This content originally appeared on diaTribe. Republished with permission.
By April Hopcroft
Key takeaways:
People with diabetes have twice the risk of experiencing hearing loss, and those with prediabetes have a 30% higher risk compared to people with normal blood sugar levels.
To prevent hearing loss, be sure to get recommended hearing screenings, keep your blood sugar in target range, and use ear protection at concerts and when in other loud spaces.
There are tools available for people with hearing loss besides hearing aids, such as smartwatches with vibration alerts, assistive apps, and support groups.
While many people develop some degree of hearing loss as they age, people with diabetes are at a higher risk for hearing loss compared to those without diabetes. Indeed, a 2021 study found that people with diabetes develop hearing loss at twice the rate of those without diabetes. Compared to people with normal blood sugar levels, people with prediabetes have a 30% higher rate of hearing loss.
Katie Koebel, audiologist and senior manager of audiology at HearingLife Canada, discussed the connection between diabetes and hearing loss and shared tips to protect your ears. We also spoke with Yoel Krigsman, who was born deaf and has type 2 diabetes, about strategies to manage both conditions.
What causes hearing loss?
Hearing loss can range from mild to severe and generally falls into two main types:
Conductive hearing loss happens when there is a blockage (like fluid or earwax) that prevents sound waves from traveling through the ear. This type of hearing loss can typically be managed with medication or surgery.
Sensorineural hearing loss is the most common type of permanent hearing loss and happens when the inner ear or auditory nerve is damaged by genetic conditions, aging, head injuries, exposure to loud noises, medications that are toxic to the ear, or certain illnesses. This condition is usually managed with hearing aids or cochlear implants.
People can also have mixed hearing loss due to a combination of conductive and sensorineural factors, Koebel noted.
The connection between diabetes and hearing loss
Researchers don’t fully understand the connection between diabetes and hearing loss, though Koebel noted that diabetes-related hearing loss involves damage to the nerves and blood vessels in the inner ear.
High blood sugar can damage the small blood vessels in the ears, much like how hyperglycemia damages the blood vessels in the kidney and heart. Koebel said that hypoglycemia (low blood sugar) also plays a role, as it reduces the nerve signals received by your ears.
Some medications can damage the inner ear and cause hearing loss. This includes certain diuretics (also called water pills), which are used by many people with diabetes who have heart failure, kidney disease, or liver disease. Some common diuretics include Edicrin, Lasix, Lozide, and Bumex.
If you are taking diuretics and experience changes in your hearing, Koebel recommended consulting with your healthcare provider and a hearing specialist.
What ear symptoms should I be concerned about?
Hearing loss often happens slowly and may be hard to notice. Sometimes, your friends or family may notice hearing loss before you are aware of it.
Symptoms may include:
Frequently asking people to repeat themselves
Trouble following conversations
Difficulty hearing in noisy areas, like restaurants or airplanes
Trouble hearing small children and people with quieter voices
Needing to increase the volume on the TV or other devices
Hearing a persistent ringing in your ears
If you experience any of these symptoms, consult with your healthcare provider to get screened for hearing loss.
How to prevent hearing loss
A few simple steps can go a long way towards protecting your ears:
Getting recommended hearing screening. The American Speech-Language-Hearing Association recommends adults without risk factors should be screened once every 10 years, and every three years after age 50.
Keeping your blood sugar close to target range. Increasing your time in range and reducing time above and below range can help prevent damage to the small blood vessels and nerves in the inner ear. For instance, a 2021 study found that people with type 2 diabetes with an A1C of 8% or above had a higher rate of hearing loss compared to those with an A1C below 8%. It’s also important to see your endocrinologist and diabetes care team regularly, Koebel noted, as hearing loss could be a sign that you need to adjust your insulin regimen or treatment plan.
Using earplugs to protect your ears at concerts or other loud events. Exposure to loud noise is a key risk factor for hearing loss, Koebel said. In addition to concertgoers, this also applies to people who work in fields like construction, she noted.
Stop smoking. Research shows that smoking is linked to a higher risk of hearing loss. Plus, quitting smoking also reduces your risk of heart disease, kidney disease, peripheral neuropathy, and lung cancer.
“If you have diabetes, even if you aren’t experiencing hearing loss, I recommend talking to your doctor or diabetes team to ensure you are following every step necessary to avoid any damage to your hearing,” Koebel said.
Tools for people with diabetes and hearing loss
There are many different tools available that can help people with hearing loss. These range from transcription apps to over-the-counter hearing aids and prescription hearing aids that are programmed to address your level of hearing loss.
In terms of doctor’s appointments and hospital visits, Koebel noted that most medical buildings are fully accessible and should be able to accommodate you at your appointments. You can always inquire at the reception desk or call or email in advance to ask about accommodations.
Vibration alerts and connectivity
If you use an insulin pump or a continuous glucose monitor (CGM), Koebel suggested connecting it to a compatible smartwatch. Since smartwatches can send alerts via vibration, this may help people who are unable to hear alarms from their CGM or phone.
For instance, Krigsman said he uses vibration for all types of alerts, including low and high blood sugar levels and issues with his pump (such as occlusions or empty reservoirs). However, he noticed that the vibration alerts drained his pump battery very quickly and he often had to purchase a new battery to keep up.
“Now, I use a Tandem pump, and I got into the habit of charging every morning daily, and that keeps up the battery issue for me,” he said. However, he noted that the vibration isn’t always noticeable, especially when it’s in his pocket or fanny pack.
Krigsman also connected his CGM with his Bluetooth hearing aids. “Using my Android phone, I hear the beeps clearly with the help of the hearing devices,” he explained.
Monitoring nighttime blood sugar levels can be challenging if you have hearing loss. Thanks to modern technology, Krigsman is able to receive vibration alerts while he sleeps through a device called the SugarPixel. The device, which is placed under his pillow, is able to read his CGM through Dexcom Follow and displays the numbers on a connected clock.
“If I go very high or low with my sugar, the bed vibrator and an extremely loud sound will blast off from that tiny box,” he said. “The nice thing about this is the sound is very randomized sound alerts that avoid ‘brain habituation’ issues.”
Apps
Apps that share CGM data can be helpful. For instance, Dexcom Follow, LibreLinkUp, and CareLink allow you to share your CGM data with family members, friends, or care partners. Krigsman also uses SugarMate, which provides blood sugar alerts to friends and family via phone call or automated text messages.
“Around my house, I have two [older] iPads, one for each floor, that will allow my family to monitor my blood glucose during their ‘waking’ hours, and it is tied with SugarMate,” he explained.
More generally, assistive apps can help you communicate in written form and can also transcribe spoken words to text. For instance, your device’s notes app as well as apps like Deaf Note can be useful for communicating via written text. Speech-to-text apps include Live Transcribe, a free app designed by the deaf community, as well as Ava, Google Live Transcribe, Microsoft Translator, and Otter.ai.
Social support and education
Social support is also key. Krigsman said his biggest success in navigating diabetes and hearing loss has been sharing what he’s learned with others online and in a hearing-impaired group.
Meanwhile, one of the biggest challenges for Krigsman has been researching new accessible tools and waiting for technology updates from healthcare companies and phone vendors. For these reasons, it can be especially helpful to talk about what works and what doesn’t work with others in the community.
“There are also many support groups for those going through a time of hearing loss,” Koebel said, adding, “It can be beneficial to be around others who understand what you’re going through.”
Accessible diabetes education is also important. For instance, Krigsman highlighted the Deaf Diabetes Can Together (DDCT) program, which provides diabetes education to those with hearing loss through American Sign Language (ASL), images, and other modes of communication.
DDCT is currently recruiting participants for an online study to find out how best to provide diabetes education in ASL. Adults with type 1 or type 2 diabetes who have hearing loss are eligible to participate.
The bottom line
It’s common for people to develop some degree of hearing loss as they age. However, people with diabetes and prediabetes have a higher chance of developing hearing loss compared to those without diabetes. Therefore, it’s important to be extra careful about protecting your ears and seeking out screening if you experience any symptoms of hearing loss.
“If you have diabetes, even if you aren’t experiencing hearing loss, I recommend talking to your doctor or diabetes team to ensure you are following every step necessary to avoid any damage to your hearing,” Koebel said.
You can prevent hearing loss by managing your blood sugar levels, receiving recommended screenings for hearing loss, and using ear protection in noisy environments, Koebel told us.
Above all, Krigsman advised patience and flexibility.
“Be patient when you are learning about diabetes, as it is A LOT to learn regardless of your disability, and everyone has their own pace of learning,” he said. “This is life-long learning and an adaptable process. Not one size fits all.”
Learn more about accessibility in diabetes care:
Living With Vision Loss and Diabetes
People With Vision and Hearing Loss Call for Better Access to Diabetes Tech
Diabetes and Workplace Discrimination