Challenges in Recovery: Swallowing and Mobility Issues Post-Diabetes ICU Care

After being admitted to the intensive care unit for diabetes and extubated from the ventilator, the patient is unable to swallow and lacks voluntary movement?

Hello Doctor,
My father was hospitalized in January 2018 due to diabetic ketoacidosis (HbA1c 14).
A few days later, he developed pneumonia and was admitted to the intensive care unit, where he was intubated.
The physician determined that he would not be able to breathe independently in the short term, so a tracheostomy was performed.
He was weaned off the ventilator in May 2018 (the tracheostomy tube has not been removed yet) and has been receiving home care since the end of May.

During the course from illness to home care, although he can breathe independently, he has been found to have difficulty swallowing and walking, and he cannot control his bowel and bladder functions.
Therefore, he has been undergoing rehabilitation (physical and speech therapy).
X-rays and MRIs have been performed, and there are no embolisms in the brain.
A swallow study revealed weakness in the throat muscles, which affects his swallowing ability.

After researching, I found a condition called "critical illness polyneuropathy." I am unsure if this is what my father is suffering from.
If so, which department should we consult (we are located in central Taiwan)? Besides rehabilitation, what other treatments could help my father recover? Thank you.

Mr. Hong, 30~39 year old female. Ask Date: 2018/10/08

Dr. Hong Weibin reply Neurology

Your father may be suffering from Critical Illness Polyneuropathy, but it is also possible that he has Diabetic Polyneuropathy due to poorly controlled diabetes.
Additionally, it is important to be cautious about potential neuromuscular junction disorders or certain autoimmune diseases that can produce antibodies attacking the body's own tissues, leading to generalized weakness.
Currently, for such conditions, it is advisable to focus on good blood sugar control and to incorporate rehabilitation.
For diagnosis, seeking assistance from a neurologist is recommended; however, it is currently suggested to consult a specialized rehabilitation physician for appropriate rehabilitation arrangements.
Furthermore, in terms of nutrition, consulting a dietitian to ensure adequate protein intake can help promote muscle growth.

Reply Date: 2018/10/08

More Info

The challenges faced by your father following his hospitalization for diabetic ketoacidosis and subsequent complications are significant and multifaceted. It is not uncommon for patients who have experienced severe illness, particularly those requiring intensive care, to encounter issues with swallowing, mobility, and overall functional recovery. These challenges can be attributed to a combination of factors, including prolonged immobility, the effects of critical illness on muscle function, and potential neurological complications.

Your father's inability to swallow and walk, as well as his issues with bladder control, are indicative of the profound impact that critical illness can have on neuromuscular function. The condition you mentioned, Critical Illness Polyneuropathy (CIP), is indeed a possibility. CIP is characterized by weakness and sensory loss due to nerve damage that can occur after prolonged stays in intensive care. This condition is often exacerbated by factors such as prolonged mechanical ventilation, sepsis, and metabolic disturbances, all of which your father experienced.

In addition to CIP, it is essential to consider the possibility of diabetic polyneuropathy, which is a common complication of poorly controlled diabetes. This condition can lead to nerve damage, resulting in weakness, numbness, and difficulties with coordination. Given your father's history of diabetes and the high hemoglobin A1c level (14), it is crucial to manage his blood sugar levels effectively to prevent further complications.

To address your father's recovery, a multidisciplinary approach is recommended. Here are some steps you can take:
1. Neurology Consultation: Given the symptoms of weakness and swallowing difficulties, a consultation with a neurologist is advisable. They can evaluate for any underlying neurological conditions and provide guidance on further diagnostic testing if necessary.

2. Rehabilitation Services: Continuing with rehabilitation services is crucial. Physical therapy can help improve mobility and strength, while occupational therapy can assist with daily living activities. Speech therapy is particularly important for addressing swallowing difficulties. A speech-language pathologist can conduct a thorough assessment and develop a tailored plan to improve swallowing function.

3. Nutritional Support: Proper nutrition is vital for recovery, especially in patients with swallowing difficulties. Consulting with a registered dietitian can help ensure that your father receives adequate nutrition, potentially through modified diets or enteral feeding if necessary.

4. Blood Sugar Management: Close monitoring and management of blood glucose levels are essential. Collaborating with an endocrinologist or diabetes educator can help optimize his diabetes management plan, which may include adjustments to insulin therapy and dietary modifications.

5. Home Health Care: If your father requires assistance with daily activities or medical care at home, consider engaging home health care services. This can provide support for medication management, wound care, and assistance with rehabilitation exercises.

6. Family Support and Education: Educating yourself and your family about your father's conditions and recovery process can empower you to provide better support. Understanding the signs of potential complications and knowing when to seek medical attention is crucial.

In summary, your father's recovery from the effects of critical illness and diabetes-related complications will require a comprehensive and coordinated approach involving multiple healthcare professionals. By addressing the neurological, nutritional, and rehabilitative aspects of his care, you can help facilitate his recovery and improve his quality of life. It is essential to maintain open communication with his healthcare team and advocate for the necessary resources and support to aid in his rehabilitation journey.

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