A traumatic accident changes the victim forever.
Sometimes, it leaves deep psychological scars. Sometimes, it takes away the person's mobility. For 32-year-old Anurag, it gave diabetes; while he was battling life and death on a hospital bed.
'The Pancreas Was Damaged Completely'
“It was early December in 2017. I was on a bike, riding from Chandigarh to Delhi after an event. My grandpa was in the ICU. Around 12 midnight, as I was nearing the Delhi border, I got a call from my mother, 'We have lost nanaji,’ she said. Before hanging up, she said, " Don't stop anywhere. Just rush home."
While I started the bike again, I lost my equilibrium. I was lost in the thoughts of me and my nanaji. I bumped into something... my body flung... there was a truck besides... and I got hit by that.
There were small rods that got inside my body. My friends took me to the nearest doctor, but he did not administer me very properly, I think.
It took a while for my family to shift me from where I was to Max Hospital.”
Anurag, a Type 1 Diabetic“My condition was very bad. The pancreas was damaged completely. The previous doctor had recommended glucose to me. But with no pancreas and glucose, your body gets a very heavy sugar dose. That was one of the reasons why, the doctors were not able to wake me. I was in somatic coma stage for a period of two weeks. The doctors started administering insulin to bring down the sugar levels, because they had to do surgery and you can’t do surgery with high sugar levels. My sugar levels had touched 1000. The surgery too had to wait. But once the surgery was done, I was told that I will have to take insulin injections everyday. Doctors told me I will have to take four insulin injections everyday for the rest of my life. “
Could it simply have been a weird coincidence that Anurag got diabetes soon after his accident? Well, it could have been... had it not been for the pancreatic injury. Dr Sumit Ray, who specialises in critical care at Artemis Hospital, explains this in detail.
Dr. Sumit Ray, Critical Care, Artemis Hospital“Pancreas is where the insulin comes from... and diabetes is a lack of insulin (or reduced insulin functioning). So when the pancreas gets damaged, it causes diabetes because the pancreas is the organ where the insulin comes from.”
Luckily, pancreatic injuries are not that common. They occur in less than 2% of blunt trauma cases, usually in motorcycle accidents and bicycle handlebar injuries. But as Dr Ray mentions, "that it causes diabetes is a well-known fact."
To a layman, diabetes is often associated with an overdose of sugar. "Meetha khaate honge (They must be eating a lot of sweets)“ is what people subconsciously think when someone tells them they have diabetes.
But diabetes has different nuances. Medically, it's divided into:
- Type 1 and Type 2 diabetes. While Type 1 is an autoimmune condition in which the pancreas says, NO MORE, as it goes on a permanent strike where it no longer produces insulin to control your blood sugar anymore.
- Type 2, on the other hand, occurs in individuals whose pancreas can still produce insulin, but their bodies can't use it correctly.
Dr Pradeep Gadge, a leading diabetologist at Dr. Gadge's Diabetes Care Centre explains that "Type 2 diabetes is most common in society – and it usually happens because of genetics, obesity, stress, etc."
It's stress which is the most unpredictable of all. Loss of a job, getting a divorce, stress can occur anytime, anywhere.
ICUs, too, are really stressful places. Being admitted in one, though, is even more stressful.
The Abdominal Tuberculosis Came First; Then Came the Diabetes
Dr Gadge mentions how in his OPD, he gets diverse stories, of how medical stress led to a patient developing Type 2 diabetes later in life.
- Patient 1: I got abdominal tuberculosis. I was operated. Half my intestine was removed. I was lying in the hospital for one and a half months. I had peritonitis and that is the first time I was detected to be diabetic.
- Patient 2: I was admitted into a hospital with dengue for 10-15 days. My condition was critical. A few days later, the doctor told me I had diabetes. First day, second day, third day: there was no diabetes. Seventh day, the doctor told me I had diabetes.
- Patient 3: I had a heart attack, and got a bypass. The third day of the bypass, I got to know I had diabetes. The first day or the second day, there was no trace of diabetes But on the third day, sugar started increasing it reached reached a level of 200-300.
"These types of stories are pretty common in our OPD", says Dr Gadge, explaining how sudden stress or trauma manifests into Type 2 diabetes.
Dr Pradeep Gadge“When you are under a lot of stress, there are a lot of inflammatory markers that develop in the body. There is an adrenaline rush of catecholamines, growth hormones; so that the wounds heal faster. There’s a whole mismatch of hormones that are otherwise secreted in a much controlled fashion, which changes the insulin dynamics. It reduces insulin sensitivity, increases insulin resistance and precipitates diabetes.”ICU and Stress: An Unavoidable but Dangerous Situation
Dr Sumit Ray, who has seen hundreds of ICU cases, explains how stress can lead to diabetes in an ICU:
Dr Sumit Ray“Many a times, the diabetes or borderline diabetes has not been diagnosed. But when critically ill, it gets obvious that you have diabetes. But that just expresses an underlying diabetes, a low grade diabetes, and a pre-diabetic state.”
Sometimes, the high sugar is temporary. After a month or two of extreme stress where other hormones are secreted, the insulin starts to maintain its natural equilibrium.
Dr Pradeep Gadge, endocrinologist“Glucose metabolism in the body is a tug of war between insulin on one side and the body’s other hormones on the other side. When a lot of stress occurs, it increases a lot of anti-insulin hormones in the body, like adrenalin, cortisol, etc. Now after a month or two, the effect of the hormones that had become dominant starts waning and then again insulin starts becoming stronger and gradually, restoring the balance. The tug of war that went from insulin’s hands is now back in its hands.”
If you think about it, diabetes as well is really nothing but a tug of war between the hormones. And when it comes to trauma or extreme medical stress, sometimes the insulin wins; and other times it fails. Some of it could have something to do with our genetics and the predisposition of our body to diabetes.
But some of it could have to do with how we react when it comes to extreme medical stress. As Dr Gadge explains, "My genetics is not modifiable but with the help of other mechanisms I can manage half the situation well."
If we are lucky, managing even half the situation can save us from diabetes.
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