Do you keep twisting your ankle or feel like you can’t trust your joints? Type 2 diabetes can have a widespread effect on the body, including the joints. Type 2 diabetes is linked to joint inflammation — also known as arthritis — which can cause pain and stiffness. Both diabetes and arthritis can also contribute to instability, making supportive tissues weaker and less able to protect your joints.

Read on to explore how diabetes affects joint health and contributes to joint instability. You’ll also learn about the link between diabetes and osteoarthritis, a common form of arthritis that can cause instability.

How Diabetes Can Affect Joint Stability

Diabetes doesn’t directly cause joint problems, like unsteady knees or twisted ankles. Instead, long-term high blood sugar (hyperglycemia) from diabetes can cause widespread issues that affect the body tissues that keep joints strong.

Below are two ways uncontrolled blood sugar levels can impact joint stability over time.

Inflammation

Long-term high blood sugar can lead the body to produce advanced glycation end-products (AGEs). These are proteins or fats exposed to sugar that can trigger inflammation.

AGEs can build up in our blood vessels and affect blood flow to the muscles and joint tissues responsible for keeping our joints mobile and stable. Without enough blood flow, people can develop sarcopenia (muscle loss). This can make them feel like they have less strength to control their joints, which can lead to a higher risk of falls.

AGEs can also build up in your joint cartilage. This is the cushion that helps absorb force and makes movement feel smooth and comfortable. The hands and knees are often most affected areas, potentially leading to cartilage damage over time. Once the cartilage wears down, the joint’s movement pattern can change, making it feel unstable.

Diabetic Neuropathy

High blood sugar can also impact nerves. About half of all people with diabetes — especially those who’ve had diabetes for many years — may experience nerve damage. Nerve damage caused by diabetes is called diabetic neuropathy.

People with diabetic neuropathy often experience a specific type called peripheral neuropathy. This causes symptoms such as tingling, pain, weakness, or numbness in the hands and feet. People with peripheral neuropathy need to protect their feet to avoid minor injuries they may not feel, including blister-like skin damage from pressure points. Injuries can become larger wounds or infections without the right care. If injuries worsen, it can make standing and walking feel unsafe.

Peripheral neuropathy can also affect your proprioception, or the body awareness that helps you keep your balance. For example, your ankle’s muscles and ligaments (stabilizing tissues that connect bones) have special mechanoreceptors, which act like sensors. These receptors send information to your brain about your body’s position in space. If the mechanoreceptors can’t communicate with your brain due to nerve damage, you may feel less coordinated on your feet. This can increase your risk for falls or injury — like a twisted ankle.

In rare cases, some people with neuropathy may develop Charcot foot (or neuropathic arthropathy). This condition happens when the joints in your feet and ankles change over time. Some researchers believe this is caused by a combination of nerve damage, muscle weakness, accelerated bone loss (similar to areas of osteoporosis) and small injuries to the area. As joint structures become less stable over time, the shape of the foot changes. This may increase the risk of pressure points and other serious complications that affect your ability to stand and walk safely.

The Link Between Diabetes and Osteoarthritis

About half of people with type 2 diabetes also have osteoarthritis, or a type of arthritis caused by wear and tear of the cartilage in your joints. More research is needed to fully understand the relationship, but researchers suggest a few possible explanations.

One link may be the high rate of obesity among people with diabetes, as excess body weight places stress on the joint cartilage. As mentioned earlier, some studies suggest that the buildup of AGE plays a big role in promoting inflammation and contributing to cartilage damage over time.

How Diabetes, Osteoarthritis, and Ankle Instability Can Connect

Osteoarthritis often affects the spine, knees, and hips. Common symptoms include pain, stiffness, swelling, and instability. While the ankles aren’t usually affected, you still may feel unsteady on your feet due to osteoarthritis symptoms in other joints.

People with aching joints might change how they do everyday activities. They may avoid using a leg that is hurting or change their walking pattern. This can lead to muscle weakness and balance issues. Research suggests that people with pain in one knee or hip are 53 percent more likely to fall. Those with pain in two joints (like both knees) are 74 percent more likely to fall, and people with three or four painful joints are 85 percent more likely to fall.

Half of people with diabetes also have osteoarthritis, and half of all people with diabetes may develop nerve damage. For that reason, those with both conditions should take extra care of their foot and ankle health. If someone has painful knee osteoarthritis and diabetic neuropathy causing pain or weakness, they may be placing themselves at risk of an ankle sprain, fracture, or another injury.

Once you sprain your ankle, it’s easy to reinjure it, especially if the first sprain wasn’t treated properly. The ligaments that keep your ankle stable can loosen. The mechanoreceptors in those tissues may then stop communicating with the brain as well as they once did. Some people develop chronic ankle instability. This is a condition where the ankle’s surrounding tissues are less effective in protecting the joint because they keep getting injured.

When To Seek Care

Talk to your healthcare team if you’re experiencing any symptoms of joint instability from osteoarthritis or the effects of diabetes, including:

• Constant pain
• Joint popping or cracking sounds
• Swelling or warmth, particularly when compared to the same joint on the other side of the body
• Bruising
• Limited joint movement
• Feeling like the joint gives out

Some people with diabetes may not notice symptoms right away. “I twisted my left ankle and didn’t even realize it until today,” wrote one DiabetesTeam member. Since peripheral neuropathy can make it difficult to feel symptoms, it’s important to check your feet and ankles closely every day to make sure they look healthy. Make a note of any changes in your skin, nail, or joint shape and tell your doctor if you notice new or worsening issues.

Common Treatment Options

Physical therapy is one of the main ways to manage joint pain and instability. A physical therapist can teach you exercises, stretches, balance activities, and fall prevention strategies to support your joint health and help you move safely and confidently.

Your doctor may also recommend other noninvasive treatments, like taking anti-inflammatory medications to manage pain, using ice to calm the joint, or temporarily wearing a brace for stability as you regain strength. Taking pressure off the joint can help lower inflammation and support healing. People with diabetes and osteoarthritis may also benefit from lifestyle changes, like controlling blood sugar, maintaining a healthy weight, and improving diet and exercise habits.

For some, changing daily footwear can make a big difference. Properly fitted rubber-soled shoes provide traction when you walk, helping you feel steadier. One DiabetesTeam member wrote that their osteoarthritis and foot issues affected their balance, but orthotics — devices ranging from shoe inserts to custom braces — helped. “After I had surgery on my foot, I had some orthotics made for my shoes. My balance is much better now,” they wrote. Ask your doctor if orthotics should be part of your treatment plan.

Join the Conversation

On DiabetesTeam, people share their experiences with diabetes, get advice, and find support from others who understand.

Do you have diabetes and experience unstable joints? What helps you feel more confident on your feet? Let others know in the comments below.