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Diabetes and the Opportunity for Audiology

Pickup, Christine, AuD

doi: 10.1097/01.HJ.0000549530.91699.57

Dr. Pickup founded Mt. Harrison Audiology in 2014 after recognizing the need for hearing care in the Mini-Cassia area of Idaho. She specializes in assessment and treatment hearing loss, tinnitus, auditory processing disorder.

Diabetes. When I first heard my diagnosis, I thought, “OK, reduce my sugar intake, exercise more… I can do this.” I was in shock. I had no idea how every aspect of my life would be altered because of diabetes. I am a wife, a mom, a doctor of audiology who owns a private practice, and a type 1 diabetic.

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My diagnosis began in the summer of 2012. After several exhausting months of building a home and getting allergy attacks, I took a nap one afternoon and woke up with blurred vision. I've worn glasses since the age of 9, but this was odd. My glasses were of no help. I could see clearly on the periphery, but my main field of vision was fuzzy. After waiting to see if my vision would improve over the weekend, I was able to get a last-minute appointment with an ophthalmologist. I had no known family history of diabetes, but blood tests confirmed I had high blood sugar. The next day, I was seen by my family physician who started me on oral medications and told me to not have sugary drinks. I knew that diabetes and sugar were related, but I didn't realize at the time that all carbohydrates affect blood glucose. The assumption was that due to my age, I had type 2 diabetes.

The following months were difficult. Despite radical changes to my diet and increased exercise, my glucose levels continued to rise. I was referred to a diabetes specialist who correctly diagnosed me with type 1 diabetes. At that appointment, I began my journey in understanding and using insulin. Diabetes management has become easier over time, but it takes constant vigilance.

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Much like hearing loss, diabetes is a chronic metabolic disorder that is managed, not cured. Diabetes can be a very isolating disease. Patients with diabetes deal with the day-to-day burden of performing the same functions as a pancreas. Although the burden is less for some, having hearing loss can be a daily struggle to listen, communicate, and compensate for an ear that is damaged. Having diabetes has helped me empathize more with patients whom I diagnose with hearing loss, and has changed the way I counsel them and recommend treatment options.

Audiologists have the knowledge and expertise to support a patient with diabetes. People with diabetes have an increased risk of hearing loss due to the microvascular damage caused by high blood sugar. Audiologists should obtain baseline hearing evaluations for patients with diabetes, then monitor yearly for hearing loss, much like an optometrist monitors changes in retinal health or a podiatrist monitors neuropathy in feet. We can provide hearing loss treatment that can mitigate social isolation, ensure patients’ understanding of medical counsel and instructions, and reduce their risk for cognitive decline.

When reviewing patients’ medical history, ask them about how they are managing their health. The interplay of insulin, carbohydrate, and protein intake, along with exercise, can change on a daily basis. Essentially, diabetes is a carbohydrate metabolism issue. Too much sugar in the blood can make it thick and cause damage to tiny capillaries and nerve endings. This in turn can cause neuropathy in the inner ear, just as it can cause retinopathy or neuropathy in the feet. Encourage patients to complete their daily management goals. If the patient is struggling, refer him or her to other professionals who can better assist in diabetes management, such as a diabetic educator.

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When patients express concerns about the expense of medical care, I let them know I understand completely. We live at a great time when we can use insulin pumps and modern hearing aids that sync with smartphones; we literally have the world in our pockets. But these devices come with a cost that can be a burden to individuals and families. My experience is that quality of life matters. The tools I have available make my life easier and help me stay healthy. Properly-fit hearing aids and aural rehabilitation can have the same effect.

Hearing health professionals need not be timid in recommending treatment that will benefit our patients, improve their self-esteem, and reduce their risk for other complications.

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Research has shown a link between uncontrolled high blood glucose levels and hearing/balance issues (J Clin Endocrinol Metab. 2013 Jan;98(1):51). Yet, most physicians are not aware of the link, nor do most public health programs recognize this link. The Audiology Project is a collective effort of a small group of audiologists that aims to educate fellow colleagues and advocate for the inclusion of audiology in the medical management of diabetes and other chronic conditions. Just as a person with diabetes is typically advised to have his or her eyes or feet checked, they should also have their hearing examined yearly. Can you picture how busy our offices would be if we were routinely monitoring most people with diabetes for hearing loss? How would treating hearing loss improve the outcomes for each of those patients?

Being at a crossroads with so many disruptions to our field, audiologists may need to expand our horizons, exercise our expertise to the fullest extent of our scope of practice, and collaborate with other medical teams to help patients with diabetes and hearing loss better manage their conditions.

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