Maintaining Our Balance: Diabetes Factors That Increase Risk For Falls

Having good balance is something we naturally take for granted—until we begin to lose it.

Our balance is dependent on the coordination of input from our eyes (spatial location), skin (touch), joints (vibrations, pressure), and our inner ear. The body automatically integrates this data to help us ambulate in a vertical position.

Diabetes-Related Risks

When some of the input required for good balance is missing, it puts us at greater risk for falling. Though input deficits are more common to those over age 65, there are diabetes-related factors that can increase the likelihood of falling at any age:

• Medications. Insulin users with A1C levels under seven percent, indicating tight glucose control, have a four times higher risk for falls owed to an increased likelihood of hypoglycemia, or low blood sugar. This is particularly true for older individuals. Hypoglycemia can cause blurred vision, weakness, and dizziness.
• Having tight glucose control while on oral diabetes medications is not associated with an increased rate of falls. However, some drugs, such as metformin, can trigger a vitamin B12 deficiency, and that can instigate balance problems.
• Whether on insulin or oral diabetes drugs, people taking several prescription medications for various health conditions may experience drug side effects that include muscle weakness, and dizziness.
• Diabetes Complications. Approximately one third of people with diabetes develop peripheral neuropathy (nerve damage), a condition that may cause numbness, sensation loss, and pain in the legs and feet. Those with neuropathy can experience instability while walking, especially when traversing uneven surfaces.
• Another complication, diabetic nephropathy (kidney disease), can lead to a vitamin D deficiency, which in turn causes instability from impaired muscle strength, and risk of fracture owed to poor bone density.
• Also, people with vision impairment from diabetic retinopathy, cataracts, glaucoma, or macular degeneration are at increased risk for falling, as are those with joint disease or deformity, skin breakdown, or slow healing wounds on legs and feet.
• Home Hazards. A third to one-half of falls are attributed to home hazards such as slippery surfaces, raised thresholds, loose area rugs, poor lighting, and electrical cords in walkways. If these external risks are combined with internal diabetes-related risks, the likelihood of falls increases dramatically.

It’s especially important that seniors become aware of balance issues related to age and diabetes, and to consider preventive action. Twenty to 30 percent of older people who take a tumble end up with moderate to severe injuries, including head traumas, and hip fractures. These falls can lead to life-altering disability, or worse. About 18,000 older adults die from falls every year.

Letting Others Know

Because many individuals are embarrassed, or fear losing their independence after a fall, many incidents are never reported to family members, caregivers, or doctors. However, by letting others know when we’ve fallen, and seeking to remedy the cause of our fall we can prevent future mishaps, and likely maintain independence longer.

Both the American and British Geriatrics Societies recommend older individuals have an annual physician’s assessment for fall risk. This should include an evaluation of a person’s health history, fall history, the side effects of current medications, and any mobility issues. If a high risk for falls is determined, referrals to occupational or physical therapists can be made for individualized assistance.

Sources: Foundation for Peripheral Neuropathy; Emily Piven Haltiwanger, OTD, MHE, OTR/Diabetes Self Management
Photo credit: woodleywonderworks