April 5, 2004
Hyperglycemia and DKA
Question from Indianapolis, Indiana, USA:
I am a brittle diabetic and take two types of insulin. I take six units of Humalog prior to each meal and 30 units of Lantus at bedtime. Two weeks ago, I had a steroid injection in my spine due to herniated discs. This has caused my blood sugars to be extremely high and I am wondering if and at what point I should go to the emergency room. My family physician told me to double my Humalog and increase Lantus by 10 additional units. I have been doing this for four days. Last night, my blood sugar was 515 mg/dl [28.6 mmol/L] and I have traces of ketones in my urine. My doctor says merely to increase my Lantus by another four units to 44 units of Lantus at bedtime. My sugars have been running in the mid 300s to 500s (mg/dl [about 18.0 to 29 mmol/L] for two weeks now and I wonder if I should go to the emergency room and at what point. What can they do at the emergency room that I can’t do at home?
Answer:
Given your concern, I would consider evaluation in the ER as soon as possible. The effect of the steroids is generally 48 to 72 hours with epidural injections. This appears to be something else. I would definitely discuss this again with your physician and insist he/she should see you ASAP, if not, you should seriously consider an ER visit to determine the cause of this.
ABS
