Falls in diabetics
Research indicates that falls are the most significant in elderly diabetics.
There is a significant and troubling link between diabetes (DM) and falls in the elderly.
Having diabetes increases the risk of falling because the condition can cause physical impairments that may make you less steady on your feet. According to one study, a person with diabetes who is older than 65 is 17 times more likely to suffer a fall than a younger man or woman who doesn’t have diabetes.
Problems from diabetes such as nerve damage, foot problems, and reduced vision may increase your risk of a fall. So can some medicines.
Keeping your blood sugar near your target level can help prevent falls. You also can exercise to improve strength and balance and can arrange your home to be safer.
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(1) Peripheral neuropathy in diabetics causes falls :
Numbness in the extremities can produce changes in gait, impact posture and affect balance, making diabetics more likely to take a tumble. The National Institute of Health estimates that 60-70% of Diabetes patients have some form of diabetic neuropathy.
Peripheral neuropathy or loss of sensation in the feet and/or a loss of balance can increase risk for a fall..
Individuals with DM are prone to fall for reasons such as decreased sensorimotor function, musculoskeletal/neuromuscular deficits, foot and body pain, pharmacological complications, and specialty (off loading) footwear device.
Recent studies comparing elderly patients diagnosed with lower extremity peripheral neuropathy with a control group of non neuropathic elders over a one year period found that the patients with peripheral neuropathy had a fourfold higher incidence of falls.
Peripheral neuropathy or loss of sensation in the feet and/or a loss of balance can increase risk for a fall.
(2) Hypoglycemia as the condition for falls:
Hypoglycemia occurs when your blood sugar (glucose) level falls too low for bodily functions to continue. There are several reasons why this can happen. The most common reason for low blood sugar is a side effect of medications used to treat diabetes.
Blood sugar below 70 mg/dL (3.9 mmol/L) is considered low. Blood sugar at or below this level can be harmful. The medical name of low blood sugar is hypoglycemia.
The consequences caused by hypoglycaemia episodes, in which blood sugar drops rapidly, causing falls.
Hypoglycemia—Low blood glucose (also called blood sugar) can trigger a loss of balance and lead to a fall, so check blood glucose regularly.
In older adults with diabetes, severe hypoglycemia is common and associated with falls.
Typical early warning signs are feeling hungry, trembling or shakiness, and sweating. In more severe cases, you may also feel confused and have difficulty concentrating. In very severe cases, a person experiencing hypoglycaemia can lose consciousness.
Research indicates that falls are the most significant consequences caused by hypoglycaemia episodes, in which blood sugar drops rapidly, causing light-headedness or fainting
Reduced vision makes it hard to see impediments like stairs, cords and changes in grade that cause falls.
(3) Cardiovascular issues cause of falls:
Adults with heart failure and arrhythmia (irregular heartbeat) have an especially high risk of falls.
One main artery supplies blood to the organs of the hearing and balance systems. Due to this blood vessel's small size and the lack of alternate routes for blood to travel, the hearing and balance systems are particularly susceptible to decreased blood flow and damage.
Cardiovascular disease, heart attack and stroke
Older people with cardiovascular issues are 29% more likely to fall and require a trip to the hospital, due in part to light-headedness and dizziness, dramatic changes in heart rate or blood pressure or diminished alertness.
Adults with heart failure and arrhythmia (irregular heartbeat) have an especially high risk of falls because their heart may not pump as efficiently, or may beat in an irregular rhythm, causing a decrease in blood flow to the brain.
(4) Vestibular dysfunction and falls:
According to the Centers for Disease Control and Prevention, diabetes can damage small blood vessels in the ears and your vestibular systems
It is noteworthy that diabetes has been reported to affect vestibular function in both animal and clinical studies. Pathophysiological changes in peripheral and central vestibular structures due to diabetes have been noted. Vestibular dysfunction is associated with impaired balance and a higher risk of falls.
Vestibular balance disorders can affect your balance and make you feel disoriented. Common causes include inner ear problems, medicines, infections, and traumatic brain injury. These disorders can occur at any age. But they are most common as you get older.
(5) Vision loss can lead to unsteadiness and difficulty seeing obstructing objects. Large-joint issues—People with type I diabetes seem to develop large-joint issues, and this can lead to pain and disability.
Older adults with impaired vision have been shown to be more likely to fall than their sighted peers. Hip fractures have been linked to visual impairment and to individual measures of vision such as reduced visual acuity, contrast sensitivity and visual field.
People with poor vision can easily lose stability and change different gaits to avoid obstacles, thus increasing the risk of slips, trips, and falls
The results of the study indicate that people with cataract, AMD, or glaucoma have a higher risk of both falls or fractures compared with people without these eye diseases.
Macular degeneration, cataracts, diabetic retinopathy and glaucoma are strongly associated with falls because they cause poor contrast sensitivity, reduced depth perception and visual field loss.
Partial or complete vision loss can also occur after a head trauma. The area of the brain that has been affected as well as the extent of the damage will determine your field of view.
The poor eye sight may be caused by normal ageing of the eye, an eye condition, another health condition such as stroke or dementia. Although anyone maybe at risk of falling, it is important to be aware that people with sight loss are more likely to fall and have multiple falls than those without sight loss of similar age.
(6) Weakness of muscles:
Damage to your peripheral nerves can weaken and shrink the muscles that are connected to them. This most commonly happens in your hands, lower legs, and feet. Such damage can weaken your grip, make you less stable on your feet, or make it difficult or even impossible to walk.
(7) Dementia and falls
Dementia is a syndrome (a group of related symptoms) that is associated with an ongoing decline of the brain and its abilities. Some of these symptoms include memory loss and difficulties with thinking, problem solving, communication and language.Falls are common in older people and people with dementia, and can make it difficult for them to live independently. One in three adults over the age of 65, and half of people over 80, will experience at least one fall a year.
People with stage 6 dementia are at high risk for falls and injury due to confusion, disorientation, and decreased physical coordination.
People with dementia are at higher risk of depression, which can make you less active, and affect how well you eat, drink and sleep, leading to an increased falls
The good news is that many complications of diabetes – and the fall risk associated with them – can be avoided.
(1) Keep an eye on your blood glucose levels
Regularly monitor and manage blood glucose levels, which reduces the likelihood of developing neuropathy and hypo/hyperglycaemia.
(2) Stay physically active
Physical exercise helps lower your blood sugar level. You should aim for 2.5 hours of activity a week. You can be active anywhere as long as what you're doing gets you out of breath. This could be fast walking, climbing stairs or doing more strenuous housework or gardening.
(3) Eat well
There's nothing you cannot eat if you have type 2 diabetes, but you'll have to limit certain foods.
It is recommended by the NHS to:Eat a wide range of foods – including fruit, vegetables and some starchy foods like pasta
Keep sugar, fat and salt to a minimum
Eat breakfast, lunch and dinner every day – do not skip meals
(4)Get regular check-ups
It’s important to see your GP on a regular basis for blood tests and ongoing monitoring. It is also important to visit your optician to evaluate your eye health.
Information compiled by Dr. Bhairavsinh Raol
