Can trauma precipitate the onset of Diabetes Mellitus?

This Month’s Question:
Can trauma precipitate the onset of Diabetes Mellitus?

MD Consulting Services Answer:
Recently we have been asked to consult on three separate cases in which the attorney’s client was injured in an accident resulting in the same medical damage in the case. Although these three clients were involved in very different accidents, all three of these clients developed Diabetes Mellitus (DM) shortly after having sustained multiple traumatic injuries which had nothing to do with the clients’ pancreas.

Diabetes Mellitus is a condition in which a person has a high blood sugar (glucose) level, either because the body doesn’t produce enough insulin, or because body cells don’t properly respond to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb glucose and turn it into energy. If the body cells do not absorb the glucose, the glucose accumulates in the blood (hyperglycemia), leading to vascular, nerve, kidney, heart and other complications.
There are two main forms of DM. The first kind is called Type 1 diabetes and results from the body’s failure to produce insulin, and presently requires the person to inject insulin. The second kind of DM is called Type 2 diabetes and results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.
In our first case while shopping, a rack of household items weighing approximately 700 pounds fell on the client when an employee lost control of the rack. The client sustained serious injuries to her spine and back.
The client was diagnosed with Type 1 Diabetes Mellitus approximately two months after the accident. The diagnosis was made when the client presented to the hospital in diabetic ketoacidosis requiring an ICU hospitalization. Diabetic ketoacidosis is a complication of diabetes that occurs when the body cannot use sugar as a fuel source because the body has no insulin or not enough insulin, and fat is used instead. Byproducts of fat breakdown, called ketones, build up in the body. The build up of ketones can lead to severe illness or even death. The client is now insulin dependent and her blood sugar, despite a great deal of diligence, is only moderately controlled.
In another case, on a January night while walking home a man fell into an approximate 5-foot-deep hole at a construction site. There were no fences or warning signs that there was a hole and the hole was unprotected for passersby. The client lost consciousness and was trapped in the hole for about 10 hours. His core temperature when found was 61° F. It was something of a miracle he survived at all. From the first emergency room visit until the present, the client has had elevated glucose levels and has been diagnosed with Type 2 DM.
The cause of Diabetes Mellitus is unknown, however, there is ample evidence in the medical literature that in individuals with a predisposition or a susceptibility to DM, trauma can provoke the onset of the disease. The literature states the trauma can be physical or emotional and in both of the cases mentioned, physical and emotional trauma were sustained.

It is known that these susceptible individuals have latent diabetes or a heredity predisposition that changes DM to an active form of Diabetes Mellitus following trauma.
Both clients had a predisposition to developing DM. One medical journal article states “to prove that trauma is the cause of diabetes in any individual case evidence must be at hand to show (a) that the disease did not exist before the trauma (b) That the trauma was severe (such as but not limited to injuring the pancreas) (my addition in italics) (c) That the symptoms and signs of the disease developed within a reasonable period following the trauma (d) That the symptoms and signs of diabetes were not transitory but permanent.”
Another journal article states “after discussion with university endocrinologists and diabetologists, a consensus exists that, viewed in retrospect, non-clinical latent diabetes mellitus became clinical Type 1 diabetes approximately 3 weeks after an industrial accident. Therefore, viewed in the context of sub-clinical versus clinical disease, it seems equally likely that the work-related injury was important in precipitating the disease. Notwithstanding the theoretical claims, we would affirm that the injury gave rise to his illness.” This paper was referring to Type 1 diabetes, however, this theory holds true for Type 2 diabetes as well. There are several other medical journal articles that support the theory that trauma can induce DM.
It is our suggestion that in all cases of severe trauma attorneys should look for reports in the medical records stating the client developed either Type 1 or Type 2 Diabetes Mellitus or it is reported that the client has developed persistent elevated blood glucose levels or an elevated A1c not previously found.

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