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Diabetes

Long term spinal cord injury (SCI) and diabetes? According to some researchers the two go together like coffee and cream, like Bonnie and Clyde. Dr. Bill Bauman, for example, has studied diabetes extensively in spinal cord injured people. He writes that as many as 20 percent of spinal cord injury survivors have adult-onset diabetes; an even larger percentage, he says, don't have symptoms, yet their laboratory bloodwork findings suggest their bodies do not use insulin properly. What does this mean for SCI survivors? What should you do if you are diagnosed as having diabetes? Read on:

What Is Diabetes?
Diabetes is a chronic disease in which the body doesn't make enough insulin – a hormone from the pancreas – or somehow doesn't use it correctly. As a result, glucose or blood sugar that is normally carried to the body's cells for fuel instead builds up in the bloodstream. This extra glucose – called high blood sugar – can damage all organs of the body, especially the eyes, kidneys, and blood vessels.

Type I (insulin-dependent) diabetes starts in childhood or young adulthood, and requires daily insulin injections. Type II diabetes – which often is called adult-onset diabetes – usually occurs in adults over 40 and accounts for 95% of all diabetes cases. This type is of most concern to SCI survivors. While it usually can be controlled through diet and exercise, some people also need oral medications or insulin injections.

Symptoms:
Early symptoms are dehydration, excessive urination, extreme thirst, increased appetite and weight loss. However–perhaps unfortunately–you may have no symptoms at all.

Long-term Implications:
In addition to diabetic coma and insulin shock, which can be life-threatening, diabetes is a grab bag of complications. Atherosclerosis–hardening of the arteries–can damage the heart or affect circulation in feet and legs, sometimes requiring amputation. Kidney, eye, and peripheral nerve damage can also occur. The best news about diabetes is that it is controllable.

Risk Factors:
By far the most important risk factor is age. Others are a family history of the disease,
being overweight, and inactivity. Diabetes is slightly more prevalent in women and nonwhite people . Estimates of incidence for diabetes in the over-40 population vary from 2 to 16%.

The SCI Factor:
So how do you fit into the picture? Where does the additional risk, if any, come from?

  • SCI alters the body’s metabolism. Frequently muscle mass is lost below the level of injury, and at the same time, fat tissue may increase throughout the body–both above and below the injury site. These two factors alter metabolism enough to affect how insulin is used by the body.
  • Inactivity further impairs glucose tolerance and causes abnormal insulin levels.
  • Illnesses like influenza and pneumonia–and even injuries–may cause blood glucose swings, adding to the risk created by SCI itself.
  • The older you get, the greater your chances of developing diabetes are. Though everyone gets old, some researchers and clinicians–and more than a few survivors themselves–feel that people with SCI get old faster than nondisabled people. If aging is accelerated after SCI, they feel, diabetes may make its appearance sooner.

Diagnosis:
Diagnosis is fairly simple, and is often the result of a routine urine test. The appearance of the already described symptoms, high levels of glucose in the urine, or elevated blood sugar levels on repeated blood tests are the usual indications. Fasting blood sugar tests are sometimes needed.

Treatment:
Doctors treat diabetes by keeping blood glucose levels as close to normal as possible through diet, exercise, oral medications and, when necessary, added insulin. Other than working to lessen risk factors, there is no way to actually end the disease. But major improvement is possible, and you play the key role.

If you have diabetes, get involved in a good diabetes education program. Most people learn to check their own blood sugar levels and to adjust their diet, exercise and insulin doses. They can also read their body’s built-in warning signs or symptoms of changes in the insulin-glucose balance. Your doctor can teach you these things or refer you to a class. A large local hospital may have a nurse educator who specializes in diabetes education, and printed information is easily found in libraries or through your local diabetes association.

Diet:
Diets are custom-tailored for each individual, based on sex, activity level, disease progression and your own physician’s philosophy on how precisely blood sugar levels should be controlled. They should be followed carefully. If you have a friend with diabetes, do not assume his or her diet will work for you.
Regardless of whether or not you must follow a strict diet, there still are some general dietary guidelines:

  • Always eat at a regular time; avoid skipping meals; avoid sweets and desserts.
  • Limit fats–especially saturated ones–in order to minimize the risk of circulatory complications.
  • If you will be using alcohol on a particular day, you may have to decrease your fat and carbohydrate intake to accommodate it.
  • Some early studies suggest that high fiber diets help decrease glucose levels.

Exercise:
Exercise and physical activity help. When aerobic capacity improves, so does glucose tolerance. If you have never exercised, if you have other medical or orthopedic problems, or even if you don’t know where to start, it would be a good idea to work with your physician or therapist. If you are using insulin to manage your diabetes, it’s not just a good idea to work with your doctor, it’s essential.

Avoiding Complications:
Be especially careful in watching for complications. Most involve the circulatory system, creating risk of visual changes, cardiac problems and amputations. Regular vision checkups and monitoring your cardiac status are crucial.
Exercise, infection and fever can affect metabolism and insulin needs, so changes in treatment may be needed. Learn how to anticipate and respond to these changes.

Watch your skin closely. Foot care is vital–wear loose socks, soft shoes that fit well, and keep your nails trimmed. Danger signs: skin breakdown that won’t heal, changes in the color and texture of your toes, and swelling in the ankles. Don't ignore them.

Stress:
Some researchers feel that stress aggravates diabetes. Find ways to relax, such as hobbies, trips, relaxation tapes, or–best of all–kill two birds with one stone and start that aerobic exercise program.

Getting Help:
Look for professionals who understand SCI as well as diabetes, starting with your SCI
center. If you can't find one doctor well versed in both issues, find two who are willing to work together. Your ultimate resource, though, is yourself. Learn as much as you can. Take control of your care and speak up for yourself.

Resources:

  • The American Diabetes Association affiliate in your state
  • Your state health department's diabetes control program

Parting Thoughts:
Yes, there probably is a higher incidence of diabetes among SCI survivors. But many of the reasons for that increase are as much from how SCI affects your lifestyle–through diet, weight gain and decreased activity–as they are from the actual physiological change.

Because SCI survivors have the same causes and risks as nondisabled people, they can benefit from the same lifestyle changes, such as diet, weight, exercise, and stress management. Careful management of diabetes generally has excellent results.

This is one of more than 20 educational brochures developed by Craig Hospital while it was a federally-funded Rehabilitation Research & Training Center on Aging with Spinal Cord Injury. The opinions expressed here are not necessarily those of the funding agency, the National Institute on Disability and Rehabilitation Research of the US Department of Education.

For a hard copy of a METS brochure, click on your selection above and hit the "print" button on your browser. If you'd like to ask for one directly from Craig Hospital, you can contact us by telephone at 303-789-8202, or you can e-mail us at HealthResources@craighospital.org.