Q. I’m 45 and a C6 quad for 17 years. I just read Tim Gilmer’s article on diabetes [October 2016] that mentioned a Canadian study saying people with SCI are 2.5 times more likely to develop type 2 diabetes than the general public. I go in for yearly check-ups, but my doctor never mentioned this. Should I get a diabetes test? And if so, what test? Is there a way to reduce my odds of developing type 2 diabetes? If you get it, is it reversible?
A. Here are some type 2 diabetes basics: A hormone, insulin, regulates the correct balance of glucose (blood sugar) in your blood — signaling the liver when to release glucose for needed energy and when to store it in the liver, muscles and fat cells when glucose levels rise. Type 2 diabetes happens when the body does not respond properly to insulin (insulin resistance), or doesn’t make enough insulin, which causes glucose levels in the blood stream to rise.
Excess glucose levels produce an inflammatory response in the vascular system, which leads to vascular damage. Over time this can cause serious complications, from kidney damage, to vision loss, to heart disease.
“SCI and diabetes are especially dangerous in terms of wounds on the legs because SCI has already compromised blood flow, and uncontrolled diabetes further compromises blood flow,” says Cat Davis, certified rehab RN of Craig Hospital’s SCI Nurse Advice Hotline. “Lack of circulation from damaged blood vessels makes wound healing much more difficult.” The takeaway is to follow steps to prevent, delay, or control diabetes before blood vessels become damaged.
Here are ways to prevent or delay the onset of type 2 diabetes, according to the American Diabetes Association: regular physical activity, maintaining a healthy weight, and eating healthy, protein-rich, low-carb food, fruits (in moderation) and vegetables. If you do develop type 2 diabetes, adopting these lifestyle habits is vital to controlling it. Studies show that for some people these lifestyle changes can “reverse” the condition and eliminate the need for diabetes medication, depending on length of time you have had it, severity, and genetics. Those with a family history of diabetes are at higher risk.
Identifying higher than normal blood glucose levels early is one step in improving your odds. Have your physician order a fasting blood sugar count — which is included in a Comprehensive Metabolic Panel or Chem 20 Panel as part of your annual physical, explains Kathleen Dunn, a recently retired clinical nurse specialist and rehab case manager. If the readings are abnormal, Dunn says your doctor should follow up with an A1C test, which determines blood levels over the past three months. Studies show that type 2 diabetes tends to occur in the 45-49 age range with SCI compared with 60-64 in the nondisabled population.
Another reason to have annual blood glucose tests is that it’s rare for people with either pre-diabetes or type 2 diabetes to have physical symptoms, says Dunn. According to the Mayo Clinic, you can have type 2 diabetes for years and not know it.
Maintaining a proper body mass index is another way to increase your odds against type 2 diabetes. Obesity is thought to be a factor in type 2 diabetes because it creates changes in metabolism that cause fat tissue to release fat molecules into the blood. This interferes with insulin cells and reduces their effectiveness.
Exercise on a regular basis can also tilt the odds in your favor. Regular physical activity along with modest weight loss have been shown to lower type 2 diabetes risk by 58 percent in high-risk populations, according to a joint position statement by The American College of Sports Medicine and American Diabetes Association. Physical activity causes active muscles to pull glucose from the blood to burn for fuel. Benefits are immediate. A single session of moderate physical activity for 30 minutes increases insulin action and glucose tolerance for more than 24 hours. A week of five 30-minute sessions can improve whole-body insulin sensitivity in people with type 2 diabetes. The effects are similar whether activity is done in one 30-minute session or two or three sessions totaling 30 minutes.
Resistance exercise with free weights, Therabands or weight machines also helps with glucose control, according to the joint statement. A randomized controlled trial showed that resistance training for 16 weeks resulted in a 46.3 percent increase in insulin action and a 7.1 percent reduction in fasting blood glucose levels for older men with type 2 diabetes. Resistance exercise should be done at least twice a week on nonconsecutive days.
Ideally, aerobic exercise should be included, too — pushing your chair, swimming, hand cycling or using an arm ergometer, doing seated aerobics, etc. Thirty-minute sessions at moderate intensity, (40-60 percent maximum heart rate) for at least three days a week (ideally five) are recommended.
Talk with your doctor about heart or blood pressure medications you may take before starting an exercise program. For instance, beta blockers (high blood pressure medication) are known to lower heart rate response and maximum heart rate. Your doctor can help you adjust your target heart rate accordingly.
Theo Braddy 57, a C4-5 quad for 42 years, found out the hard way how serious type 2 diabetes can be. Over the years Braddy had put on 50 pounds. He was so focused on his work that he wasn’t paying attention to his diet, drinking lots of sugary sodas or juice with high sugar content.
Three years ago, Braddy’s doctor told him his sugar levels were high and he had to watch his sugar intake. “But I didn’t make the connection that I was heading toward diabetes. I didn’t know how serious it was,” he recalls. Six months later he became extremely fatigued, like he had a UTI, and was constantly thirsty, so he doubled up on sodas. “It got so bad I went into a sort of brain fog for two days. On the second day I woke up and my vision was blurry, so I went to the emergency room. The doctor said I have diabetes and my glucose levels had become so high I was in a waking diabetic coma. I was close to death!”
He was put on insulin and got serious about exercise and nutrition. “Now I eat a breakfast with little to no carbs, a mid-morning snack, a light lunch, mid-afternoon snack and sensible dinner. For exercise, I do 10-15 minutes every day on an arm ergometer (table mounted stationary handcycle) or hit a heavy punching bag, which is my favorite. I pull my power chair up to it and go to town — at my injury level I only have shoulder and biceps control, no triceps, but that’s enough to work the bag.”
Within six months of his healthier lifestyle he was able to get off of insulin shots, and now controls his diabetes by taking one pill a day. His insulin levels are stabilized, so he went from doing a blood-glucose finger-prick test five times a day to only one each morning.
“If I had known how serious this is, I would have started eating right and exercising the moment I heard my sugar levels were elevated,” he says. “People need to be aware of their blood sugar levels. If you catch rising blood sugar early, you can take steps to manage it before crossing the threshold into diabetes.”
- Diabetes and Spinal Cord Injury: Prevention and Treatment: craighospital.org/resources/diabetes-and-spinal-cord-injury-prevention-and-treatment
- Diabetes and Obesity: www.diabetes.co.uk/diabetes-and-obesity.html
- Diabetes and SCI: Control Your Carbs and Exercise: newmobility.com/2016/10/diabetes-and-sci/
- Exercise and Type 2 Diabetes: ncbi.nlm.nih.gov/pmc/articles/PMC2992225/
- Spinal Cord Injury and Type II Diabetes: ncbi.nlm.nih.gov/pmc/articles/PMC3821709/
- Target Aerobic Heart Rate: heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/Target-Heart-Rates_UCM_434341_Article.jsp#.WftsELaZNjt
- Weight Management and target weight for people with SCI: unitedspinal.org/resource-center/askus/index.php?pg=kb.page&id=2422