The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


Can Having Diabetes Increase Your Risk of Falling?

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Friday, Apr 13, 2018


Diabetes mellitus (DM) is a condition where the body either does not produce insulin (type 1 DM), or is resistant to the effects of insulin (type 2 DM). Between 5-10% of individuals with DM have type 1, while the remaining 90-95% have type 2.

With both types of DM, blood glucose levels are much higher than normal. Type 1 DM is usually caused by autoimmune factors, while type 2 DM is most often caused by upper body obesity, sedentary lifestyle, aging, and genetics. According to the Centers for Disease Control and Prevention, the prevalence of DM among U.S. adults is approximately 9.4%, which is an all-time high. This translates into approximately 30 million people, many of whom have undiagnosed type 2 DM.  

Health Risks of Diabetes: Neuropathy   

The health risks that arise from having DM are enormous. DM is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations. Another serious condition that can arise from having DM is neuropathy (nerve damage). This occurs when blood glucose levels remain too high for too long. Some of these excess glucose molecules become permanently attached to nerve cells via a process called glycation; which causes a decline in the ability of nerves to function properly. Among the types of nerves affected by neuropathy are sensory nerves which take information from the peripheral areas of the body to the brain and spinal cord, and motor nerves which stimulate muscle contraction. It is very common for the nerves of the lower leg and feet to be affected by neuropathy.

A recent study out of Romania sought to evaluate the relationship between the presence and severity of diabetic neuropathy with balance impairment and the risk of falls in patients with type 2 DM. A total of 198 men and women with an average age of 61 years and average 7-year duration of DM, were enrolled. First, the presence and severity of neuropathy was assessed by using the Michigan Neuropathy Screening Instrument. Next, the presence and severity of balance impairment was evaluated by using four separate tests: the Berg Balance Scale, Single Leg Stand Test, Timed-up and Go Test, and the International Fall Efficacy Scale.

The results showed that 29% of the sample had diabetic neuropathy, which was more common in older subjects and in those with a higher body mass index (BMI). When comparing the results of the four balance impairment tests, subjects with neuropathy were shown to score significantly worse than those without neuropathy. The researchers also found that subjects with more severe neuropathy scored worse on the balance tests than those with less severe neuropathy.

Falls are the leading cause of concussions, as well as the leading cause of wrist and hip fractures in the elderly. Among the risk factors for falls in this group are a prior history of falls, poor vision, slow gait speed, low levels of leg strength, and poor balance. It is important to note that wound and fracture healing is significantly slower in the diabetic population. Thus, falls present an even greater risk of complications in this group. This study showed a significant relationship between the presence and severity of diabetic neuropathy with balance impairment. Thus, individuals with DM should be screened regularly for neuropathy as well as balance impairment. Those who are found to have either should undergo physical training programs that are designed specifically to increase leg strength and improve balance. Such programs have been shown to decrease the risk of falls in both the diabetic and non-diabetic populations. Some examples of balance exercises are shown below. Prior to attempting any of the exercises using the BOSU ball, individuals should master the beginner standing balance exercises first.  

Timar, B., Timar, R., Gaita, L., Oancea, C., Levai, C., Lungeanu, D. (2016). The impact of diabetic neuropathy on balance and on the risk of falls in patients with type 2 diabetes mellitus: a cross-sectional study. PLoS ONE, 11(4): e0154654. Doi:10. 1371/journal.pone.0154654

Note: The Cooper Institute has recently published a state of the art textbook titled Principles of Health and Fitness for Fitness Professionals. This book is an absolute must for fitness leaders or anyone in the general population who wants to learn more about health and physical fitness. The book is also a great resource for anyone who is seeking to earn a nationally accredited personal trainer certification! Click on the links above to learn more.