Patients suffering from diabetes mellitus, types 1 and 2, have a greater risk of osteoporosis, a condition which weakens bones. Diabetes causes musculoskeletal changes that cause symptoms such as joint pain and stiffness; swelling, frozen shoulder, swollen feet and more. With uncontrolled diabetes, blood sugar level is constantly fluctuating which has a detrimental effect on all organs. If one has a well- controlled diabetes, HbA1c test would show normal result with balanced blood sugar level wherein the patient can lead a regular life. In diabetes, occurrence of frozen shoulder is very common and it can be recalcitrant. It will only get better with a conservative course of treatment. However, the symptoms seem to relapse. While comparing the percentage between non-diabetic patients and diabetic patients, Dr. Gaurav Gupta, Consultant Orthopaedic Surgeon at CK Birla Hospitals –CMRI, has always encountered the later suffering two times more from bone and joint diseases.
A diabetic patient is much more prone to infection as high levels of glucose deteriorate patient’s immune system. Due to higher incidence of infection while diabetic patients going for a surgery, a thorough check-up is done to ensure their blood sugar is under control before the surgery. Mostly arthroscopic / microsurgery is done which has the lowest rate of infection that comes around 0.5 to 1 per cent. However, in case of replacement surgery there is a need of significant size of incision accelerating chances of infection. Diabetic patients also tend to have systemic comorbidities as diabetes affects other organs considerably. In such circumstances the doctor has to put greater effort by taking extra care of the patient in terms of examination, optimization, necessary precaution etc. In rare cases it happens that diabetes has destroyed a number of organs in the body that actually makes it impossible to do any surgery. Often systemic failure of multiple organs like kidney, heart, blood vessels, eyes along with high blood pressure and cholesterol worsen a diabetic patient’s condition making it almost untreatable.
Undoubtedly, with diabetes a person has an increased risk of various bones and joints disorders as collagen fibres accumulate between linings of the joints limiting all movements. Diabetes can often cause restriction of all movements – adhesive capsulitis or frozen shoulder. Diabetic patient often experiences an external rotation commonly getting affected. They are unable to lift up their arms and there is a lot of pain around the shoulder. Frozen shoulder in a diabetic person in comparison to a normal person is way more difficult to treat. Usually arthroscopic / microsurgery is done to release the scar tissue and free up the joint shoulder. Post-surgery, generally patients need an appropriate physical therapy treatment. Dr. Gupta recommends, “On day to day basis, a diabetic patient must get regular check-ups done, consult the doctor for prescribed daily routine and choose appropriate medicine or insulin as per doctor’s suggestion. Proper diet and basic fitness regime must be maintained. Keeping diabetes under control is the first step towards leading a healthy and balanced life.”
Some important statistics and facts for diabetes patients
• Every 12th knee replacement patient also needs a shoulder replacement (for arthritis)
• 2% population has shoulder problems in their 3rd year
• Rotator cuff disease is a very common shoulder problem which frequently requires arthroscopic surgery for complete cure. It affects 20% population above 40 years age
• The incidence of adhesive capsulitis or frozen shoulder has been found to be two to four times higher in diabetics than in the general population. The estimated prevalence of frozen shoulder is 11–30% in diabetic patients and 2–10% in non-diabetics. It appears at an earlier age in patients with diabetes
Things to keep in mind for diabetes patients
• Diabetes is usually not a prolonged disease if the blood sugar level is kept under control and appropriate course of treatment is thoroughly followed
• Surgical patients need to be extra careful with their medication, diet and exercise as they are more likely to succumb to infection
• In order to keep one’s bones and joints healthy, it is very important to exercise regularly for every diabetic patient. Especially for athletes, they need to take their body through a full range of exercise for maintaining total fitness. This will also help to keep away other diabetic related ailments
• Eating healthy is a must. Food items which are rich in nutrient and minerals should be at the top of every diabetic patient’s diet chart
• One major myth about joint pain that people often misunderstand is that most of the joint pains are arthritis. In reality, there are numerous causes for joint pains. The person suffering from it must visit a specialist who can discover the actual cause and take the patient through a proper course of treatment.
In conclusion Dr. Gupta says that “early diagnosis and treatment are the best possible way to cure the patient. To keep the glucose levels under control one must maintain a healthy diet and weight, while getting plenty of physical activity. Since obesity puts a patient in danger, avoiding oily food, alcohol and smoking is must. Regular follow up with the primary care physician to improve patient’s condition is highly recommended so as to prevent and eliminate diabetes related symptoms.”
Suggested by- Dr. Gaurav Gupta, Consultant Orthopaedic Surgeon at Department of Orthopaedics & Joint Replacement – CK Birla Hospitals – CMRI
Photograph by- নিজস্ব প্রতিনিধি
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