Disclosures: Sh’Rae E. Marshall: No financial relationships or conflicts of interest
Case Description: A patient with a long history of Type 1 diabetes mellitus (T1DM) sustained traumatic tetraplegia at age 29 complicated by ventilator dependence, cardiac arrests, acute respiratory distress syndrome (ARDS), and a stage 4 sacral pressure ulcer. On day 181 following the injury, the patient had an episode of Autonomic Dysreflexia (AD) in the setting of prolonged supine lying on a stage 4 ulcer. Features of this episode included hypertension, headache, diaphoresis, and altered sensorium. At that time, the patient’s blood glucose (BG) level was 598, substantially increased from the preceding BG level of 242. The patient was subsequently given topical Nitroglycerin, and 10mg of bite/swallow Nifedipine. The patient was also given 24 units of Aspart Insulin, which was individually ordered and out of typical range for this patient.
Setting: Acute Rehabilitation Center
Patient: 29 year old male; C3 ASIA Impairment Scale (AIS) A tetraplegia Assessment/
Results: Prior to his injury, the patient had inconsistent BG management and poor follow up with Endocrinology. His hemoglobin A1C (HgbA1c) was 6.8 7 days prior to the episode of AD and his BG level had never previously exceeded 350. The patient’s unprecedented elevation in BG, coincident with the episode of AD suggests a likely association.
Discussion: AD is a syndrome involving an exaggerated catecholamine response which favors elevated BG. This presentation included loss of BG control in a difficult to manage diabetic patient. There is a paucity of literature that describes AD and the concomitant exacerbation of hyperglycemia in a spinal cord injury (SCI) patient with T1DM. Taken together, this case indicates hyperglycemia should be considered as a part of the syndrome of AD.
Conclusion: Clinicians must recognize the mutual influence of AD and BG in the management of SCI patients with T1DM.
Level of Evidence: Level IV
To cite this abstract in AMA style:
Marshall SE, Ankam NS, Pendleton JC. The Mutual Influence of Autonomic Dysreflexia and Blood Glucose in the Management of Spinal Cord Injury Patients with Type 1 Diabetes [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/the-mutual-influence-of-autonomic-dysreflexia-and-blood-glucose-in-the-management-of-spinal-cord-injury-patients-with-type-1-diabetes/. Accessed May 9, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-mutual-influence-of-autonomic-dysreflexia-and-blood-glucose-in-the-management-of-spinal-cord-injury-patients-with-type-1-diabetes/