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Dr. Andrew Rynne

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Exp 50 years

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Have type 1 diabetes. Had spinal injuries in a accident. Could it be a reason of this?

Answered by
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Dr. Pavan Kumar Gupta

General & Family Physician

Practicing since :1978

Answered : 6714 Questions

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Posted on Wed, 19 Dec 2012 in Diabetes
Question: Hi there I am a 46 male, 5ft 11 inches tall and of large muscular frame.
1.     I do not drink Alcohol,
2.     I do not smoke cigarettes
3.     I do not take any recreational drugs.

In relation to food I don’t particularly like sweet foods such as deserts, cakes and sweets, I prefer savoury foods. I was living and working in the USA. I owned A High End Designer Kitchen Company and worked on most of the installations. I am said to be a perfectionist. I eventually sold the company and work around the area dried up because of the economy. The work was physically demanding. I had purchased a boat and was water skiing during the summer and skiing in the snow during the winter. I was at my lowest weight at this time which was 210llbs (95.254 Kilos)

In late 2007 I returned to my native UK I didn’t have the same financial resources in the UK as when in the USA so didn’t have the option of doing my favourite sports thus over a period of time my weight increased and reached a peak in January 2012. My weight at that time was 300llbs (136.077 Kilos) although you would look at me and would never guess that I was that heavy. The work in the UK was longer hours and it consisted of a lot of driving and computer work. You can see my website to give you more of an idea it is http://kasamydesign.co.uk/ this obviously meant I wasn’t getting the same level of exercise as previously in the USA.

I decided to do something about the weight issue, so firstly I cut the size of my meals down to half and then joined a gym. I did mainly cardiovascular exercise on bikes, running and lots of swimming the later I really enjoy.

I started to lose weight albeit it slowly at around 2llb a month (0.907 Kilos) my body was at the same time putting on Muscle mass. My chest, arms and legs were larger, but my waistline had gone down by just over 4 inches and was going back to my former shape.

I kept a record of all my weight, chest arm and leg measurements on an Excel Spreadsheet which was completed once a week. According to my excel spreadsheet on the 19th August 2012. I weighed I was 286llbs (129.273 Kilos)

On the 23rd August 2012 I was involved in a Car Accident. I suffered Spinal injuries to my neck and lower back. All the symptoms I got from the Spinal Injuries are on the Right hand side. i.e. Right Arm tingling painful and numb, Right hand tingling, painful and numb. Right leg pain and numbness I have a MRI scan report to verify this. A Spinal Surgeon has verified that these injuries are consistent with the MRI report.

I had also been diagnosed with PTSD (anxiety and a high level of stress.

Also after the accident I noticed I started to lose weight. In-fact what was previously slow weight loss from exercising had now started to accelerate although I was doing no exercise; it was around 5llbs a week (2.267 Kilos) I put this down to losing muscle mass that I had gained over the last few months.

By the last week of September 2012 I was losing weight fast at around 2llb (0.907kilos) a day, I had become thirsty all the time, (drinking upwards of 8 litres of water per day). Had trouble staying awake, was peeing a lot and my vision started to get blurry. My weight had now dropped to 230llbs (104.326 Kilos)

I first thought that I had a stomach bug or something and was going to give it the weekend at the end of September to improve or go to the doctors. By the Sunday I was feeling worse, I searched on the Internet using the symptoms. Every website I came across, said the symptoms were Type One Diabetic.

On Monday the 1st of October I went to the doctors reporting these symptoms.

1. Constantly Thirsty
2. Dry Mouth
3. Going to Toilet 30 times a day
4. Fatigue
5. Blurred Vision
6. Headache.

It was a new doctor I had never seen before, she was under GP training and the meeting was videoed. I told her I had done research on the Internet and came up with Type One Diabetes as the answer.

She asked me if I had any previous stomach issues, which I reported that I had all my life as I can remember Constipation, Bloating after eating and Acid Reflux. She did an examination on the bed but found nothing wrong, after this she suggested to get an eye test for the blurred vision.

I left the doctors thinking there was not a lot wrong with me and there was no big deal as whatever it was I was not dehydrating and I was drinking loads of water. I booked an eye test for the following Saturday

The next 3 days it got worse, where I started vomiting, drowsiness, abdominal pain and then started to find it difficult to breath, by the Thursday I collapsed into a Coma and were found by work colleagues who called an Ambulance.

I was rushed to the Hospital. The Hospital doctors said I was Ketoacidosis and Hyperglycaemic. My Sugar count was 63.70. I was linked to 4 different drips and was told by the doctors at the hospital that I was lucky to be alive.

It took 6 days of being in hospital to get the blood sugar under control. There is no sugar in my diet and never really has been, as I followed my mother using sweeteners in coffee rather than sugar and I have never really been a desert type of guy. I have always eaten three meals a day although portions used to be on the rather large side these have been cut right down now. The Consultant at the hospital diagnosed me as being Type One Diabetic.

I am now on the following medication for Type One Diabetes,

1.     Lantus Insulin, of a night (30 units) injection.
2.     Novarapid Insulin 3 times a day after meals (10 units per time) injection.

From the accident I am on the following medication.
1.     Morphine Patches
2.     Codeine/Paracetamol based pain killers.

Previous medication I was prescribed is Omeprazole this is for my stomach issues that has being long standing.

I have noticed that I no longer get any constipation or Acid Reflux or bloating.

Unfortunately prior to the accident I have never had a blood test completed.

My questions related to this are.

Have I had Diabetes this all my life without knowing?
Was the accident the key turning point?
Could the Spinal Injuries cause the Diabetes?
Could the stress of the accident cause the Diabetes?

I thank you very kindly in advance to the answers to my questions. It will help me to understand things and put them into some type of perspective.
doctor
Answered by Dr. Pavan Kumar Gupta 4 hours later
Hello,
Thanks for the query.
I have read your problem and would try to answer your queries with best of my knowledge.
Although type 1 diabetes is a diabetes of childhood and is generally brought about by the auto immune destruction of your beta cells of your pancreas,but it can take place in adults and generally comes very swiftly.
These beta cells are responsible for production of insulin which is responsible for the control of sugar.
Now I will answer your queries one by one
1...you didn't have diabetes all along your life.
2 and 3... Physical trauma on your lower back might have damaged your pancreas resulting in destruction of beta cells.
4.. The cause of your diabetes seems to be a direct trauma and not the stress.

Generally patients of diabetes type 1 in adulthood present in state of ketoacidosis  because the event is very fast,as it happened in your case.

You are rightly being treated by injectable insulin and be regular with it.
I hope to have answered your query however you may revert to me for any further query.
Best of luck.
Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Pavan Kumar Gupta 28 minutes later
Dear Dr XXXXXXX XXXXXXX XXXXXXX
Thank you for your answer, I have asked a Spine surgeon the same question. He says that it unlikely that the trauma directly caused the Type One Diabetes.

This is one section of what the MRI shows in lower back, although I have uploaded it for your convenience

L3/4 Broadbased protrusion, affecting the right lateral recess, foraminal and extra foraminal zones. This appears to be touching the right sided L3 nerve root. There is mild indentation of theca but no significant canal stenosis.

He reckoned that stress is in itself a major start-up of Type One Diabetes.

Because the event from 23rd August (Date of Accident) until the 4th October is a matter of 5 ½ weeks would you consider this a short space of time? i.e. likely to be the right amount of time for this to happen?

Are there any published cases of Type One Diabetes being caused by Trauma of the Spine?

Do you know of any published cases of Type One Diabetes being the direct result of stress?

I thank you greatly for your answers,

Kind Regards XXXXXXX XXXXXXX
doctor
Answered by Dr. Pavan Kumar Gupta 1 hour later
Hello XXXXXXX
I don't agree with the statement concerning association of stress with the onset of type 1 diabetes.
This statement is more true for diabetes type 2.
However when we talk about the trauma being the cause for onset of type I DM,,it means trauma to the pancreas directly and not because of trauma to the spine resulting in DM type 1. 
Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Pavan Kumar Gupta 4 minutes later
Dear Dr XXXXXXX XXXXXXX XXXXXXX
OK thank you for that, as I didn't receive a direct impact on the Pancreas during the accident. Is there any other way of explaining Type 1 Diabetes suddenly coming on after the accident?

Once again thank you
Kind Regards XXXXXXX XXXXXXX
doctor
Answered by Dr. Pavan Kumar Gupta 8 hours later
Hello
When I say trauma to pancreas,it doesn't mean a direct injury to the pancreas itself.It simply means an accident resulting in some severe jolting to the entire pancreas.
Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Pavan Kumar Gupta 37 minutes later
Hi there Doctor,
Thank you so much for your reply, the accident was a side collision. The major impact was taken on the passenger back wheel. I didn’t see it happening. I was pushed sideways my head smacking off the drivers side window. The seatbelt although wearing it, it did nothing to protect me.

I gained the symptoms in my neck and back and a MRI supports this, I also gained a lump on my right wrist which came up about 10 minutes after the accident.

I now have difficulty walking because of the pain and numbness and tingling in my right leg as well as other issues because of my arm.

I consider this a severe jolt would this have been enough to start the issues with the Pancreas? It took 5 weeks before ending up in the Coma, but the symptoms started not long after the accident.

Once again thank you for your answers

Kind Regards XXXXXXX XXXXXXX
doctor
Answered by Dr. Pavan Kumar Gupta 26 minutes later
Hello
I think this severe jolt was sufficient to start the damage in pancreas.
Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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