Orange Juice to the Rescue: A Case Report of Concussion Recovery Complicated by Type 1 Diabetes Mellitus in a Pediatric Patient.

Case Diagnosis: A 17-year-old female with newly diagnosed Type 1 Diabetes Mellitus (T1DM) presented to the emergency department after a motor vehicle collision with loss of consciousness for less than 30 minutes and a Glasgow Coma Scale score of 15.

Case Description or Program Description: Presenting symptoms were mid-thoracic back pain and headache. On day two, post-injury, she endorsed memory difficulties, mild headache, fatigue, and neck pain. On exam, she had mildly symptomatic vestibular ocular reflexes and poor delayed recall testing but demonstrated intact strength and sensation without evidence of post-traumatic amnesia. Computed tomography imaging of the head was unremarkable, but spinal imaging showed fractures of the L5 vertebral superior endplate and L2-4 transverse processes. Physiatry ultimately diagnosed her with a mild traumatic brain injury (mTBI).

Setting: Academic Outpatient Pediatric Physiatry Clinic

Assessment/Results: When the patient returned for her one-week concussion follow-up, she reported ongoing daily headaches, fatigue, and neck pain. Review of systems was notable for nightly hypoglycemia in the 40s. At this visit, her blood glucose was 64, orange juice was administered accordingly. On request, a pediatric endocrinology provider evaluated the patient in our concussion clinic to coordinate real-time insulin adjustments and arrange close follow-up.

Discussion (relevance): This patient’s concussion recovery was complicated by age, language barrier, and a recent diagnosis of T1DM. Cognitive symptoms of mTBI, such as working memory and attention deficits, can be worsened by hypoglycemia, increasing the risk of poor glycemic control due to challenges with dietary and insulin management. Additionally, mTBI symptoms like headache and irritability can overlap with hypoglycemia. Thus, glucose management became the focus of this encounter for mTBI follow-up.

Conclusions: By taking a holistic approach to her care, our team identified an issue that could have been detrimental to her mTBI recovery and overall health. This case highlights the importance of person-centered rehabilitation and multidisciplinary care coordination to optimize patient outcomes.