Diabetes is a disease marked by excessive blood sugar. Diabetes is a serious illness that increases the risk of heart attacks and strokes. According to the American Diabetes Association (ADA), more than a quarter of adults over 65 have diabetes. Elders with diabetes also have a higher risk of falling, fall more often, and are more likely to break a hip than elders without diabetes.
Why Diabetes Increases Fall Risk
Diabetes is associated with several complications that increase the likelihood of falling.
Low Blood Sugar
A drop in blood sugar (hypoglycemia) most commonly occurs in diabetics taking insulin, but it can also occur with oral medications that enhance the action of insulin. There are many reasons for a drop in blood sugar, including skipping a meal, exercising more strenuously than normal or not adjusting medication when blood sugar levels change.
Early signs and symptoms of low blood sugar include sweating, shakiness, weakness, hunger, dizziness and nausea. With profound drops in blood sugar, persons may experience slurred speech, drowsiness and confusion.
High Blood Sugar
High blood sugar (diabetic hyperosmolar syndrome) occurs in persons with uncontrolled diabetes or those who don't know they have diabetes. It can also occur if persons are under stress, or have an illness or infection. Signs and symptoms include excessive thirst and increased urination, weakness, leg cramps, and confusion.
Diabetes leads to visual disorders (diabetic retinopathy, cataracts and glaucoma). The resulting eye changes can contribute to falling (makes it difficult to see things clearly, interferes with depth perception and the ability to quickly adjust from bright to dim light and vice versa).
Half of all individuals with diabetes eventually have some type of nerve damage (diabetic peripheral neuropathy) that is characterized by a loss of sensation in the feet and legs, typically in a stocking-and-glove pattern. Nerve damage leads to unsteady balance (when standing and walking) and can also affect one’s mood and sleep patterns, which contributes to fall risk.
Diabetes affects the kidneys (nephropathy), which can result in urinary incontinence and/or increased nighttime urination (nocturia or frequent toileting) and fall risk.
Persons with diabetes can develop foot problems (blisters, corns, calluses, ingrown toenails, etc.), which interferes with walking and balance. Foot problems most often happen when there is nerve damage, which results in loss of feeling in the feet. Diabetic nerve damage decreases the ability to feel pain, heat, and cold or any foot injury. Nerve damage can also lead to changes in the shape of the person’s feet and toes (hammertoes) that contributes to unsafe walking.
Diabetes leads to loss of bone strength (osteoporosis) that increases the risk of injury, especially hip fractures.
Diabetes dramatically increases a person’s risk of developing Alzheimer’s disease (a strong risk factor for falling). Diabetes contributes to dementia in several ways:
• Insulin resistance, which causes high blood sugar and in some cases leads to diabetes
• Diabetes may interfere with the body’s ability to break down a protein (amyloid) that is linked to Alzheimer’s.
How to Control Diabetes and Fall Risk
The best way to reduce the risk of falls is to avoid any diabetic complications associated with falling. While there is no cure for diabetes, there are steps that elders and caregivers can take to manage diabetes and avoid falls.
The more you know about diabetes in old age and how it affects you specifically, the better off you will be. Likewise, if you are a caregiver for an elder with diabetes, learn about diabetes and how it affects the individual. Awareness and education are key to managing the disease and reducing the risk of problems. Asking your family doctor about diabetes and your risk of complications, and visiting the American Diabetes Association’s web site is a good place to start.
Get Regular, Ongoing Care
Regular check-ups with your family doctor helps to prevent problems or find them early when they can be treated and managed well. Ask the doctor if you are risk for certain complications (such as eye diseases, foot problems, nerve damage, etc.) and what things you need to report to the doctor to prevent problems (such as any persistent eye pain or reddening, any sudden visual loss and intolerance to glare; sores, blisters, calluses, or other foot problems; any tingling or burning of the feet, which might indicate nerve damage; etc.).
If you are taking medications of any kind, it’s a good idea to have your doctor review them. Certain medications or combinations of medications taken together can exacerbate diabetes. Also, consult with your pharmacy to get an idea of possible medication concerns to bring up with your doctor.
Low Blood Sugars
Be alert for signs of low blood sugar and report these to the doctor. Low sugar is especially dangerous; it can come on quickly and may include symptoms such as: confusion, dizziness and weakness. If you suspect low blood sugar, eating or drinking something (such as hard candy, a regular non-diet soda or fruit juice) will quickly raise the level of blood sugar.
Establish a program of exercise. A regular exercise regimen can help lose weight, better manage blood sugar levels, and improve balance. Check with your doctor before engaging in any type of exercise; it’s important to prevent the benefits of exercise from being canceled out by unsafe blood sugar levels (both low and high) and/or injury.
Elders have different responses to exercise; generally, about 30 minutes of moderately intense exercise can cause as much as a 50 point reduction in blood sugar. To manage fluctuating blood sugar levels, diabetics should keep sources of fast-acting carbohydrates handy. Also, stay hydrated during a workout; the body has trouble absorbing insulin unless it has enough water.
Lastly, a strict diet is necessary to keep blood sugar in balance. Ask your doctor for a referral to a dietician to recommend a ‘diabetes-friendly diet’, which includes foods such as fruits and vegetables, fish, lean meats, chicken or turkey without the skin, dry peas or beans, whole grains, and low-fat or skim milk and cheese.
Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at firstname.lastname@example.org.
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