Why Diabetes Raises Your Risk of Fallingby Tim Gower Health Writer
Comedians may trip and stumble for easy laughs, but there’s nothing funny about falling, which is a major health risk for older adults. Having diabetes increases that risk because the condition can cause physical impairments that may make you less steady on your feet.
According to one estimate, 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 the disease. But adopting some healthy habits and preventive strategies can help you prevent this common problem.
The perils of stumbling
The numbers tell an alarming story about the dangers of falling down. One out of five falls results in serious injuries, such as broken bones or head injuries, according to the Centers for Disease Control and Prevention (CDC).
In fact, falls are the most common cause of traumatic brain injuries and send 2.5 million older adults to emergency rooms each year; about a quarter million are hospitalized with broken hips. Breaking a hip can be debilitating, resulting in chronic pain and a reduced ability to get around. Indeed, hip fractures in the elderly are, on their own, a risk factor for early death.
Falls become a greater threat as we age for many reasons. Bones become more fragile and fracture more easily. Age-related decline in cognition, or the ability to think clearly and make sense of the world, also increases the risk for falling; at least 60 percent of older adults with cognitive impairment suffer a fall each year. Your ability to react slows as you grow older, too, so you may be less able to catch yourself or break your fall if you slip or trip.
Certain age-related diseases, including diabetes, and their treatments, can interfere with good balance and a steady gait. Several recent studies have taken a closer look at how and why this condition makes people more prone to taking a spill.
Diabetes complications and falls
The hallmark of diabetes, elevated blood glucose, causes some degree of nerve damage, or neuropathy, in up to half of all people who develop the disease.
Chronically elevated glucose has a large impact on the longest nerves in our bodies; these convey sensory information from the feet and toes to the spinal cord. The resulting loss of sensation and muscle tone is often worst in the feet and ankles, which can make it harder simply to stand up and walk, especially on uneven surfaces. The threat of neuropathy is one of the major reasons that people with diabetes have such a high risk for falls.
In a 2016 study published in the journal PLOS One, Romanian researchers examined 198 people with type 2 diabetes to determine if they had neuropathy, and graded its severity in those who had evidence of nerve damage. Next, they evaluated all of the participants’ balance and risk for falling with several standard tests, such as measuring how long each subject could stand on one leg or how well he or she was able to rise from a chair without any hands.
The study found that people who had neuropathy had the worst balance; those who had the more severe nerve damage were judged to have a greater risk for falls. Older adults with diabetes are also more likely than others to develop functional disabilities, such as having trouble climbing stairs or walking for an extended period. Loss of muscle mass is a problem, too.
High glucose levels can damage blood vessels, including those that nourish the retina, which is light-sensitive tissue at the back of the eye. The resulting condition, retinopathy, is the leading cause of vision loss in people with diabetes.
However, diabetes patients have an increased risk for other vision problems, such as cataracts and glaucoma. Not surprisingly, vision loss is linked to frequent falls, too, since good eyesight is essential to ensure you don’t trip over the dog or a curb.
A 2014 survey by the CDC found that close to half of older adults with severely impaired vision (46.7 percent) said they had fallen in the last year, compared with slightly more than one quarter (27.7 percent) of people without major loss of vision.
Other risk factors for falls
For some diabetes patients, aggressive attempts to lower blood glucose can increase the likelihood of developing severe hypoglycemia (or very low blood glucose) up to threefold. Since a drop in blood glucose can leave you feeling woozy and confused, it’s no surprise that a 2015 study in the journal Medicine found that diabetes patients with a history of severe hypoglycemia have an increased risk for falls.
Diabetes patients often require more than one medication to manage blood glucose, and frequently have other medical conditions, such as heart disease and high blood pressure that require drug treatment.
Some studies suggest that taking multiple medications makes people more prone to falls; one examination of older diabetes patients in a care facility found that each drug added to a treatment regimen increased the risk for falling by 7 percent. Some drugs, such as sedatives, seem like obvious candidates for making people unsteady on their feet.
However, even certain blood pressure medicines can disturb balance and also weaken bones, making them more susceptible to fractures if you fall. Furthermore, a significant portion of people with diabetes also have high blood pressure, and medications to treat it can often leave people feeling light-headed without warning, thus increasing the risk for falling.
One of the leading risk factors for type 2 diabetes, obesity, has also been linked to falls. In a 2015 study published in Obesity Research and Clinical Practice, a group of Mexican doctors interviewed 134 type 2 diabetes patients and found that those who had a body mass index (BMI, a measurement of body fat) of 35 or higher were significantly more likely to have suffered a fall in the last year than those with lower BMIs. Many of the reported falls occurred under seemingly safe circumstances, such as walking on a flat surface in broad daylight.
Stay in step
A 2015 study in the journal Age and Ageing found that fear of falling is common among patients with diabetes, who often end up restricting their activities as a result. Fortunately, there are many steps you can take to maintain good balance and posture, as well as make your environment safer to navigate.
For starters, it’s important to check in with your doctor on a routine basis to ensure that your medication regimen isn’t causing bouts of hypoglycemia or in any way interfering with your balance. If you have osteoporosis, take all necessary medications.
If you don’t currently exercise regularly, talk to your doctor about starting soon. Your regimen should include both aerobic exercise (such as walking or swimming) and strength training (for example using weights or exercise bands). Several studies have shown that exercise reduces the risk of falls or prevents serious injury if you do take a tumble.
Changes to your home and habits can help keep you on your feet, too. Rooms in your house should be well lit, with floors free of clutter. Remove throw rugs, which can be slippery, install handrails in the bathroom, and use a nonskid mat in the tub or shower. Wear shoes with rubber soles and consider using a cane or walker, if necessary.
Watch out for phone, television, appliance, and other cords criss-crossing rooms or hallways. Avoid walking around the house on hardwood or other smooth surfaces in socks. If you live in a region with cold winters, avoid walking on icy paths; melt ice with salt or kitty litter. If you consume alcohol, do so in moderation. Most of all, don’t let a fear of falling keep you from enjoying life.