Mayor Thomas M. Menino’s diabetes -- disclosed during a news conference Monday when he was transferred to a rehabilitation hospital -- was likely triggered by the multiple medical problems he had when he began a month-long stay at Brigham and Women’s Hospital in October, one of his doctors said Tuesday.
Dr. Charles Morris, an internist at the Brigham who helped treat the mayor, said via e-mail that the mayor entered the hospital with an elevated blood sugar level that he believes was exacerbated by the “stress of being sick.” High blood sugar is an indicator of diabetes.
He added that it’s “not common” to develop diabetes in the hospital, and that the condition most likely explains why an infection developed in Menino’s back near a compressed backbone in his lower spine, which extended his hospital stay.
The mayor was hospitalized Oct. 26 with an upper respiratory infection and a blood clot in his lung -- which ordinarily takes five to seven days to treat, according to published research -- but his stay was prolonged by a series of gradually unfolding events, including back pain that initially improved and then worsened, requiring further diagnostic testing, Morris said.
“That testing indicated evidence of an infection in the back, for which he required initiation of antibiotic therapy,” said Morris. “Once we were confident he had improved enough from all of these issues, we felt comfortable transferring him to a rehabilitation hospital.”
While the mayor had been taking steroid medications to reduce intestinal inflammation caused by his Crohn’s disease, Morris said that most likely the drugs, which can raise blood sugar levels, didn’t contribute to the diabetes diagnosis.
Menino’s obesity put him at greater risk of developing type 2 diabetes, as well as the blood clot in his lung that cut short a vacation to Italy with his wife. “Obesity contributes to an increased risk for a number of medical problems and complicates medical problems that someone already has,” said Dr. Amanda Powell, an obesity medicine physician at Boston Medical Center.
Dr. Allison Goldfine, an endocrinologist and head of clinical research at the Joslin Diabetes Center, said “diabetes can develop between medical visits, and it’s usually a pretty long progression. Stresses like acute medical illness or medications can unmask the disease, but usually in people who already were beginning to show signs of high blood sugar levels.”
An estimated 6 to 8 percent of adult Americans have type 2 diabetes, and the American Diabetes Association recommends that all adults age 45 and older get a routine blood test every three years to measure their sugar levels. Those at increased risk because they have a family history, high blood pressure, or are overweight should check with their doctor about getting screened for diabetes earlier and more frequently.
Morris didn’t discuss what treatment Menino was getting for his diabetes, but most likely it will include recommendations to change his diet and increase his exercise.
Menino was taken by ambulance to Spaulding Rehabilitation Hospital, where spokesman Timothy Sullivan said physicians have not yet mapped out a program for Menino. But most patients leaving a hospital after several weeks receive both physical and occupational therapy to help them regain strength. The mayor lost a considerable amount of weight in the hospital, much of which may be lost muscle mass from being bedridden.