The Relationship Between Trauma and Diabetes
Introduction
Diabetes mellitus (DM) is a medical condition which affects the way someone’s body makes and uses insulin. It is a disease which develops when the blood glucose levels rise above the normal limits [1].
Insulin normally acts as a catalyst which helps accelerate movement of blood glucose into the cells; diabetes will develop when there is no body response or poor functioning of insulin [2].
Although our understanding of the causes of diabetes remains unknown, we do know that the condition is preceded by the body’s own immune system attacking and killing the beta cells in the pancreas that are responsible for insulin production. (Note: Individuals can have a predisposition to developing diabetes, and external factors like the environment and lifestyle also contribute to its development.)
In some cases, injury (i.e. trauma) has been shown to make the functionality of insulin abnormal, leading to the development of diabetes. However, even with increased knowledge and awareness of the disease, there is still a lot we can learn about the development of diabetes following injury or illness.
This article will explore how trauma and diabetes are related.
Defining Trauma
To understand how trauma can impact our health, we must first define it.
Trauma is the Greek word for “wound”. While the Greeks used the term primarily for physical injuries, trauma can also refer to emotional wounds [3] or an emotional response resulting from events that one has experienced, such as accident, sexual abuse, or a natural disaster [4]. A person may experience trauma as a response to any event they find physically or emotionally threatening or harmful [5].
There are several types of trauma, including [6]:
- Acute trauma: Resulting from a single stressful or dangerous event.
- Chronic trauma: Resulting from repeated exposure to stressful events. This can include cases of abuse, bullying, or domestic violence.
- Complex trauma: Resulting from exposure to multiple traumatic events.
Secondary trauma, or vicarious trauma, is another form in which a person develops symptoms from close contact with someone else who has gone through a traumatic event [7].
There are many reasons why an individual might experience any of the forms of trauma above, including (but not limited to) physical trauma such as accidents, experiencing a natural disaster, prolonged drug use, psychological stress, and abuse.
Relationship Between Trauma and Diabetes
The type of trauma experienced is related to both the mechanism by which the disease manifests, as well as how likely it is for someone to develop diabetes. It’s important to note that while instances of stress or trauma have been correlated with a diabetes diagnosis, there are other more salient factors that put someone at risk. In particular, family history of diabetes and lifestyle behaviors are important risk factors.
Let’s look at three types of trauma and how they impact us.
High Stress Levels
During stressful situations, the body produces high amounts of the hormones cortisol and adrenaline. Excess of these hormones makes it difficult for insulin uptake in the body to occur, leading to insulin resistance [8].
Additionally, high levels of stress hormones can cause insulin-producing cells to stop functioning properly, resulting in decreased insulin levels. As a result, blood glucose levels rise. Sustained high levels of blood glucose over time leads to diabetes.
Physical Trauma
Physical trauma, critical illness (ex: hemorrhage, sepsis, etc.), or injury (ex: burn) have been shown to cause acute insulin resistance and hyperglycemia [9]. This limits the ability of cells to uptake glucose, leading to increased levels of sugar in the blood. The exact mechanisms by which this happens are not entirely clear - they are complex and have multiple causative pathways. Additionally, physical trauma to the pancreas and liver themselves can impact insulin production and result in acute insulin resistance.
For individuals who are in critical condition or have experienced a physical trauma, intensive insulin treatment (administered in a hospital setting) has shown to decrease mortality and morbidity [9]. More research is being done in this field to better understand the effects of this treatment.
Early Childhood Trauma
Children are an incredibly vulnerable group as far as trauma-induced diabetes is concerned, as their brains are still developing and handling stressful situations can be very difficult. Research indicates that stressful events or life crises can “triple the risk of children developing type 1 diabetes” [10].
When a child experiences stressful conditions or traumatic events, their autoimmune response is triggered. These events cause their bodies to respond very aggressively by releasing hormones in relation to the fear and stress they are experiencing. If a young person copes with this stress through drugs or self-medicating, they could also damage their body’s ability to produce or use insulin effectively.
Of course, stressful life events are unavoidable. The most important thing is to seek adequate support from a professional to cope with these events and avoid any potential consequences [11].
Wrapping Up
The expanding research on the subject has uncovered mechanisms by which trauma - both acute and chronic - can lead to the development of diabetes. Research has focused on understanding how trauma affects our bodies, how much it increases our risk, and how we can address the impact of trauma through medications and lifestyle changes. Understanding this relationship is difficult - to show that trauma is indeed the cause of diabetes in any individual case, the evidence must show that the disease did not exist before the trauma, that the symptoms and signs of the disease developed within a reasonable period after the trauma, and that the effect was not transitory.