It is widely known that part of managing diabetes means keeping tabs on related complications that affect eyesight, the feet, kidneys, blood pressure, and even oral health.
What is commonly missing from that checklist is hearing.
Research shows that those with diabetes are twice as likely to have hearing loss compared to those without the disease. Those diagnosed with prediabetes are also more likely to have audio issues.
Published in the Annals of Internal Medicine in 2008 and funded by the National Institutes of Health, the study found a link between diabetes and hearing loss.
It reported “hearing impairment may be an underrecognized complication of diabetes.”
Though the results have been out for at least eight years, many diabetics are still unaware of this complication, and often don’t know their hearing has deteriorated.
It is usually family members who notice first, as they are told to “speak up” or find their spoken word to someone with hearing loss is returned with “What did you say?”
Issues related to balance may prompt a patient to schedule an appointment with an otolaryngologist or ENT.
“We initially see them because they are having dizzy problems.
Then we do a hearing test and find they are losing their hearing as well,” said Dr. Afser Shariff, an ENT at the independent practice ENT Physicians located in Toledo and Oregon.
He has diagnosed hearing loss in people as young as 40.
Dr. Shariff said complications from diabetes erodes the nerves in the inner ear, just as it can chip away at other organs and appendages.
Diabetics can suffer from diabetic neuropathy, long-term damage to nervous structures, traditionally related to pain in the legs or pain in the arms.
Diabetic retinopathy, long-term nerve damage to the retina, is a leading cause of blindness, he said.
“If you think of diabetes in the neuropathic sense, yes, then you are definitely going to have hearing loss as a growing component of diabetes.
Especially since more and more people have diabetes and they live longer than they ever used to,” he said.
Experts advise those living with diabetes to take a comprehensive approach to leading a healthy lifestyle, as ailments like high blood pressure affect nerve damage.
“It also damages a portion of the brain, the periventricular white matter, where you have the microvessels.
Patients who have diabetes and high blood pressure tend to have a higher rate of damage to a central part of their brain from long-standing diabetes and high blood pressure,” Dr. Shariff said.
That central brain is responsible for processing the sensations from your feet, ears, and eyes. In turn all three of those body systems form a “compensatory mechanism” responsible for our sense of balance.
Dr. Shariff explained it as a highway system, with cars coming from three different starting points, traveling to reach the city center.
If the road is clear, all three reach the destination and are processed on time. However, with diabetes, imagine that road covered in potholes and construction, delaying the cars or messages.
“The message gets there at different times and the brain gets a little confused cause ‘Wait a minute, what is going on here? My feet are saying one thing, my eyes are saying another.
Even though they are saying the same thing, they are arriving at different times and I don’t know what to make of it,’ ” he said.
So even with a hearing aid, it may take someone a while to comprehend what is said.
If you have hearing loss, don’t wait to get a hearing aid. Treating adult hearing loss at the early stages reduces the risk of dementia, Dr. Shariff said.
Alison Johnson, an audiologist at ProMedica Flower Hospital Hearing Center, said that diabetics along with family doctors are so zeroed in on the other neuropathy side effects related to eyes and appendages, that checking hearing is often overlooked.
Another factor is people believe hearing loss is a normal part of aging.
“Really it is not. It is really wear and tear and some people have more of that than others. That is why it is linked to aging, sometimes,” she said.
She said diabetics and prediabetics should be proactive in getting a baseline hearing test.
The test establishes your normal hearing and audiologists can compare it to succeeding tests, indicating if there has been a change over time.
Anyone with noise exposure or who suffers from an ailment that affects the ears should follow up with annual tests.
“People always ask, ‘Well, how fast will my hearing change?’ Well if I don’t have anything to compare it to, I don’t know,” she said.
Typically the person with hearing loss is not the first one to notice the problem because it happens so gradually, she said.
Tinnitus, a ringing in the ear, can be an early symptom.
A patient with hearing aids still needs an annual hearing check, so the devices can be programmed accordingly.
Diabetics in poor health are more susceptible to nerve damage caused by the elevated blood sugar levels.
“This is another reason why we want you to manage your blood sugars and be in good control,” said Jeannie Wagner, registered dietitian and certified diabetes educator at Mercy Health St. Vincent Hospital.
A balanced diet and exercising routinely helps to minimize the aggravating factors, such as uncontrolled lipids or uncontrolled blood pressure.
Sugar circulating in the bloodstream stays within the blood vessels themselves, depositing and causing damage, she said. Physical activity helps move sugar out of the bloodstream and into the cells.
Avoid foods that have excess sugar. Eat more complex carbohydrates and fiber and be mindful of fat content.
Dr. Shariff said that diabetics will still have some damage, but diet and exercise are integral to limiting the damage.
“Exercise is critical,” he said. “It is what keeps nerves healthy. It helps to strengthen the blood flow. Most of the damage is a combination of nerve damage and vascular damage from inadequate blood flow.”
He recommended incorporating low-impact fitness into your health routine, such as tai chi, yoga, or Pilates. Those three exercises have been found to be beneficial.
They are also kind on the joints and help maintain balance through your 80s and 90s, he said.