The increase in activity, working with the Physiotherapists or Prosthetists during rehabilitation can cause your blood sugar levels to drop quickly. If they go below 4mmol/l this is called a ‘hypo’.

You are at more risk of a hypo when you are attending or have attended rehabilitation. To have an artificial limb fitted and to learn how to use it will involve using more energy than you have been used to while using a wheelchair.

For some it may have been a long time since you were walking, for others it may only have been a few weeks but the effect of walking in the parallel bars may still make you feel like you have run a mile.

To get the most out of your visit to the Prosthetic department your blood sugar level needs to be under control.

How to prevent blood sugar problems with rehabilitation

Hypos can happen up to 36 hours after strenuous or prolonged physical activity, so you might need to adjust your medication or carbohydrate intake to compensate.(e.g. consider a bed time snack).

For planned exercise, reducing your insulin would be the preferred choice, while additional carbohydrate would be needed for unplanned exercise. Your diabetes healthcare professional will be able to help with what works best for you.

Do not inject insulin into your leg if you are going to be walking or exercising the leg muscles within the next 12 hours (muscle use increases the rate the insulin is absorbed)

Do not attend for your appointment if you are unwell. Please contact the centre if you are unable to attend – 01228 814783

Be aware that anxiety or worrying about the rehabilitation process can make your blood sugar levels drop more than you would expect, or can sometime raise them.

Remember that the DVLA states that you must not drive for 45 mins after a hypo has been treated.

Your blood glucose levels should be reading between 7 and 13 before starting your physio/prosthetic session (unless your therapist advises you differently i.e. after we know how you react to the exercise)

Bring appropriate food with you—see overleaf.

Avoid chocolate and fatty foods as they can cause you to gain weight. Check your blood sugar levels before and after your treatment session. This can be done using a blood glucose monitor in the department to ensure readings are correct as the machine is calibrated daily. These readings can be compared to your monitor.

Blood Sugar Levels after exercise/rehabilitation

If less than 6mmol/l - take 20g of carbs

If less than 8mmol/L - take 10g of carbs

10mmol/L and above - no extra needed.

More than 13mmol/L - discuss with your therapist

15mmol/L and over - the senior therapist will review your symptoms and discuss the cause with you. You may not be able to participate in rehabilitation. Your BM readings may need to be discussed with your diabetic specialist nurse.

How can you recognise when your blood sugar is getting too low?

You may feel some of these symptoms:

  • Short tempered or cross
  • Shaky
  • Sweaty
  • A bit confused Heart beat racing or slow
  • Difficult to concentrate
  • Feel hot
  • Feel sick
  • Feel hungry
  • Eyesight blurred

Confirm it by testing your blood sugar levels with a monitoring kit in the department

If it is below 4mmol/l you are having a ‘hypo’

What do you do if you have a hypo?

Immediately treat with a 15–20g of a short-acting carbohydrate such as:

  • 200ml full sugar fizzy drink
  • 200ml of fruit juice
  • Lucozade (only 100ml )
  • five sweets, e.g. jelly babies
  • 4 teaspoons of sugar in warm water

Check your blood sugar again after 10-15 minutes and if still low repeat the treatment. Once returned to above 4mmol/l take 10-20g carbohydrate (see below)

Follow-on treatment

 To prevent your blood sugar levels dropping again, you will need a follow-on snack of 10g–20g of a longer-acting carbohydrate such as:

  • half a sandwich or slice toast
  • Fruit (banana, apple etc.)
  • a large bowl of cereal or 1 Weetabix
  • 2 digestive biscuits
  • 200ml of milk or 1 yoghurt (15g)
  •  the next meal if due

Our Amputee patients are on open access to the Prosthetic department in the Specialist Rehabilitation and Mobility Centre (SRMC) at the Cumberland Infirmary.

This means that you can phone to make an appointment yourself rather than being referred by another health professional

Please discuss any concerns regarding your diabetes and rehabilitation with your prosthetic/physiotherapy team at SRMC

Contact details:

Prosthetic Multi-Disciplinary Team

Prosthetic Department Specialist Rehabilitation and Mobility Centre (SRMC)

Cumberland Infirmary

Tel: 01228 616868

Monday – Friday 8.30am – 4.30pm

Useful websites:

www.diabetes.org.uk

www.dafne.uk.com 

www.cumbriapartnership.nhs.uk/cumbria-diabetes 

DVLA. Assessing fitness to Drive. 2015

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For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302