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Dr. Andrew Rynne

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Having dry mouth, frequent urination, fatigue, blurred Vision, headache. Diagnosed with Post Traumatic Stress Disorder. Why got diabetes?

Answered by
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Dr. Jonas Sundarakumar

Psychiatrist

Practicing since :2003

Answered : 2190 Questions

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Posted on Mon, 24 Dec 2012 in Anxiety and Stress
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.
Can an Road Traffic Accident without being life threatening cause PTSD?
Was the accident the key turning point to Diabetes?
Could the Spinal Injuries cause the Diabetes?
Could the stress/PTSD 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. Jonas Sundarakumar 9 hours later
Hello and welcome to Healthcare Magic. Thanks for your query.

I have gone through your history in detail and have answered your questions below:

1) PTSD develops when an individual is exposed to a sudden, severe and overwhelming emotional trauma. Usually these traumatic events involve the risk of injury or death. But it is NOT mandatory that the event has to be life threatening in all cases. Moreover, each person's mental make-up and coping skills vary and so, some people can develop PTSD in response to situations which may not be considered overwhelming to others. So, in summary, a Road Traffic Accident without being life threatening can cause PTSD.

2) It is very unlikely that the accident was key turning point to diabetes. Especially, type 1 diabetes develops due to "auto-immune" destruction of the insulin producing cells in the pancreas. It has a strong genetic and biological background and does not develop or get triggered as a result of situational causes.

3) Spinal injuries cannot cause diabetes. The insulin / sugar regulatory mechanisms do not involve the spinal cord in any way.

4) Stress or PTSD cannot cause diabetes. But in a person who already has diabetes, stress can sometimes be associated with poor sugar control.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 34 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.

When I go to sleep I do not sleep very well, I wake up after dreaming about the accident, usually soaking with sweat.

I now have a dislike of the car, I don’t want to drive. When I am in the car, I will brake really sharply if anyone comes near me and I either close my eyes or look away.

The day of the accident emotions were already running high, as I was taking my wife and daughter to the Airport and knowing that it would be about 3 months before I seen them again.

I’ve seen a Consultant Clinical Psychologist, he said that the accident started PTSD, A few weeks later I end up in a Coma and nearly die I become a Type One Diabetic.
My GP says that I got the PTSD from that not the accident, but I have not spoken much to him.

I get really irritable with people now, really stroppy and I don’t like it. It is not what I am like normally.

Do you think the accident caused this or was it the hospital situation a few weeks later and if not why I am so scared in the car and have nightmares about it?
doctor
Answered by Dr. Jonas Sundarakumar 15 hours later
Hello again,

Well, my opinion is that you most likely developed the PTSD in response to the car accident. The reasons are the following:
- There are various types of stress-related disorders, but the core features which make a PTSD stand out are:
* re-experiencing the traumatic event, in the form of flashbacks or nightmares
* avoidance of stimuli associated with the trauma
* hyperarousal, in the form of difficulty in falling asleep, hypervigilance or increased anger
In your case, all three of these core features are present in relation to your car accident.

- Secondly, whether you fully saw the accident or not, the impact seems to be sufficient to cause significant psychological trauma, and will definitely quality as an 'overwhelming' trauma.

- Thirdly, though a diabetic coma is actually a life-threatening 'medical' emergency, still you are unlikely to have experienced a severe psychological impact at the time of falling into coma, 'coz it would have probably happened all of a sudden, without your knowledge (you have mentioned that you were actually found collapsed and brought to the hospital by your colleagues). So, I don't see this event of falling into coma to have been an overwhelming psychological trauma. Similarly, the subsequent hospital stay is also unlikely to qualify as an extra-ordinary or overwhelming traumatic experience.

So, I feel that the car accident was the traumatic event which resulted in the PTSD, and not the diabetic coma or subsequent hospitalization.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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