DIABETES OSTEOPOROSISDIABETES OSTEOPOROSIS is a disease that can be prevented but, once established, is very difficult to manage. It becomes an expensive and painful disaster.
Type IType I diabetes has long been known to be associated with osteoporosis. In women, for example, there is a much higher rate of hip fracture compared to non-diabetic women. How long you have had diabetes is a major factor. Women who have had type I for more than five years are a massive 12 times more likely to have a hip fracture than non-diabetic women. Low BMD (Bone Mineral Density) is clearly a complication of Type I diabetes.Obviously thus children who have type I diabetes are particularly vulnerable. They aren’t going to have diabetes for 5+ years. They are going to have it for 50+ years. In particular, if they are less than 20, whilst they are still building up their bone calcium, they may never reach adequate bone density. These fractures, of course, are not merely the result of diabetic osteoporosis, or weak bone structure. Diabetics are also prone to a variety of eye conditions, for example, (like cataracts) that increase the number of falls because of poor eye sight. Diabetics also frequently have an altered gait (changes in the way they walk due to a diabetic nerve condition) and their balance is often poor. The long and short of it is increased falls and, coupled with diabetic osteoporosis, that means broken bones. Type IIIn Type II diabetes the bones may actually be slightly stronger than normal but there is still an increased risk of hip and other fracture. Why? Because Type II diabetics are usually obese and often have a couch potato lifestyle – thus their balance is often not good and, because of poorer coordination and eyesight, they also tend to faller harder and more often than non-diabetic women.You may also have to get up more often at night to go to the toilet and, if it’s dark, the risk of falls is much greater. The Kegal exercises are important for all women (men too, really), but particularly for diabetics. Poorly controlled blood sugar?Sedentary diabetics, and those whose life style is poor, often find their blood sugar is not well controlled and that certainly is associated with bone loss when compared with well-controlled diabetics.There are what we call modifiable risk factors in the management of diabetes osteoporosis. We are capable of change but diabetics who refuse to face the reality of osteoporosis will experience much pain. Modifiable Risk FactorsObesityObesity of course is the primary cause of Type II diabetes, and extremely difficult to manage. I address it in a crass and direct way: "If you don't want to have lots of pain, and you want to see your grandchildren grow up, then get it off." It makes me no friends in the first instance, but about 15% of obese persons respond well to the direct approach.Our free weight loss programs have had considerable success with those who have the desire to avoid pain and live long in the land. It involves a restriction of carbohydrate in the diet: bread, pasta, rice, potatoes, flour products and sugar primarily. Because fruit is so important in the diet we are reluctant to forbid fruit, but it is somewhat curbed. Type II diabetics can often completely cure themselves of diabetes osteoporosis simply by losing the necessary weight. SmokingSmokers all know that their habit will cost them about ten years of their lives - and the end is usually S-H-one-T, unless they are lucky enough to have a massive MI or stroke.Smoking also is one of the main causes of osteoporosis. Cellular tissues, including the bones, are starved of an adequate supply of oxygen with the obvious consequences. But with diabetes osteoporosis it is far worse. A nightmare because it involves not only bone loss but blindness, loss of a limb and cardiovascular accidents. More falls ... Risk of fallingI was recently walking with a poorly controlled teenage diabetic and her mother when the girl missed a step and fell headlong. She simply never saw the curb - I suspect the early loss of peripheral vision associated with diabetes.These are some simple exercises that diabetics can do to reduce the risk of falling. How to stop falling. What's to be done?This summary of diabetes osteoporosis may seem rather depressing. Quite the contrary, the scenario I have painted need not happen. I have numerous diabetic patients who in the eighties are extremely healthy. They follow the rules. The alternative is too ghastly to contemplate.
"Those who will not hear, must feel." Dutch proverb.
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