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Those annoying calf cramps

Aug 19, 2014

Have you had patients complain about calf cramps at night?  They can be incredibly bothersome and painful.  When I see a patient with diabetes and ask about pain, I am often told about annoying calf cramps.  They can come without warning and wake a person up from a sound sleep.  Most people will wriggle and stretch and get up from bed to try to walk them out.

What causes them?  There are several possibilities.  Here are a few common ones:
   • Dehydration: I ask the person if they think they are dehydrated.  People often know if they are or aren’t.  If there is a chance that this is the cause, I suggest increasing fluid intake (water) unless they have a medical restriction.
   • Potassium deficiency: This is especially likely if the person is taking a diuretic for hypertension, including many people we see with diabetes.  Potassium levels should be evaluated and, if there is an imbalance, addressed.
   • Neuropathy: If the person has neuropathy, there may be hyperactivity of the nerve/muscle causing the cramps.
   • Overuse: I ask if there has been an activity lately that would have overused the muscle.  In my experience, this is the least common cause.  If it is the case, the irritated muscle should settle on its own over a few days.  Delayed-onset muscle soreness peaks about two days after exercise/physical activity so the pain should decrease shortly after that.

What to do?  It is best if the cause of the cramps can be identified and managed.  But, there are those situations when it isn’t determined. Sometimes, it is necessary to just treat the symptom.

In either case, I have found a substantial decrease in report of cramps if calf muscle stretches are done routinely before going to bed.  Interestingly, when I did a search for the evidence, I didn’t find support.  But, since this is a pretty low-risk intervention, it seems worth a try.  This is the stretch I most often suggest to manage those annoying cramps:

Calf Stretch

• Stand facing the wall at arm’s length from the wall, feet shoulder-width apart.
• Place hands on the wall at shoulder height.
• Step one foot forward, allowing that knee to bend.  Keep the back knee straight and heel on the floor.  Be sure the back foot is straight or slightly toed in rather than toed out (to maintain the arch of the foot).
• You should feel a comfortable stretch in the back calf muscle.  Don’t stretch too hard or the calf will cramp to protect itself. 
• Hold this position for 30 seconds without bouncing.  Change sides and repeat.  You can do 1-2 repetitions on each side in the evening before going to bed.


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  1. Oct 12, 2014

    Another potential deficiency can contribute to muscle cramps in people with diabetes who are active, and that is magnesium. Insulin use causes some loss of magnesium, but it's also commonly deficient in individuals with type 2 diabetes. Given that it is involved in more than 300 enzymatic reactions in the body associated with fuel metabolism, it is no surprise that a magnesium deficiency can lead to suboptimal performance and more frequent cramps associated with exercise.
  2. Aug 19, 2014

    Thank you for this review/reminder! Actually had this conversation last night--no, not with a patient, but my husband! We debated on dehydration being a cause of calf cramps. Guess I was right! I wish I could print your blog so that I may provide it to patients (and my husband!). It is a nice review of the problem. Well done, as usual, Ms. Kemmis!

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