral is part of good physical therapy care.
The best diabetes exercise plan is the one the patient can understand, trust, and repeat.
📂 Supplemental Information / Citations
Centers for Disease Control and Prevention. National Diabetes Statistics Report. CDC. Updated January 21, 2026. Accessed July 3, 2026.
American Diabetes Association Professional Practice Committee for Diabetes. 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(suppl 1). doi:10.2337/dc26-S002
Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther. 2008;88(11):1254-1264. doi:10.2522/ptj.20080020
American Diabetes Association Professional Practice Committee for Diabetes. 3. Prevention or delay of diabetes and associated comorbidities: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(suppl 1). doi:10.2337/dc26-S003
American Diabetes Association Professional Practice Committee for Diabetes. 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(suppl 1). doi:10.2337/dc26-S005
Balducci S, Sacchetti M, Haxhi J, et al. Physical exercise as therapy for type 2 diabetes mellitus. Diabetes Metab Res Rev. 2014;30(suppl 1):13-23. doi:10.1002/dmrr.2514
Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-2079. doi:10.2337/dc16-1728
Woelfel SL, Wendland DM. The role of physical therapy in managing peripheral artery disease and diabetes. Semin Vasc Surg. 2025;38(1):101-109. doi:10.1053/j.semvascsurg.2025.01.006
Wendland DM, Altenburger EA, Swen SB, Haan JD. Diabetic foot ulcer beyond wound closure: clinical practice guideline. Phys Ther. 2025;105(1). doi:10.1093/ptj/pzae171
American Physical Therapy Association. Scope of Practice. APTA. Accessed July 3, 2026.
American Physical Therapy Association. Patient Screenings. APTA. Accessed July 3, 2026.
American Physical Therapy Association. Documentation: Initial Examination and Evaluation. APTA. Accessed July 3, 2026.
American Physical Therapy Association. Role of the physical therapist and APTA in diet and nutrition. APTA Policies & Bylaws. Published September 20, 2019. Accessed July 3, 2026.
Freire LB, Brasil-Neto JP, da Silva ML, et al. Risk factors for falls in older adults with diabetes mellitus: systematic review and meta-analysis. BMC Geriatr. 2024;24(1):201. doi:10.1186/s12877-024-04668-0
Mulcahy J, DeLaRosby A, Norwood T. Transforming care: implications of glucagon-like peptide-1 receptor agonists on physical therapist practice. Phys Ther. 2025;105(6). doi:10.1093/ptj/pzaf061
This content drafted, researched, edited, and generated by:
McKinley Pollock, PT, DPT
McKinley Pollock, PT, DPT, OCS, CSCS is a physical therapist with a background in orthopedics and sports rehabilitation. Dr. Pollock earned his doctorate of physical therapy from Campbell University in 2021, is a board-certified orthopedic clinical specialist (OCS), and certified strength and conditioning specialist (CSCS). Dr. Pollock enjoys combining lessons learned from his DPT training and research, translating these into clinical practice. His passions include promoting relationships between patients & clinicians to promote clinical effectiveness, satisfaction, and efficiency, the implementation of primary preventative medicine into clinical practice, and leadership and education development.
© 2026 The Joint Connection Company. All rights reserved.
The content on this website, including all text, graphics, and materials, is the exclusive property of The Joint Connection Company and is protected by applicable copyright and intellectual property laws. No part of this site may be reproduced, distributed, or used without prior written permission.