By Kim Phelps, RN, CRRN, CBIS
Rainbow Rehabilitation Centers
Diabetes is frequently described as a disease that affects the way the body uses glucose. While this statement is true, diabetes is more complicated than that, and when a traumatic brain injury (TBI) is added into the mix, the management of diabetes and the TBI can be further complicated.
There are several types of diabetes, but Type 1, Type 2, and Diabetes Insipidus are the three types that can impact the management of diabetes due to a traumatic brain injury.
Type 1 is defined as a chronic autoimmune disease in which the immune system kills the insulin producing beta cells in the pancreas. The cause is unknown but can follow a viral infection. Genetics can also be a risk factor for Type 1 diabetes. A person who is diagnosed with Type 1 diabetes will typically be prescribed insulin immediately.
There is no cure for Type 1 diabetes. Diet, exercise, and strict glucose control with insulin are all part of diabetic care to keep glucose levels in an optimal range.
Type 2 diabetes is more often diagnosed in older adults or during middle age. With Type 2 diabetes, your body still produces insulin, but it may not be enough insulin or enough usable insulin to control blood glucose. This is characterized as insulin resistance.
The risk factors for Type 2 diabetes include obesity, sedentary lifestyle, and genetics. For many who are diagnosed with Type 2 diabetes, diet and exercise can significantly improve blood glucose levels and can prevent further issues or improve the associated complications. If these lifestyle changes do not decrease blood glucose levels, then oral medications will be prescribed. If these medications do not provide adequate glucose control, then insulin will be needed.
Diabetes Insipidus (DI) is a condition that leads to frequent urination and excessive thirst. It can be caused by a deficiency of antidiuretic hormone (ADH). Trauma from head injury, tumors, or surgery can damage the pituitary gland or hypothalamus and lead to ADH deficiency. Medication and fluid intake control is needed for management of DI.
FACT OR FICTION?
Treatment for Type 1, Type 2 and Diabetic Insipidus are the same.
FICTION: Though all three forms of diabetes are related to the endocrine system, treatment for Type 1 and Type 2 diabetes are similar, but DI is different. Type 1 and 2 are related to the pancreas and production of insulin which controls blood glucose. DI is related to the hypothalamus and pituitary gland and lack of production of antidiuretic hormone.
Diabetes is caused by eating too much sugar, and DI is caused by drinking too much water1
FICTION: Sugary foods do not cause diabetes, but can elevate blood glucose if you have diabetes. If you are diagnosed with Type 1 or 2 diabetes, following a healthy diet by consuming a variety of foods is recommended. Your physician or a dietitian can give you guidelines on how to count carbohydrates and suggestions for healthy eating.
You cannot contract diabetes insipidus by drinking too much water. Damage to the hypothalamus by trauma or disease process can be the cause of DI.
Follow up with an endocrinologist is recommended to help you determine a treatment plan.
A traumatic brain injury will impact my treatment for diabetes or vice versa.
FACT: Type 1 and 2 diabetes or DI can have an impact on care regarding treatment and outcome. Symptoms of Type 1 and 2 diabetes can be exacerbated after a severe TBI.
Following a TBI, factors such as stress, inflammation, surgery, IVs, diet, decreased mobility, change in metabolism, and infection can all lead to hyperglycemia. Several classifications of medications can also lead to hyperglycemia, especially antipsychotics which may cause unwanted weight gain. Hyperglycemia is also a known cause of cognitive deterioration.
Regardless of the cause of hyperglycemia following a TBI, the course of treatment will focus on returning glucose to normal parameters and prevent hypoglycemia.
A person will not be able to manage their diabetes independently following a TBI.
FICTION: Factors such as decreased cognition, visual and/or physical changes may cause challenges following a TBI, but there is a variety of adaptive equipment and techniques available that can assist with managing diabetes as independently as possible.
For those with impaired cognition, there are alarm watches and phones to remind you to take your medication or insulin, continual glucose monitors that alert family members if your glucose is too high or too low, insulin pumps that read your glucose and administer insulin, and memory insulin pens.
For those with physical limitations, there are larger meters, lancet devices you can use with one hand, lancet drums with multiple needles, larger syringes, cozies for insulin bottles, safety shields for bottles, and vial safe bottles for better gripping.
Many of these devices can also be used by the visually impaired.
There is a wealth of adaptive supplies available. See your endocrinologist or diabetic specialist for a complete guide that can assist you with your specific needs.
Just as each brain injury is different, each course of diabetes is different. When these two worlds collide, a new set of problems can arise. By following recommendations from your physician and treatment team, developing skills and techniques to manage your brain injury and diabetes can help you reach your optimal level of independence and health.
- Myths and Facts: Stop Diabetes” website: http://www.stopdiabetes.com/ get-the-facts/myths-and-facts.html (accessed July 6, 2018