Diabetes and Its Impact on Orthopaedic Conditions

Diabetes mellitus is a chronic medical condition that occurs when the body cannot properly regulate blood sugar (glucose) levels. This happens either because the pancreas does not produce enough insulin (Type 1 diabetes) or because the body does not respond well to insulin (Type 2 diabetes). Type 1 diabetes usually begins in childhood or adolescence and requires regular insulin injections for treatment. Type 2 diabetes is more common and often develops in adults, especially those who are overweight or have a family history of diabetes. Uncontrolled diabetes can lead to serious health problems, including complications that affect the bones, joints, and overall musculoskeletal system.

Symptoms of Diabetes

Many people with Type 2 diabetes have minimal symptoms, however, the long-term effects of poorly controlled diabetes can be devastating. People with diabetes may experience a range of symptoms, which can become more severe if their blood sugar levels remain high for a long time. Common symptoms include frequent urination, excessive thirst, fatigue, blurred vision, and slow wound healing. If diabetes is poorly controlled for years, it can cause serious complications such as nerve damage (neuropathy), poor circulation, and an increased risk of infections. These complications can lead to problems like foot ulcers, joint damage (Charcot arthropathy), and even amputations in severe cases where an infection or loss of blood supply to an extremity cannot be adequately treated. Since diabetes affects many parts of the body, keeping it under control is crucial to preventing long-term health issues.

How is Diabetes Diagnosed?

Doctors diagnose diabetes using blood tests that measure glucose levels. A fasting blood sugar test checks the amount of sugar in the blood after not eating for at least eight hours. A fasting blood glucose level of 126mg/dL or greater (Normal = 70-99mg/dL) is consistent with a diagnosis of diabetes. Another test, called the A1C test, measures average blood sugar levels over the past two to three months. An A1C level of >6.5% is concerning for diabetes (Normal < 5.7%). If these tests show consistently high blood sugar levels, a person is diagnosed with diabetes. In some cases, additional tests, such as an oral glucose tolerance test, may be used to confirm the diagnosis. Early detection and treatment of diabetes can help prevent complications and improve overall health.

The Effect of Diabetes on Orthopaedic Conditions

Diabetes, especially if poorly controlled, can lead to several orthopaedic problems. One serious condition is Charcot arthropathy, in which nerve damage causes joint breakdown, most commonly in the foot and ankle, leading to severe deformity. Diabetic ulcers can also develop, especially in the feet, due to poor circulation and nerve damage. When it comes to orthopaedic surgery, diabetes increases the risk of complications, including poor wound healing, post-operative infections, and problems with bone healing. Fractures and surgical procedures like joint fusions may not heal properly in diabetic patients, increasing the chances of nonunion (when a bone fails to heal). Because of these risks, it is important for people with diabetes to have good blood sugar control before and after surgery.

Treatment of Diabetes in Orthopaedic Patients

Managing diabetes involves a combination of lifestyle changes, medications, and sometimes insulin therapy. Eating a healthy diet, exercising regularly, and maintaining a healthy weight can help control blood sugar levels. Medications such as metformin or insulin injections may be needed to keep blood sugar in a normal range. For people with diabetes undergoing orthopaedic surgery, keeping blood sugar levels stable is crucial for a successful recovery. Poorly controlled diabetes can slow healing and increase the risk of complications, while good diabetic management helps improve surgical outcomes and overall bone and joint health.

Edited by Stephen Pinney MD, February 27th, 2025