According to many diabetes organizations and studies, falls, especially in the home, are the number-one cause of injury for people age 60 and older, as well as the second-likeliest cause of injury for people ages 40 to 59. According to a recent study, older adults with diabetes, especially those using insulin, are more likely to fall, causing injury and possible hospitalization. The researchers stressed that those people with diabetes were more likely to experience falls because of poor standing balance, a history of falling, and often an A1c of 8 percent or higher (for more about the A1c test, see the chapter “Taking Charge of Diabetes”).
Because of this risk of falling, health care professionals offer several suggestions to people with diabetes.
These include controlling blood glucose levels; practicing balance and strength exercises (ask your doctor for suggestions as to the type of exercises needed); and keeping hallways, stairs, and major pathways in the home clear of boxes, cords, and sundry other items that are easy to trip over.
If possible, have grab bars, railings, and nonslip rugs throughout the house (especially in the bathroom) to make navigation easier.
Finally, see an eye care professional at least once a year. (Diabetics have more problems with vision loss than people without diabetes.)
Older adults with diabetes are even more likely to suffer injury from falls than those without the disease.
How can a person with diabetes help family and friends understand what to do in a diabetic emergency?
The best thing people with diabetes can do for themselves and their friends, families, and neighbors who check on them periodically is to leave a note of instructions on their refrigerator in case of a diabetic emergency. (Be sure to tell others where the list is located!) On the note, the person with diabetes should legibly list the emergency number (911 in most places), the hospital he or she would like to be taken to in an emergency, the location of the glucagon kit (with quick, visual instructions inside the kit), the primary-care physician’s name and telephone number, the insurance company (perhaps even a copy of the insurance card), and emergency contact numbers (family, friends, caregivers, etc.).
DIABETES AND BLOOD AND ORGAN DONATIONS
Can a person with diabetes give blood?
Yes, a person with diabetes can donate blood, platelets, and plasma.
According to the American Red Cross (an organization that controls about 45 percent of the blood supply in the United States), people with type 1 or type 2 diabetes that is well controlled by insulin or oral medications are eligible to donate.
Of course, other qualifications have to be met, such as being in good health, weighing over 110 pounds, and being over age 17.
Some states also have their own specific restrictions, such as different age requirements, or, for example in California, refusing blood donation from a person who has diabetes and uses bovine-derived insulin.
Why are some people with bronze diabetes often not allowed to donate blood?
According to the American Red Cross, people with bronze diabetes, a form of diabetes caused by hemochromatosis (excess iron in the blood), are currently prohibited from giving blood donations. It is not necessarily the bronze diabetes that stops a person from donating but the overall hemochromatosis disease, which usually begins before bronze diabetes develops. (For more information about hemochromatosis and bronze diabetes, see the chapter “Other Types of Diabetes.”)
Not everyone agrees.
Although there is no risk of passing on this genetic disease to other people through blood transfusions, the Red Cross still does not allow such donations.
Yet the Food and Drug Administration does permit people with hemochromatosis to donate blood, as long as the blood is specially marked and there are certain restrictions and rules about how blood banks can use this blood.
Because of such regulations, most blood banks in the United States currently do not accept donations by people with hemochromatosis.
Most other countries do not have such rules and have no restrictions on people with hemochromatosis that keep them from donating blood.
Can a person with diabetes donate an organ, such as a kidney, to a relative?
No, in most cases, a person with diabetes cannot donate an organ to a relative. This is because the disease, whether type 1, type 2, or other type of diabetes, affects the kidneys, pancreas, and other organs to a certain extent depending on the person’s condition. In addition, the surgery for such operations often puts the person with diabetes at risk, mainly owing to a weakened immune system.
Can a person with diabetes donate an organ (or organs) upon death?
Yes, according to the National Kidney Foundation, if a person who had diabetes had normally functioning organs, then he or she can donate those organ(s) after death. But there is an exception: An insulin-dependent diabetic cannot donate the pancreas after death.
The Handy Diabetes Answer Book
TAKING CHARGE OF DIABETES
WHO HELPS A PERSON WITH DIABETES?
Who are “trained diabetes personnel”?
Trained diabetes personnel are nonmedical people who have received in-depth training about diabetes and diabetes management.
They are often hired by school systems to help students with diabetes take care of certain tasks, such as blood glucose monitoring, administering insulin, and helping to recognize possible emergencies, such as hypoglycemia and hyperglycemia.
They can also help the school nurse or diabetes-trained health care professional test urine or blood for ketones, if necessary.
They are also often referred to as unlicensed assistive personnel, assistive personnel, paraprofessionals, or trained nonmedical personnel.
What is the Diabetes Complications Severity Index?
The Diabetes Complications Severity Index is a tool used to predict deaths and hospitalizations among people with diabetes. It was developed to model the severity of diabetes complications at any one point in time and is used by researchers (used to predict mortality, hospitalizations, and severity of these complications), by hospitals, and even to understand health care costs. The severity index includes seven categories of complications: cardiovascular disease, nephropathy, retinopathy, peripheral vascular disease, stroke, neuropathy, and metabolic problems.
HEALTH-CARE TESTS AND DIABETES
What is the fasting plasma glucose (or fasting blood glucose) test?
The fasting plasma glucose test is a test that measures blood glucose levels after a person has not eaten for at least eight hours (some suggest 12 to 14, depending on the testing lab). Thus, no foods interfere with the results. According to the American Diabetes Association and Harvard Medical School, for the majority of people, a fasting plasma glucose level of less than 100 mg/dL (milligrams per deciliter) is considered normal.
If the blood glucose level is at or above 126 mg/dL, it is an indication of diabetes. If a person’s reading suggests diabetes, most health care professionals suggest a second test to confirm the results, as various conditions (such as excessive stress) can cause blood glucose levels to fluctuate. A person with a blood glucose level between 100 and 126 mg/dL is thought to be prediabetic (for more about prediabetes, see the chapter “Prediabetes and Type 1 Diabetes”).
What is a random plasma glucose (or random blood glucose) test?
A random plasma glucose (also called random blood glucose) test measures the glucose in a person’s blood.
For this test, the person does not have to fast.
But overall, the amount of carbohydrates, and the amount of time since the person had a snack or meal, can affect the outcome of the test.
Although it is usually not as reliable as other tests (see below), it is most often used for emergencies (for example, in a hospital emergency room) or if a doctor needs a faster result of a person’s glucose level.
In this case, if the glucose reading is over 200 mg/dl, the person probably has diabetes, although there may be other circumstances that result in a high measurement.
If the number is high, then a fasting glucose test (see above) is usually ordered by the person’s health care professional.
How is an oral glucose-tolerance test used to determine blood glucose levels?
An oral glucose-tolerance test is used to determine blood glucose levels after a person has fasted overnight (the usual length of the fast is around 12 hours). The person then drinks a sugar solution, and another reading is taken two hours later. If the levels rise and fall quickly, then the person usually does not have indications of diabetes; if the levels rise above normal and decrease slowly, then it may indicate that the person has diabetes.
While this test is thought to be accurate, it is mostly used for determining gestational diabetes in pregnant women.
This is because the fasting plasma glucose test is less time consuming than the oral glucose-tolerance test (the fasting test is done after fasting for around 12 hours only).
If an oral glucose-tolerance test is taken, a blood glucose measurement less than 140 mg/dL when the two-hour blood sample is taken is normal; if the reading is 200 mg/dL or higher, then the person is thought to have diabetes.
If the number is between 140 and 200 mg/dL, then the person is thought to have prediabetes.
What is a glycated hemoglobin (HbA1c, or more often seen as A1c) test?
A glycated hemoglobin (also called glycosylated hemoglobin or glycohemoglobin) test, or HbA1c, often abbreviated as A1c, measures a person’s blood glucose levels over the preceding two to three months.
Glucose in the blood attaches itself to hemoglobin (an oxygen-carrying protein in red blood cells).
Thus, the higher a person’s blood glucose level, the more hemoglobin is bound to glucose.
Because red blood cells have a lifespan of about three months, the HbA1c measurement, as a percentage, reflects the blood glucose control over that period.
The A1c percentages are often used by health care professionals to diagnose diabetes, and no fasting is required. The percentages are as follows: Normal (no diabetes), when the reading is less than 5.7 percent; prediabetes, when the reading is 5.7 to 6.4 percent; and diabetes, when the reading is 6.5 percent or higher. (The test result may be in error if a person has anemia, kidney disease, or certain blood disorders.) If the level is 7 percent and the person has diabetes, then it often indicates that his or her blood glucose levels are not well controlled.
How can a person with diabetes convert HbA1c (A1c) data into average blood glucose level?
There is a general way for a person with diabetes to convert HbA1c data into average blood glucose level. The following lists this conversion:
HbA1c to Blood Glucose Level Conversion
HbA1c
Blood Glucose Level
6.0 %
135 mg/dl
6.5 %
153 mg/dl
7.0 %
170 mg/dl
7.5 %
188 mg/dl
8.0 %
205 mg/dl
8.5 %
223 mg/dl
9.0 %
240 mg/dl
9.5 %
258 mg/dl
10.0 %
275 mg/dl
10.5 %
293 mg/dl
11.0 %
310 mg/dl
11.5 %
328 mg/dl
12.0 %
345 mg/dl
SELF-MONITORING DIABETES WITH METERS
How does a person with either type 1 or 2 diabetes monitor blood sugar levels?
Most people with diabetes, types 1 and 2 and even some with prediabetes, monitor their blood glucose levels using a blood glucose meter. In general, the glucose meter measures a person’s blood glucose in milligrams per deciliter (seen as mg/dl or mg/dL).
What are test strips?
Most glucometers require what are called test strips in order to obtain a reading of a person’s blood glucose level. The strip contains special enzymes designed to react with the person’s blood.