Bones, Joints, and Falls: The Injury Nobody Plans For

Chapter 40 · Vihang Rahul Vasa

Nobody plans to fall. But a fall in the bathroom, a slip on a wet floor, a twisted ankle on the stairs: in my view these are among the most common ways a person living with diabetes goes from “managing well” to being bed-bound for months. Few people think about it until it happens, and it matters more with every year of age.

Why bones can be weaker in diabetes. Medical research has described that years of high plasma glucose (blood sugar) can change the structure of bone. A bone-density scan may look normal, and yet the bone may be more brittle than it appears: it can break more easily, from smaller falls. This has been reported in Type 2 Diabetes, and it surprises most people. Ask your doctor what it means for you.

Why fractures can heal slowly. Healing needs a good blood supply and a body free of inflammation, and diabetes can weaken both. A fracture that heals in weeks in one person can take months in a person with uncontrolled diabetes, with a higher chance of infection, and of the bone not joining well. If surgery is needed, the risks can be higher too. This is why, after any fracture, the first thing to tell the orthopaedic doctor is that you live with diabetes, and to share your latest HbA1c (glycated haemoglobin). In my experience, good plasma glucose (blood sugar) control during healing matters as much as the plaster cast; your doctors will guide the rest.

Why people with diabetes may fall more. Several threads of this book meet here: weaker eyesight and retinopathy, when you simply cannot see well (Chapter 32); numb feet that cannot feel the floor (Chapter 38); a low plasma glucose (blood sugar) that brings dizziness (Chapter 25); and the night-time trips to the toilet that high plasma glucose (blood sugar) causes. Some medicines can add to dizziness: ask your doctor about yours.

Making the home safe: simple things that reduce the risk of a fall, though nothing prevents every fall. A non-slip mat in the bathroom and grab bars beside the toilet and in the bath. A night light between the bed and the bathroom. No loose rugs, no wires across the floor, nothing stored on the stairs. Footwear at home, always (see Chapter 39). And if you get lows at night, check your plasma glucose (blood sugar) before bed and keep something sweet within reach, and tell your doctor about the lows.

Stiff joints: the connection few people mention. Diabetes can quietly stiffen tendons and joints: a frozen shoulder that will not lift, a finger that locks (trigger finger), thickened palms, stiff hands that cannot press flat together. Medical research reports these conditions more often in people with diabetes, and in daily life they are usually dismissed as “just age.” In my view they should not be. Tell your doctor; treatment usually works better when started early.

Gout: a painful, swollen joint. Gout is a sudden, very painful swelling of one joint: most often the big toe, sometimes the ankle, knee or wrist. It usually starts at night. The joint becomes red, hot, shiny and too painful to touch. It is caused by a substance called uric acid forming sharp crystals inside the joint. People with Type 2 Diabetes get gout more often, because insulin resistance makes the kidneys hold on to uric acid instead of passing it out in the urine, so it builds up in the blood. Belly fat, high blood pressure, fatty liver, alcohol and sugary drinks all push it higher. I have not had gout myself, but I have watched friends dismiss a red, hot, swollen toe as a sprain. It may not be a sprain. If a joint swells up suddenly like this, see your doctor as soon as you can: do not wait for it to pass. If the joint is hot and swollen and you also have fever, that needs urgent care the same day. Gout can be treated, and uric acid is a simple blood test your doctor can add to your routine checks.

Sports injuries. The same logic applies to a sprain or a torn ligament: it may take longer to heal than in a person without diabetes, and playing through the pain can make it worse. Warm up properly, stop when something hurts, and see a doctor for any injury that is not clearly better within a week. Do not self-medicate painkillers for weeks on end: some of them are hard on the kidneys, which diabetes already burdens. Ask your doctor what is safe for you.

A bone check. Ask your doctor whether a bone-density scan and a Vitamin D test are due (Chapter 10). Keeping plasma glucose (blood sugar) in range, staying active, and keeping muscles strong are, in my view, the best protection your bones have, with your doctor’s guidance on all three.

The message is simple: a person living with diabetes cannot afford a fall. Prevent it in the home, protect the bones with control, and after any injury: tell the doctor about your diabetes first.

(References for this chapter, fracture risk, bone healing, falls, joint stiffness, and gout in diabetes, are listed in Appendix B.)

Illustration: Chapter 40 illustrated summary. Bones, joints and safer steps: fractures may heal slowly; stiff joints and gout can cause problems.

Chapter 40 Bones, joints and safer steps: fractures may heal slowly; stiff joints and gout can cause problems. Use non-slip surfaces, grab bars, clear paths and night lighting. Injury and bone review is doctor-led; a hot joint with fever needs urgent care.

Chapter at a glance: an AI-generated illustration to be read with the chapter, not instead of it. The people shown are not real.