People with diabetes over the age of 65 are three times more likely to be hospitalized in a given year for falls. That’s why preventing falls in this age group is important to help reduce declines in mobility, activity avoidance, loss of physical independence, and even death.
We Use Three Important Senses to Maintain Our Balance
Why does being diagnosed with diabetes put you at an increased risk for falls? Before we answer that question, we have to identify how we maintain our balance.
1. Sense of TouchThe ability of our legs and brain to communicate lets us know where we are physically in space. This allows our brain to understand how dynamic a surface is (e.g., soft, hard, uneven, buoyant, angled) and how to correct our posture to maintain that position. For example, if we are walking up a hill, we naturally pitch our bodies forward so we do not fall backward.
Our ability to see. Our eyes are constantly in communication with our brain, telling us where we physically are. For example, if you see stairs or a rock on the ground, you adjust your gait so you do not trip.
3. Ears (Vestibular)
Our ears have several gravity detectors, including an accelerometer (to detect speed). They are constantly sending a corrective signal to our brains and down to our feet to tell us where we are in space. Think of your ears like a gyroscope - they provide a point of reference to help us navigate the terrain below our feet. For example, if you start jumping up and down, the gravity detectors in your ears are physically moving up and down to signal that sensation.
These three senses, hearing, vision and touch, are all important to help keep us upright and prevent us from falling. Deterioration of one or more of these sensory systems may adversely affect balance and increase fall risk.
How Complications from Diabetes Contribute to Poor Balance
So now let’s talk about how four common complications from diabetes can contribute to poor balance (disequilibrium).
1. Diabetic Peripheral Neuropathy (DPN)
Deterioration of nerves that are responsible for the sense of touch may lead to neuropathy. Peripheral neuropathy can be described as a numbness, tingling, or burning sensation of the feet and/or legs. A reduction in sensation and control of the lower limbs reduces the ability to detect surface changes. An example of this would be from walking on a firm surface, such as concrete, transitioning to an uneven surface, such as a lawn.
2. Retinopathy and Macular Degeneration
Blurred central vision and reduced contrast sensitivity (color differences) can lead to the inability to recognize balance threats, such as navigating around obstacles in the environment. These conditions are complicated further by poorly lit areas, like using the bathroom in the middle of the night, and tripping hazards, such as throw rugs.
3. Vestibular Dysfunction
Vestibular Dysfunction is a reduction in nerve and sensory organ function that is responsible for sending motor commands to tell us where we are in space. When wrong information regarding head and/or body movement is being exchanged, it can lead to dizziness and imbalance. Your brain is receiving two different signals, and is unable to decide which one is correct.
4. Blood Pressure Control/Stroke
Having elevated blood pressure can often accompany diabetes. This can be a risk factor for stroke. Strokes (abnormal bleeding in the brain) can affect cognitive function and motor control, and often impacts balance.
What can we do to reduce the risk of falling if we have diabetes? Prevention is key! Keep track of your numbers. Follow doctor’s orders, take your medications, follow a healthy diet, and exercise. Physical exercise is not just good for your joints and muscles; it is good for your ears, balance and fall prevention, too! Stay active. The old sayings are true: a body in motion stays in motion; and if you don’t use it, you lose it!