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- Sun Jul 25, 2010 10:34 am
My friend has been hospitalized in ICU due to his blood sugar being over 550. The have gotten it down to 200 but it is unstable and is now back over 400. He is a normally healthy person and not a diagnosed diabetic. Not obese. He was in a motorcycle accident 2 months ago. Could undetected pancreatic injury be a cause?
| Dr.M.Aroon kamath
- Tue Jul 27, 2010 6:06 am
Trauma to the pancreas is usually due to two types of injuries namely,
- blunt abdominal trauma and
- penetrating abdominal trauma.
Pancreatic injury following trauma is unusual, and there are few data regarding the long term outcomes. Actual incidence of trauma-induced endocrine and exocrine pancreatic dysfunction is largely unknown.Of the few cases reported, most had occurred months or years following the trauma.
In trauma patients, whose pancreas is removed to varying extents, exocrine or endocrine insufficiency has been noted to be rare and usually occurs only in patients when >80-90% of the pancreas is removed. In low-grade pancreatic injuries treated nonoperatively, the remaining pancreatic tissue usually can regain its normal physiology regardless of trauma-induced parenchymal damage.The pancreas seems to have a good functional reserve.
It is possible that exocrine or endocrine deficiencies may be expected to occur if the injured pancreas is already diseased(ex;chronic pancreatitis). Smaller resections in these cases may have the potential to cause these deficiencies.Relative pancreatic insufficiency may also occur and should be considered if symptoms of altered glucose hemostasis or malabsorption manifest following the injury.
Development of diabetes mellitus(DM) has been reported in the literature following blunt trauma induced acute hemorrhagic pancreatitis. Post -traumatic interstitial fibrosis of the pancreas leading to strangling of the trapped islet tissue has been postulated as the causative factor.Milder forms of post-traumatic pancreatitis have not been reported to cause DM.
I could find only one case report in the Can Med Assoc J of 1952 August; of a trauma patient who presumably developed diabetes acutely following abdominal trauma.
Can Med Assoc J. 1952 August; 67(2): 143–144.
Some reports of DM in patients undergoing 'necrosectomies' for necrotizing pancreatitis have been reported(although not in the context of trauma).
The high glucose levels seen in your friend's case should be interpreted with caution.There are many variables in ICU patients that can affect the blood glucose levels.
I hope this information is of help to you.
| Dr. A. Rajput
- Sat Jul 31, 2010 12:34 pm
In your friend's case, both accident and diabetes seem to be different events and seem unrelated.
Blood sugars do fluctuate a lot in initial stages when diabetes is diagnosed. Insulin/drugs are to be titrated initially. Hope he is well. His blood sugars will become normal eventually with proper treatment with insulin/drugs.