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What do Diabetes and Falling Have in Common
1/21/2013
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.
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. 

Why Diabetes Increases Fall Risk? Diabetes is associated with several complications that increase the likelihood of falling.

Short-Term Complications

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.
Long-Term Complications

Eye Damage

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).

Nerve Damage
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.

Kidney Damage
Diabetes affects the kidneys (nephropathy), which can result in urinary incontinence and/or increased nighttime urination (nocturia or frequent toileting) and fall risk.

Foot Damage
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.

Bone Damage
Diabetes leads to loss of bone strength (osteoporosis) that increases the risk of injury, especially hip fractures.

Alzheimer's Risk
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.
To read more of Dr. Reins list of Short Term Complications and Long Term Complications and what can be done to decrease the risks of falling CLICK HERE

 

Dr. Rein has authored a course Managing Falls In the Nursing Home: Who, Why and What Next? 
For many years, it was assumed that falls were unavoidable accidents, due to just being old, and that nothing, apart from restricting a resident’s mobility or placing them in physical restraints, could be done to prevent falls. Over the past several years, however, interest in fall prevention flourished and, as a result, our thinking about falls has dramatically changed. We now have a better understanding of why falls occur and, more importantly, what can be done to prevent falls from happening. We also now know that falls are not caused by old age itself. But rather, as you will learn, falls have known causes, such as physical illness, medications, and environmental hazards. The biggest lesson we have learned, however, is that while falls may occur often, falls can never be accepted as ordinary events, since there is a great deal that we can do to prevent them. Knowing why a resident may be a fall risk and what can be done to prevent them from falling is an important aspect in managing falls in the nursing home.
CLICK HERE to read the complete details of this course, purchase and begin your course right away!

Pedagogy author Maureen Sullivan offers a course Diabetes: An Introduction, this 3.5 hour continuing education course will improve your knowledge of Diabetes, treatments and management. The goal of this Continuing Education program is to educate all levels of providers on the chronic disease process known as diabetes, and to empower them to recognize their own personal risk factors. The program will discuss lifestyle changes, as well as overview medications available to treat diabetes. Additionally, the program will discuss medication conditions associated with diabetes, their treatment goals, and proper patient education. Finally, the program is written to enhance the practice of healthcare providers in all areas of practice, from acute care settings to long term care facilities. Specific guidelines will be outlined for the care of a diabetic patient in a variety of clinical settings.
CLICK HERE to read the complete details of this course, purchase and begin your course right away!

Pedagogy author Judy Gilman has authored a course Continuous Subcutaneous Insulin Infusion in Long Term Care (CSII), for those nurses managing the resident or patient that uses an insulin pump.

Since the introduction of insulin pumps several decades ago, Continuous Subcutaneous Insulin Infusion (CSII) therapy has become the preferred method of treatment for everyone with Type 1 Diabetes. For patients using CSII, it replaces multiple daily injections (MDI) of insulin. CSII is also used for some people with Type 2 Diabetes who, as a result of the progression of their diabetes, require MDI of insulin a day, similar to a person who has Type 1 Diabetes. This means that the number of patients with diabetes being admitted to Long Term Care (LTC) who utilize CSII has increased and will continue to do so. Patients are being admitted for LTC at younger ages than previously, often due injuries and illnesses that require them to have assistance during an extended recovery. Many of the patients admitted to LTC are mentally alert but need of physical care during an extended recovery or rehabilitation time. The dilemma in the LTC setting, when a patient is admitted who has been on CSII, is whether to continue the CSII or revert back to MDI of insulin. In this course, we will explore when it is appropriate to leave the patient on CSII, when to consider reverting to multiple injections and how to manage an insulin pump in LTC when it is determined to be the preferred method of treatment. Videos, pictures and links to pertinent web sites are included to enhance the learning experience.
CLICK HERE to read the complete details of this course, purchase and begin your course right away!
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