Diabetes with Spinal Cord Injury: November is Diabetes Month


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?
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.






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