Misinformation - What A Pain

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1

I'm so happy to hear Bret Michaels is out of the hospital, but troubled by some of the reports. Specifically, that there was something about the Celebrity Apprentice contestant's type 1 diabetes that kept him from getting pain relief.

I'd never heard diabetes can interfere with pain relief and, as a mom of a little boy with type 1, it made me worry. What happens if Benny - heaven forbid - ever needs that kind of help? Will he have to suffer?

Here's what I read in People Magazine:

"In addition to the side-effect hyponatremia, which can lead to seizures (Michaels's doctor said he has not had any), the rocker has been suffering from back pain and increased spasms – because as a diabetic, he has not been able to take certain medications. (Doctors say they'll) usually give patients steroids to lessen the pain but they can also "make glucose levels go out of control so unfortunately [Bret has] had to suffer."

I know, it's People - not the Journal of the American Medical Association - but millions of people will see it and take it at face value. I read the same thing in some other publications and in blogs, so I emailed my fabulous pediatric endocrinologists for their take.

Dr. Mark Vanderwel wrote back:

"The only thing I can think of which could even remotely limit pain relief is if he already has microvascular complications from poorly controlled T1DM, but even then I don’t know how this would limit pain relief.

If you’re talking about glucocorticoids like prednisone or hydrocortisone, the answer is yes, if absolutely needed. Glucocorticoids will cause significant insulin resistance, and people with type 1 may find that they need to double or more their insulin doses while on glucocorticoids."

But Dr. V was clear, there is no reason to assume that type 1 diabetes means pain can't ultimately be treated.

His associate, Dr. Mark Parker's response was a little more direct. I can't print his actual wording (this is a family blog) but he called the report erroneous and mistaken. Just with more, um, colorful language.

Did I mention I love my docs?

2

It is likely that the report is erroneous. But sometimes we will be faced with very rational decisions. Do we want instant relief with the side effect of loosing any chance to control our glucose levels for one week? This is true for cortisone or glucocorticoids like your doctor wrote. It is not like people have to suffer but if the situation is bearable it is good to have a choice. He is a rocker so he prefered the pain.

3

Steroids are a nightmare for someone with T1, but that doesn’t always preclude their usage. My personal experience with steroids is that their claimed benefits are almost never ultimately worth the hassle they cause.

4

I had to use cortisone for a week last year, and it did not change THAT much my bs levels. But then again, i am type 2.
On the other hand, i am happy for Brett’s recovery really:)

5

Sounds to me like either the reporter got it wrong, or the doctor who spoke to the reporter was out of his depth when it came to managing the pain & diabetes simultaneously. Or both.