The Link Between Diabetes & Ergonomics

These are  injuries and disorders that affect the body’s movement or musculoskeletal system (i.e. muscles, tendons, ligaments, joints, nerves, discs, blood vessels, etc.). 

Not all musculoskeletal risk factors are work-related; they can result from other individual risk factors, such as medical conditions like rheumatoid arthritis, diabetes, and obesity, or life phases like pregnancy or menopause.

It is important to remember that it is usually not just one risk factor that results in an injury, but rather a combination of factors. 

Diabetes is a medical condition in which people cannot produce enough insulin, or their bodies cannot adequately use the insulin they have produced. 

Insulin is the hormone that controls the level of glucose, which is a form of sugar, in the bloodstream by regulating its movement into your cells. 

The Main Types of Diabetes:

• Type 1 diabetes is an autoimmune disease in which the pancreas does not produce insulin. It is not preventable. Those living with type 1 diabetes require insulin.
• Type 2 diabetes develops when the pancreas stops producing enough insulin or when the body stops using the insulin that is produced effectively. Many people with type 2 diabetes can manage the condition through diet and exercise, while others may also need to take medication.
• Gestational diabetes develops when a woman’s body stops adequately producing or using insulin while she is pregnant. Affecting 2%  -4% of all pregnancies, this form of diabetes usually goes away once the baby is born. However, mother and child remain at a higher risk of developing type 2 diabetes later in life. 

Statistics show that approximately 13% of the South African population has diabetes, but we know that there is a large undiagnosed population. A recent study that screened previously untested individuals found that 67% of those screened were prediabetic, and 22% diabetic. 

While diabetes is widely recognised as causing significant morbidity and premature mortality due to myocardial infarction, stroke, renal failure, visual impairment, and foot ulceration, it is less widely known that diabetes is associated with a number of musculoskeletal conditions. 

Over time, if a person does not receive effective treatment, diabetes can lead to the breakdown of the musculoskeletal system. This can involve:

• Changes in nerves 
•  Tendon damage
•  Joint pain, damage, and a limited range of joint movement

Musculoskeletal Disorder Risk Factors

• World-related Risks
• High Task Repetition
• Forceful Exertions
• Awkward Postures
• Sustained Postures
• Contact Stress
• Extended Exposure
• Individual Risks
• Anthropometry (Body Size and Dimensions)
• Poor Work Habits
• Physical Fitness
• Health Status
• Other Habits (Like Smoking)
• Changes to Nerves

Nerves are essential to how the body works. They enable us to move, send messages about how things feel, and control automatic functions such as breathing.

Neuropathy happens when high levels of fats or sugar in the blood damage the nerves in the body. It can affect virtually any nerve in the body, with a wide range of symptoms.

Between one-third and a half of people with diabetes have neuropathy.

Peripheral symmetric neuropathy is the most common form of diabetic neuropathy, and it affects the feet and hands. 

If these pre-charged nerves are exposed to any of the work-related ergonomic risk factors, injury risk is increased. Carpal Tunnel Syndrome, for example, is very common.

Symptoms of Neuropathy in Hands

• Tingling, Burning & Prickling Sensations

This is often the first symptom, like tiny pinpricks dancing across your skin.

• Pain or Discomfort

Hand neuropathy can cause sharp, shooting pain, especially at night or in cold weather.

• Muscle Weakness & Wasting

Your hands may feel weak and thin, making it harder to perform everyday tasks. 

• Temperature Changes

Hands might feel colder or hotter than usual, or appear discoloured.

• Numbness or Loss of Feeling

Your hands may feel like they’re asleep, making it difficult to grasp or manipulate objects.  

• Clumsy Fingers

Buttoning, typing, or writing can become a struggle due to fine motor skill loss.

• Reflex Trouble

Reduced or absent reflexes in your hands can indicate nerve damage. 

• Skin Concerns

Dryness, cracking, or infections can develop as a result of nerve damage. 

Tendon Damage

Tendons are found all over the body. Their function is to transfer the force from the muscles to the bones to allow movement. 

Tendon damage happens because of substances called advanced glycation end products (AGEs). They form when protein or fat mixes with sugar in the bloodstream.

The body normally makes AGEs at a slow and steady pace. But in individuals with diabetes, the extra sugar in the blood cranks up the speed, which affects the tendons.

AGEs form a bond with the protein in the tendon, called collagen. This can change the tendons’ structure and affect how well they work. They could get thicker than normal and might not be able to hold as much weight as they used to. As a result, the odds of getting a tear in one of the tendons go up.

Rotator Cuff Injury

The rotator cuff is a group of muscles and tendons that surround the shoulder, keeping the head of the upper arm bone firmly within the shallow socket of the shoulder.

These muscles rotate the arm and move the arm out to the side.

The tendons move through a small gap between the end of the collar bone and the top of the arm. 

Thicker tendons increase the risk of impingement and injury caused by awkward and static postures as well as repetitive movement.

Joint Damage & Pain

Diabetic neuropathy can cause pain, numbness, and a tingling sensation in the joints, often in the lower extremities. 

Reduced sensation and proprioception (sensing where a limb is) can lead to falls or small injuries. The effects of these traumas can build up to cause changes in joint structure and chronic joint pain.

Osteoarthritis is a chronic inflammatory condition of the joints that causes pain, inflammation, stiffness, and swelling as a result of cartilage degradation

52% of people with type 2 diabetes develop osteoarthritis – about twice as many as those without diabetes.

Want to know more about incorporating sound ergonomics in your workplace?

The Health with Heart Corporate Wellness Ergonomics Programme draws on the expertise of our ergonomics team and our commitment to strategic solutions and innovative interventions to offer you a customised digital assessment tool. 

ABOUT THE AUTHOR

Colleen Fandam is the Physiotherapist and Ergonomist at Health with Heart - a holistic wellness solution that includes a warm-hearted practice in Sandton; bespoke corporate wellness programmes; unique retreats and medical travel experiences; an educational podcast and portal; and a community outreach initiative. For more information or to get in touch, follow @health_w_heart on Instagram or @HealthwithHeartDoctors on Facebook, or visit www.healthwithheart.co.za.