Question: My 41-year-old son was born with cerebral palsy and does not walk or talk. His last blood test had a glucose reading of 167, and his hemoglobin and hematocrit were a little high. What should I be doing to stave off anything bad?
Dr. Hibberd's Answer:
Your son deserves the same preventive advice anyone without cerebral palsy has come to expect. Vascular disease and cardiovascular disease are accelerated by inactivity. His elevated glucoses will lead to accelerated vascular disease and its complications, which include vision loss, stroke, heart attack, and renal failure.
It makes sense to address his blood glucoses and treat his condition. He needs more evaluation to diagnose whether he is diabetic or prediabetic. A fasting glucose of 126 or more will confirm diabetes while a fasting of 100 to 110 will be seen as prediabetic. A HbA1C blood test will establish his level of glucose control over the past three months and help guide your treatment.
Simple dietary measures such as avoiding concentrated sweets, and eating a diet high in fiber and low in fat may be recommended by your dietician whose advice will be guided by the American Diabetic Association. These steps and limiting calories (often 1,800 or 2,400 calories daily) will help, and a simple medication regimen may be all he needs.
His elevated hemoglobin and hematocrit may require intervention depending on whether or not the cause can be determined. Polycythemia (hemoglobin over 18) does have some increase risk for stroke, and sometimes your hematologist may advise periodic phlebotomy or medications to keep the blood cells from increasing to a point where they may decrease free flow of nutrients to the small vessels of brain and other sensitive tissues.
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