Did My Accident Cause The Diabetes?
Can diabetes be caused after an accident? Yes, if the accident causes a major injury to the pancreas, say doctors.
A traumatic accident changes the victim forever.
Sometimes, it leaves deep psychological scars. Sometimes, it takes away the person's mobility. For 32-year-old Anurag, it gave diabetes; while he was battling life and death on a hospital bed.
'My Pancreas Was Damaged Completely'
“It was early December in 2017. I was on a bike, riding from Chandigarh to Delhi. Around 12 midnight, as I was nearing the Delhi border, I got a call from my mother, 'We have lost nanaji,’ she said. Before hanging up, she told me, " Don't stop anywhere. Just rush home."
While I started the bike again, I lost my equilibrium. I was lost in the thoughts of me and my nanaji.
My body flung - there was a truck besides and I got hit by that. There were small rods that got inside my body. My friends took me to the nearest doctor, but he did not administer me properly, I think.
It took a while for my family to shift me from where I was to Max Hospital.”
“My condition was very bad. The pancreas was damaged completely. The previous doctor had recommended glucose to me. But with no pancreas and glucose being injected, the body gets a very heavy sugar dose. That was one of the reasons why, the doctors were not able to wake me. I was in somatic coma stage for a period of two weeks. The doctors started administering insulin to bring down the sugar levels. My sugar levels had touched 1000. The surgery too had to wait. Once the surgery was done, doctors told me I will have to take four insulin injections everyday for the rest of my life. “Anurag, a Type 1 Diabetic
Could it simply have been a coincidence that Anurag got diabetes soon after his accident? Yes, had it not been for the pancreatic injury. Dr Sumit Ray, who specialises in critical care at Artemis Hospital, explains the implications of a pancreatic injury in detail.
“Pancreas is where the insulin comes from, and diabetes is a lack of insulin (or reduced insulin functioning). So when the pancreas gets damaged, it causes diabetes"Dr. Sumit Ray, Critical Care, Artemis Hospital
Luckily, pancreatic injuries are not that common. They occur in less than 2% of blunt trauma cases, usually in motorcycle accidents and bicycle handlebar injuries. But that such an injury could have the potential to cause diabetes in the patient is "a well-known fact," says Dr. Ray.
To a layman, diabetes is often associated with an overdose of sugar. "Meetha khaate honge (They must be eating a lot of sweets)“ is what people subconsciously think when someone tells them they have diabetes.
But diabetes has different nuances. Medically, it's divided into:
Type 1 and Type 2 diabetes. While Type 1 is an autoimmune condition in which the pancreas goes on a permanent strike, no longer producing insulin to control the blood sugar.
Type 2 occurs in individuals whose pancreas can still produce insulin, however their bodies can't use it correctly.
Dr Pradeep Gadge, a leading diabetologist who runs Mumbai-based Dr. Gadge's Diabetes Care Centre explains that while Type 2 diabetes usually happens because of genetics and obesity, it's stress, particularly acute medical stress, which has gone on to manifest diabetes in many of his patients.
The Abdominal Tuberculosis Came First; Then Came the Diabetes
Patient 1: I got abdominal tuberculosis and was operated. Half my intestine was removed. I was lying in the hospital for one and a half months. That is the first time I was detected to be diabetic.
Patient 2: I was admitted into a hospital with dengue for 10-15 days. My condition was critical. First day, second day, third day: there was no diabetes. Seventh day, the doctor told me I had diabetes.
Patient 3: I had a heart attack, and got a bypass. The first day or the second day, there was no trace of diabetes. But on the third day, sugar started increasing and it reached a level of 200-300. The third day of the bypass, I got to know I had diabetes.
"These types of stories are pretty common in our OPD", says Dr Gadge, explaining how sudden medical stress or trauma manifests into Type 2 diabetes.
It also doesn't help that of all the factors that cause Type 2, stress can be the most unpredictable of all. Being admitted in an ICU can be an extremely stressful situation for anyone, making them a space where some patients could be more vulnerable to Type 2 diabetes.
“When you are under a lot of stress, there are a lot of inflammatory markers that develop in the body. There is an adrenaline rush of catecholamines, growth hormones; so that the wounds heal faster. There’s a whole mismatch of hormones that are otherwise secreted in a much controlled fashion, which changes the insulin dynamics. It reduces insulin sensitivity, increases insulin resistance and precipitates diabetes.”Dr Pradeep Gadge
ICU and Stress: An Unavoidable but Dangerous Situation
Dr Sumit Ray, who has seen hundreds of ICU cases, explains a major reason why diabetes gets diagnosed in an ICU:
“Many a times, the diabetes or borderline diabetes has not been diagnosed. But when critically ill, it gets obvious that you have diabetes. But that just expresses an underlying diabetes... a low grade diabetes... and a pre-diabetic state.”Dr Sumit Ray
According to Dr. Ray, sometimes patients admitted in an ICU already have an underlying diabetic situation. However, with the medical stress, the diabetes manifests into its full form.
Sometimes, though, the high sugar could be temporary. After a month or two of extreme stress, Dr. Gadge reveals some of his patients' insulin started to maintain its natural equilibrium.
“Glucose metabolism in the body is a tug of war between insulin on one side and the body’s other hormones on the other side. When a lot of stress occurs, it increases a lot of anti-insulin hormones in the body, like adrenalin, cortisol, etc. Now after a month or two, the effect of the hormones that had become dominant starts waning and then again insulin starts becoming stronger and gradually, restoring the balance. The tug of war that went from insulin’s hands is now back in its hands.”Dr Pradeep Gadge, endocrinologist
If you think about it, diabetes is really nothing but a tug of war - where sometimes the insulin wins; and other times it fails. And while some of it could have something to do with our genetics and the predisposition of our body to diabetes, it could also have something to do with how we react when it comes to extreme medical stress.
As Dr. Gadge says, "My genetics is not modifiable but with the help of other mechanisms, I can manage half the situation well."
If we are lucky, managing even half the situation could save us from diabetes.
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