November is National Diabetes Awareness month! We kicked this off with our diabetes forum, where participants could access information about our Joslin Diabetes Center affiliate site, other hospital departments, diabetes medication and devices, and community services (i.e., YMCA) and then attended a presentation. Colleagues and I represented the Physical Medicine & Rehabilitation Department at the forum as part of our monthly activities to raise awareness about diabetes.
A person with diabetes may be at increased risk of falls due to many factors including visual problems, decreased nerve input from neuropathy and painful lower extremities
Blood glucose screenings and risk assessments are common activities to raise awareness of diabetes, but this year we decided to offer a balance screening. It was easy to put together, fun to take part in, and very helpful to the participants. Why would we do a balance screening? Because many people have balance dysfunction, which can lead to falls; falls can result in major injuries including fractures and concussion/head trauma which can negatively impact a person’s life; and a person with diabetes may be at increased risk of falls due to many factors including visual problems, decreased nerve input from neuropathy and painful lower extremities to name a few.
Three of us from the physical therapy (PT) department carried out the screening at an exhibit table with a small space in front to do the screening. We also brought plenty of the Centers for Disease Control and Prevention’s free Stopping Elderly Accidents, Deaths & Injuries (STEADI) materials, including the 4-Stage Balance Test and related brochures.
As people came to the table, we asked “Would you like to see how your balance is?” The most common response was something like “I know it’s terrible.” Then, there was often a reason to follow. “My knees hurt.” “I have neuropathy.” “I can’t feel my feet.” Our response was “Yes that can harm your balance. Let’s check it out and see what you might be able to do to help.” Most people readily agreed to go through the brief assessment.
For the screening, we had people perform the 4-Stage Balance Test with narrow, tight semi-tandem, tandem, and single limb stances for up to 10 seconds. Additionally, we had them stand in whichever position created a little imbalance and, with our careful guarding, had them close their eyes. If there was increased sway with eyes closed, we noted that.
As with any screening, we wanted to send each person away with ideas to address their challenges. A handout we provided them explained the results of their screening along with some exercises to improve lower extremity strength, static balance and dynamic balance. We also had a section to address increased sway with eyes closed, including suggestions like: work with your healthcare provider to evaluate eye health; be sure your eyeglass are clean and have an up-to-date prescription; try to maintain blood glucose in goal ranges; and never move about in the dark.
Though blood glucose and other health parameters are very important for long-term health with diabetes, balance is equally important.
Some participants were already in PT, some said they would talk to their healthcare provider about balance work, some would look into a community class for balance, some would have their eyes checked, some needed an evaluation of their vestibular system, some would start the general exercises we provided, and most took the Staying Independent
brochure. Many engaged with the topic, so we’ll offer the screenings again next year.
The work you do every day for people with, or at risk for diabetes helps them have the best health and quality of life possible! Though blood glucose and other health parameters are very important for long-term health with diabetes, balance is equally important. With just one bad step, in a millisecond, a person’s life can change from the negative results from a fall. Consider performing this screening or coordinating with a PT, occupational therapist, exercise specialist or community contact who works in balance and fall safety. If you do not have access to one, I am happy to share our materials. Just send a request to firstname.lastname@example.org.
About the Author
AADE President-elect Karen Kemmis is a physical therapist and certified diabetes educator, and also holds certifications in Pilates for rehabilitation and exercise for aging adults. She is based out of SUNY Upstate Medical University in Syracuse, NY and splits her time between a Joslin Diabetes Center affiliate, an outpatient rehabilitation department, and a PT program where she is an adjunct professor.
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