Type II Diabetes and Paralysis
Diabetes is a chronic condition that occurs when the body’s naturally made hormone, insulin, is not released, or enough is not released from the pancreas to help your body metabolize food. Insulin is a transporter for carrying glucose (sugar) from food into your cells which the body will then be used for energy. Since glucose cannot enter the cell, it builds up in the bloodstream, damaging your organs. Any organ can be affected, including the eyes (blindness), kidneys (kidney failure), and heart (heart attack or clogged arteries). There can also be effects on the nerves (neuropathy) and blood vessels (ulcers, atherosclerosis). The brain can be affected by stroke and/or dementia.
There are different types of diabetes.
Type I Diabetes most often appears in early childhood, teens, or young adults but can develop at any age. In this situation, the body stops or slows in making insulin. The reason this type of diabetes develops is not fully understood but could be from an autoimmune reaction. Insulin is required for treatment. A rare and extreme complication of Type I diabetes can be low potassium with insulin therapy, leading to the development of quadriparesis if left untreated.
Type II Diabetes is more commonly developed in adulthood but can develop in younger individuals. The body is unable to make enough or is unable to use the hormone insulin to keep blood glucose levels in range. This is the type of diabetes that can develop as a secondary complication of paralysis. It is caused by a combination of factors, including being overweight, eating an unhealthy diet, and inactivity. After paralysis, moving the body can be difficult, which leads to weight gain and possibly the development of Type II diabetes.
Prediabetes is a condition where blood sugar is high but not high enough to be in the diagnostic range of Type II diabetes. This is a warning sign that Type II diabetes will soon evolve if steps are not taken to resolve the issue.
Some health conditions can affect blood glucose. Gestational diabetes can develop in pregnancy. It often resolves after delivery. Paralysis is a risk factor for Type II Diabetes. A genetic disorder called Rabson-Mendenhall Syndrome is characterized by severe insulin resistance. Taking in too much salt has been thought to increase the risk of Type II Diabetes.
Individuals with paralysis are at a higher risk for diabetes, especially Type II, because of lack of movement. Moving your body helps all muscles metabolize as movement increases blood flow. However, the muscles in the thighs are the largest, providing the most effective metabolism. After paralysis, the muscles in the affected area may reduce in size or may not be used as efficiently to produce effective metabolism. Genetics can also be a risk factor in diabetes of all types.
Symptoms of diabetes may not be as readily recognized in those individuals with paralysis. Increased thirst and hunger are symptoms of diabetes, but bladder program drinking restrictions may mask these or reduced feelings of hunger can be hidden due to a slow-moving bowel. Sensations of needing to urinate frequently may be covered up by catheter use and changes in messages sent to and from the brain. Weight loss from diabetes may be confused with loss in muscle mass. Sores on the body, especially in the feet, may be mistaken for pressure injuries. Infections can occur due to diabetes and from changes in the immune system from paralysis. Irritability can be from many sources, including stress and anxiety, as adjustments to paralysis are being made. Blurred vision can also occur with brain injury. Men may have erectile dysfunction, as with paralysis. Men and women may have increased urinary tract infections and yeast infections, as with paralysis. Dry, itchy skin can also be a sign of diabetes, as with paralysis.
A major complication of diabetes is diabetic neuropathy. This is a type of nerve damage due to the high concentration of glucose and triglycerides in the blood. The signs and symptoms can be the same as neuropathy from paralysis. Diabetic neuropathy typically occurs in the feet and legs as small blood vessels become damaged so they can no longer carry oxygen and nutrients to your nerves. It can also occur in the hands, arms, bladder, bowel, and nerves that control your heart rate. This may appear as pain, tingling, numbness, or weakness in your body. In some cases, it can affect the autonomic nervous system (ANS), which can already be affected by paralysis.
The usual symptoms of diabetes may not be noticed if you have paralysis, but do not ignore them. The best way to tell if you have diabetes is to have a blood glucose test at the time of your visit to your healthcare professional. Routine blood tests will indicate your blood glucose at that time. If there is a concern about your blood glucose, an A1C test is a one-time blood draw that provides information about your blood glucose over three months.
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Spinal cord injury from disease or trauma as the source of paralysis affects the whole body. There is a reduction in the amount of activity in the thighs. Some individuals compensate with arm muscle development, which does help metabolism, but may still not be as effective as the movement of the large muscles in the thighs. Individuals with brain injury or stroke may have paralysis of one side of the body. They may walk with a splint or other assistive device, but not utilize the thigh muscles of one leg. This can create a major decrease in blood glucose metabolism. Injury to the brain that affects glucose regulation can also be a source of diabetes. Pre-existing diabetes can be worsened by brain injury.
Adding activity to your lower extremities is essential to help metabolize blood glucose. Moving your legs either on your own, passively by moving your legs with your arms, or having someone move your legs for you will be a good start. Exercise equipment that moves your lower legs also helps move the thigh muscles. Therabands are elastic sheets of plastic, leg loops, or even a towel that can be used to help move your legs manually.
There is some evidence that standing can help put pressure on the bones and muscles that may help. A standing frame or standing frame with gliders for moving the legs utilizes muscles in both arms and legs. Functional electrical stimulating equipment, such as FES bikes, provides a huge source of muscle movement.
Watching your diet is an essential element in reducing your risk of diabetes. Individuals who cannot move their bodies or choose not to move tend to gain weight. Being overweight is a diabetic risk. A dietitian or nutritionist can help you understand your dietary needs to provide nutrition for your personal health needs, including paralysis, and avoid or treat diabetes.
Diabetic diets should include fruits, vegetables, whole grains, beans, and low-fat dairy. Fiber helps control your blood glucose and assists with a bowel program. Fish twice a week provides omega-3 fatty acids. Avocados, nuts, and oils should be eaten but only in moderation.
Foods to avoid are saturated fats (butter, beef, hot dogs, sausage, and bacon), trans fats (processed foods, bakery items, shortening, and stick margarine), cholesterol (high-fat dairy, egg yolks, liver), and sodium or salt. Avoid sweets, including sweetened drinks (soda, fruit punch, and energy drinks), and alcohol, which contains a lot of sugar.
Carbohydrates are transformed in the body into glucose. They are high content in some foods. If you are diabetic, you will need to monitor your carbohydrate counts. The dietitian or nutritionist will help you learn how to calculate these.
Stopping smoking, inhalants, and other drugs can assist your body in increasing blood flow and supplying oxygen and nutrients to your cells. Nicotine blocks the needed nutrients to your cells. Giving up smoking is difficult as nicotine is an addiction. There are programs that will help you. Research indicates lower blood glucose levels can be achieved within eight weeks of smoking cessation.
With diabetes, blood glucose must be monitored to avoid highs or lows, which can lead to hyperglycemia or hypoglycemia. Hyperglycemia, too much glucose in the blood, can lead to headaches, blurred vision, increased thirst and urination, and blurred vision. Left untreated, permanent vision, kidney, heart conditions, and neuropathy can occur. Hypoglycemia, too little glucose in your blood leads to shaking, sweating, dizziness, hunger, nervousness, confusion, irritability, and a fast heartbeat. Untreated hypoglycemia can cause seizures, fainting, coma, and death. Blood glucose monitoring is performed by pricking a finger, putting a drop of blood on a test strip, and reading the result through a blood glucose meter. Newer monitors can be attached to the skin, or soon-to-be available watches will monitor your blood glucose.
Medications are available to help control diabetes. These come in oral and injectable forms. The most common oral medication is metformin, but there are many others as well. Injectable medications include dulaglutide (Trulicity) and semaglutide (Ozempic, Wegovy). Some diabetic medications have the beneficial side effect of curbing your appetite to help you lose weight. Even though you can take medications to help control blood glucose, medications do not cure diabetes. You need to utilize the benefits of all three actions, exercise, diet, and medication, to control diabetes. Very rarely is insulin prescribed for Type II Diabetes.
Once you have been diagnosed with Type II Diabetes, you can learn to control it. It does not resolve but can be managed.
Pediatric Consideration:
Type II Diabetes is not a common diagnosis in children. However, adult diseases are slowly finding their way into childhood. Risk factors of immobility, weight gain, sedentary lifestyle, genetics, and paralysis, among other factors, can increase the odds. Combined with issues of paralysis, children may not be able to relate symptoms to you, or they may not be at a stage of development where they are able to notice a change in their body function.
With diagnosis and treatment, working with your healthcare professional and a dietitian or nutritionist, you will be able to help your child manage diabetes. Activity, diet, medication, and monitoring of their blood glucose will enable a healthy, long life.