Diabetes and Work Injury: The Impact on Treatment and Recovery

Diabetes usually does not influence any necessary treatment decisions for injuries. Steroids, by injection or orally, will transiently make diabetes worse, but diabetes does not preclude the use of this medicine. Some diabetics with diabetic kidney disease are advised to not use NSAID’s (Advil, Aleve, etc) but other options exist in those situations. Some elective treatments can be delayed if diabetes requires better control.

Recovery from an injury is more difficult to determine or predict as many different variables must be considered and each situation individually reviewed. Some injured workers develop illness from work, COVID-19 being one of many examples. Diabetics, especially those with obesity, have a much higher risk of complications with an increase in morbidity and mortality. 

Wounds (cuts, abrasions, puncture wounds) can take longer to heal often due to poor local blood flow from small vessel disease (microvascular disease) or more advanced peripheral vascular disease, both more common in diabetics. The more typical musculoskeletal injuries (soft tissue strains/sprains) are not as likely to be impacted from diabetes directly. Many diabetics have some degree of obesity and often that is accompanied by poor muscular strength and health (a deconditioned status) so recovery, indirectly, can be delayed for those reasons.

The preexisting condition of diabetes does not usually influence disease or injury causation determination.  Sometimes it explains the problem that can be diagnosed in error as a work injury.  I recently completed an IME on a person with accepted fractures of two metatarsal (foot) bones, but those fractures, in actuality, reflected complications of diabetes (diabetic neuroarthropathy, Charcot’s foot).  I review, not uncommonly, work injury claims of a blister from shoes, boots, or just walking at work, and an infection that follows, and I have seen that accepted in some cases. Those cases usually are a diabetic pressure ulcer, and ulcers would never follow a basic friction blister that is superficial.

Question:

Can a preexisting condition of diabetes be worsened by a worker's exposure to workplace stressors? 

Answer:

Acute severe stress events will cause a spike in blood sugar but only temporarily.  This can be seen with severe pain from injury or severe illness.  General workplace stress however is quite different, and that would not cause an established diabetes condition to worsen. 

Dr. Daniel Mangum, D.O., is an internal medicine specialist in Portland, Oregon and has over 36 years of experience in the medical field. He received his medical degree from College of Osteopathic Medicine of the Pacific and has been in practice for more than 20 years.

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A Previous "Ask the Doctor" Response
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