When I started writing our 411 series on diabetes complications, I expected that it would take me roughly a year to cover them all. Off the top of my head, I knew the Big Four: blindness, kidney failure, neuropathy, and heart disease. I knew there were some "lesser known" — or at least, lesser recognized — complications like depression and erectile dysfunction. But we're now 18 months into the 411 series, and there are still more. Oy!
Because honestly, it seems that if a part is in your body, diabetes will find some way to affect it.
Like your hearing, for example, which can be compromised due to diabetes. Who knew?! It turns out May is also national Better Hearing Month.
My first reaction to a recent press release about Sonus, a Minnesota-based company that distributes hearing aids, teaming up with the American Diabetes Association, was: "Why??" When I learned that hearing loss is twice as common in people with diabetes, and 14% worse in diabetic women, all I could do was roll my eyes. "Well, of course it is!" I thought (sarcasm, it seems, is another complication of diabetes).
Later, I got on the phone with Dr. Kathleen Yaremchuk, Chair of Otolaryngology (ear, nose & throat medicine) at the Henry Ford Clinic and head of research for an observational study on hearing loss and diabetes. The first thing I told her was that most of us PWDs never even considered hearing loss as a possible complication of diabetes.
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"Why in the world does diabetes affect your hearing?" I asked.
"We know in kidney disease, visual problems and peripheral neuropathy, there are changes in the nerves themselves and we hypothesize that it's the same process in the ears," Dr. Yaremchuk explained.
In the study conducted by her and her team, the results showed that men and women with good control (defined as an A1c of under 9% -- a pretty broad definition of good!) had better hearing than those with poor control, but the good control group had worse hearing than those who didn't have diabetes. The study also indicated that the differences in quality of hearing was more prominent in women with diabetes.
If this news comes as a surprise, then check out this PSA from Sonus and the American Diabetes Association, which takes a "surprise approach" to sharing facts about hearing loss and diabetes:
Can You Hear Me Now?
It isn't always obvious when you have hearing loss. Unlike profound deafness, hearing loss from diabetes is usually more mild and it can sometimes take quite a while before you realize there's an issue. If you find yourself constantly asking people to repeat themselves, or if you find that you have difficulty focusing on a conversation when at a restaurant or other noisy public place, you might be experiencing hearing loss.
"Often times people know they have hearing loss because of their loved ones, who will say 'Can't you hear me?'" says Dr. Rebecca Younk, Director of Professional Development at Sonus's parent company, Amplifon. "It's not that you can't hear, you just can't understand what they said."
People with more severe hearing loss often find ways to adapt to the deficiency by learning to lip read or simply faking that they can hear what people are saying. But that's dangerous because the longer you go without getting help, the worse your hearing can get.
If you're already suffering from hearing loss, that doesn't necessarily mean you'll have to wear bulky hearing aids. Coping strategies include changing the environment where you listen, making sure that you're facing the person speaking (rather than straining to hear from another room), or sitting in a booth at a restaurant instead of an open table, which can help you focus; your ear is structured so that it hears sound directly in front of you best. Watching people's lips, everyone has some ability to "speech read," and you can get better at it over time. People also communicate through body language, so looking at the person speaking can often help fill in the gaps.
It's also important not to keep your hearing loss a secret from friends and family, because part of adapting is making sure that both you and the person you're speaking with understand good communication techniques. It won't help if they're muttering or moving around while talking!
If necessary, there are also hearing aids, which amplify sound. Hearing aid technology has come a long way in recent years, and they are much smaller than you might think. Most hearing aids fit inside the ear canal and others are not likely to see it unless you're very close!
Protecting Your Hearing
Here's a shocker: the top tip for prevention is... keep your A1c under 7%! But that's just too easy to recommend. What else can you do?
Protect your sensitive ears, of course. One of the reasons why hearing goes downhill for older folks is that besides the natural progression of age, we expose our ears to loud noise far too often than is healthy.
Younk says that the loudest sustained volume a person can tolerate is about 85 decibels, which is the point at which a person would need to yell in order to be heard over background noise.
"85 decibels is the breaking point," Younk explained. "You don't want to be at that level for more than 4 to 8 hours. Unfortunately, for every 3 to 5 decibels over that, you have to divide your exposure time by half." So for instance, you wouldn't want to go to a concert, where the noise level is usually around 105 to 110 decibels, for more than an hour to an hour and a half. But say you don't go to concerts very often. Did you know lawn-mowing clocks in at 95 decibels? Leaf-blowers and snow-blowers are also dangerous to your hearing, so if you're planning on doing a bit of landscaping, make sure you take breaks or wear earplugs!
The basic rule of thumb, according to Younk, is: "If you have to raise your voice to have a conversation over it, that noise is dangerous."
Along with your eyes, feet, and kidneys, your ears need regular screening, too. Again, this is something that most of us are not likely to think about in association with diabetes! Amplifon and the ADA recommended getting screened by an audiologist every 2 to 3 years if you're under age 50, and every year when you're over 50 or if you already have hearing loss. (Yes, an audiologist is a hearing doctor, and here's a helpful link to find one in your area.)
Getting screened for hearing is important because hearing loss is correlated with other health issues, like depression -- and folks with hearing loss are less likely to be social and physically active, according to the HearUSA network and other experts. As part of that nasty old viscious cycle, these lifestyle changes can contribute to other diabetes complications, like heart disease.
In the video, we saw that only 15% of doctors will ever ask a PWD patient about their hearing... and in 18 years of type 1 diabetes myself, I have never had my hearing tested. Yikes! Time to get that covered...
How about you all? Have you ever been tested for hearing loss? Are you currently dealing with diabetes-related hearing loss? We'd love to hear from you.