By Patty Kunze, RN, BSN and Roberta Palmer, RN
Years ago, someone came up with the idea to recognize a condition each
month. For example, September is spinal
cord injury month, October is Breast Cancer awareness month, and November is the
month of diabetes awareness. Awareness months, weeks, and days are
important because they allow people with certain health conditions, along with
their loved ones, advocacy organizations, and support groups, to rally around a
common cause: health. Educational, fundraising, and support events are often
held during these times. Upon our
investigation, two different sites did not list September as being Spinal Cord
Injury Month although Congress designated it to be so in July 2015. It would be interesting to know if only the U.S.
spinal cord injury population is raising awareness during the month of
September but that’s another story.
We are here to discuss diabetes and the relationship to spinal cord injury. When we set out to investigate the correlation of diabetes and spinal cord injury, we located an article written by National Institute of Health stating “overall prevalence of diabetes in individuals with an SCI/D was 20% (3 times higher than in the general population).” Not surprising results and they make sense considering we are unable to walk, run, or move as we once did prior to our spinal cord injury. In a nutshell, we are unable to fully exercise as before. Because we are not moving as we once did, our muscle mass is changing and allowing fat to accumulate much quicker than before, therefore the insulin is being used differently. In an additional article from Craig Hospital, “Long term spinal cord injury (SCI) and diabetes? Some research suggests the two go hand in hand with as many as 20% of spinal cord injured people having adult-onset diabetes.” Wow, two comments with the same results. So if persons with spinal cord injury are 20% at higher risk than the general public, what can be done to decrease our risk of diabetes after injury?
We are here to discuss diabetes and the relationship to spinal cord injury. When we set out to investigate the correlation of diabetes and spinal cord injury, we located an article written by National Institute of Health stating “overall prevalence of diabetes in individuals with an SCI/D was 20% (3 times higher than in the general population).” Not surprising results and they make sense considering we are unable to walk, run, or move as we once did prior to our spinal cord injury. In a nutshell, we are unable to fully exercise as before. Because we are not moving as we once did, our muscle mass is changing and allowing fat to accumulate much quicker than before, therefore the insulin is being used differently. In an additional article from Craig Hospital, “Long term spinal cord injury (SCI) and diabetes? Some research suggests the two go hand in hand with as many as 20% of spinal cord injured people having adult-onset diabetes.” Wow, two comments with the same results. So if persons with spinal cord injury are 20% at higher risk than the general public, what can be done to decrease our risk of diabetes after injury?
To understand diabetes, we need the definition of this condition – it is a chronic disease in which the body
does not make enough insulin – a hormone from the pancreas – or, does not use
the body’s insulin 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 heart, eyes, kidneys, nerves, and blood
vessels (Craig Hospital). There are two types of diabetes, Type I,
usually juvenile-onset, which requires daily insulin and Type II, usually
adult-onset, which may be diet controlled or may require oral medication or
injected insulin for control. Type I
accounts for 5% of cases while Type II is the other 95% of cases. Type II is the one we will be concerned
about.
Common symptoms include:
·
Dehydration
·
Excessive
urination
·
Extreme
thirst
·
Increased
appetite
·
Weight
change
Being spinal cord injured, these are difficult symptoms to notice. Medications prescribed after spinal cord
injury could create dry mouth, so frequent thirst is not uncommon. We may not notice weight change, increased
appetite, or frequent urination. So what
is the best way to detect diabetes, if you have not been diagnosed? Simple lab work is a great place to start.
Other factors include:
·
Family
history of diabetes
·
Being
overweight or obese
·
Inactivity
or not enough exercise (easy for us in wheelchairs)
·
Ethnicity
-- diabetes is more common in African Americans, Latinos, and Asian Americans
·
Gender --
diabetes is more prevalent among women than men
·
Age -- over
the age of 45
How to diagnose diabetes? As we
frequently suggest, physician management.
Check in with your physician and request a fasting blood sugar lab draw. It is a simple blood test to see if you have
higher than normal blood sugars. If your
fasting blood sugar is higher than normal, an A1C test can be done. That test will give you a more accurate
number over a course of a few months instead of one night number. If you get a fasting blood sugar (FBS) during
Halloween, and you’ve been munching on Halloween candy for days, that fasting
blood sugar may be falsely elevated, whereas, an A1C will give a more accurate
account of your actions.
Experts recommend routine testing for Type 2 Diabetes if you:
·
are age 45
or older
·
are
between the ages of 19 and 44, are overweight or obese, and have one or more
other diabetes risk factors (mentioned above)
·
are a
woman who had gestational diabetes (during pregnancy)
·
spinal cord injured (that’s from us at The
Rollin RN)
When you have your labs drawn and results are given to you, here is a
helpful resource to compare your labs results with:
Note: FPG may be referred to as
FBS (fasting blood sugar) and OGTT may be referred to as only GTT (glucose
tolerance test).
Diagnosis
|
A1C (percent)
|
Fasting plasma glucose (FPG)a
|
Oral glucose tolerance test (OGTT)ab
|
Random plasma glucose test (RPG)a
|
Normal
|
below 5.7
|
99 or below
|
139 or below
|
|
Prediabetes
|
5.7 to 6.4
|
100 to 125
|
140 to 199
|
|
Diabetes
|
6.5 or above
|
126 or above
|
200 or above
|
200 or above
|
Glucose
values are in milligrams per deciliter, or mg/dL.
DIET:
Diet is important in the treatment of
diabetes. But following a type 2 diabetes diet doesn’t mean you have to give up
the foods you love. The best diet is one
that is well balanced and includes a variety of healthy carbohydrates, proteins
and fats. The trick to this balancing
act is choosing the right combination of foods that will help keep blood sugar
level in your target range and avoid big swings that can cause diabetic
symptoms. These symptoms may include
frequent urination and thirst if blood sugar is too high or fatigue, dizziness,
headaches, and mood changes if blood sugar is too low.
To follow a healthy diet, you must
first understand how carbohydrates, proteins and fats affect your blood sugar.
We will take this part slowly……Carbohydrates,
which are found in grains, bread, pasta, milk, sweets, fruit and starchy
vegetables (corn, potatoes, and peas), are broken down into glucose in the
blood faster than other types of food, which raises blood sugar levels. Slow down and reread this sentence: Carbohydrates
raise blood sugar faster than other types of foods.
Protein and fats on the other hand do not directly raise blood
sugar levels, which is a positive. Especially since protein is such an
important part of the diet for those with SCI. Foods that provide protein include meat, poultry, fish, tofu, cheese,
milk, dairy products, eggs, and dried beans.
To target a good blood sugar level,
eat a variety of foods but monitor portions for foods with high carbohydrate
content since they have the most impact on blood sugar level. This is why some people count their
carbohydrates at meals and snacks. To
repeat, avoid high carbohydrate content,
read side labels on packaging. These labels are very
helpful in that they display the amount of carbohydrates, proteins and fats
found in your foods. This makes it easy
for planning and tracking your daily dietary intake.
Example of
a Nutrition Label found on food packaging:
Knowing what to
eat can be confusing so here are some general guidelines:
• Always eat at a regular time; avoid
skipping meals.
• Keep healthy snacks handy to avoid
hunger and high glucose levels. For example:
·
Apples or celery with almond butter
·
Nuts
·
Trail mix without the sweetened
ingredients
·
Hard boiled eggs
·
Turkey
·
Plain Greek yogurt
·
Raw veggies with hummus
• Avoid sweets and desserts.
• Limit fats—especially saturated
ones—in order to minimize the risk of circulatory complications.
(Heart disease and diabetes can go hand
and hand)
• Limit alcohol consumption.
• High fiber diets help decrease
glucose levels and as an added bonus may help your bowel program to work more
swiftly and predictably.
• Choose water over diet or other
calorie-free drinks (artificial sweeteners can often act like real sugar on
glucose levels).
Diets should be
custom-tailored for each individual, based on gender, activity level, disease
progression and physician philosophy on how precisely blood sugar levels should
be controlled and followed.
While there is no
longer a “diabetic diet,” there are general goals for meal planning and healthy
eating. A dietitian can help develop a nutrition program specific to each
individual.
REMEMBER: Carbohydrates in moderation and adequate
protein to preserve lean body mass and prevent or aid in healing of pressure
ulcers for SCI.
EXERCISE:
Exercise is
another key element in controlling diabetes. It can lower blood sugar levels
prompting the body to use insulin more effectively. Over time, exercise can
help lower A1C levels, which reflects blood sugar control over the past 3
months. It may even reduce the amount of medication originally needed to treat
an individual.
People with SCI
may have a difficult time achieving exercise goals due to mobility issues. Everyday activities such as transferring,
doing pressure reliefs, and working the muscles that function is a good place
to start. In addition to everyday activities, add in some extra exercises when
you can. Stretching is good for the body anytime and ideal both before and
after exercise. Cardio exercise is great for getting the heart pumping and
burning calories. Strength training uses
weights or resistance bands and helps build muscle. Put some good music on and dance in your
chair. Or go for a roll around the
block.
Before starting any kind of exercise program
check with your doctor or healthcare team.
It is important to talk about how any medication you're taking might affect you
during exercise. Some drugs may cause your blood sugar drop too low. Simple steps, such as testing your blood
sugar before you work out and eating a snack if your level is below a certain
number can help a lot.
Together with
your doctor or health care team you can come up with a physical activity plan
that is safe and geared just for you.
It’s all good!! Roll
on ♿♿♿!!!
References:
Diabetes Mellitus in Individuals with Spinal
Cord Injury or Disorder. Retrieved September 27, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1864854/.
Diabetes and Spinal Cord Injury: Prevention and
Treatment. Retrieved September 27, 2017 from https://craighospital.org/resources/diabetes-and-spinal-cord-injury-prevention-and-treatment.
Diabetes Test and Diagnosis. Retrieved
October 12, 2017 from https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis.
Health Awareness Months, Weeks, and Days.
Retrieved October 4, 2017 from https://www.healthline.com/health/directory-awareness-months.
About the Authors:
Patty Kunze has been a Registered Nurse since 1983. She holds a Bachelor’s of Science Degree in Nursing and worked several years in a Spinal Cord Injury Unit at the local Veterans Administration Medical Center as a new graduate. She has been a flight transport nurse for Neonatal Intensive Care, an assistant manager of Labor and Delivery, and an instructor of nursing students. In 2009, she was involved in an auto accident which left her paralyzed (T3-4 complete paraplegic) from chest down. But she continues her nursing career while sitting in her wheelchair as a nurse paralegal and writing articles for others with spinal cord injuries as The Rollin RN ™.
Roberta Palmer has been a Registered Nurse for 20 years. She has knowledge in Family Practice, Allery and Immunology, Special Pharmacy Medication and Counseling, and she is a RN Health Coach. In 2014, she was involved in an ATV accident which also left her paralyzed (T3-4 complete paraplegic) from chest down.
Patty Kunze has been a Registered Nurse since 1983. She holds a Bachelor’s of Science Degree in Nursing and worked several years in a Spinal Cord Injury Unit at the local Veterans Administration Medical Center as a new graduate. She has been a flight transport nurse for Neonatal Intensive Care, an assistant manager of Labor and Delivery, and an instructor of nursing students. In 2009, she was involved in an auto accident which left her paralyzed (T3-4 complete paraplegic) from chest down. But she continues her nursing career while sitting in her wheelchair as a nurse paralegal and writing articles for others with spinal cord injuries as The Rollin RN ™.
Roberta Palmer has been a Registered Nurse for 20 years. She has knowledge in Family Practice, Allery and Immunology, Special Pharmacy Medication and Counseling, and she is a RN Health Coach. In 2014, she was involved in an ATV accident which also left her paralyzed (T3-4 complete paraplegic) from chest down.
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