
July 31, 2004
Hyperglycemia and DKA
Question from Australia:
As I understand it, ketoacidosis is the big problem with elevated blood sugars. I am a reasonably healthy male and do not believe that I should be a slave to the big “D”. I go to the gym and carry on a small business, amongst other activities. I inject insulin three times a day.
Occasionally, I fall off the “straight and narrow” and sometimes discover that my blood sugar is 15 mmol/L [270 mg/dl]. Surely some research has been done to minimize the bad effects of ketoacidosis? Is there any drug, herb, food type that would minimize the effects?
Answer:
Ketoacidosis is the decompensated state associated with insulin deficiency. Mortality for the condition has now fallen to less than 1%. It should be looked at as the acute risk of poor glucose control. However, it is not the only acute risk. It may not be the most significant risk, as the microvascular complications can be even more devastating and are related to chronic high blood sugar control. When acute high blood sugar control occurs, it is not necessarily suggestive of chronic complications as these are tightly associated with the A1c. The big deal is not to get too up tight with a few bad readings, but to use the information to buckle down and make things better with a better long-term goal, as reflected in the A1c, in mind.
When diabetic ketoacidosis (DKA) occurs, hospitalization is required. Intravenous insulin, fluids, and treatment of any underlying infection or medical problem is required. When diabetic ketoacidosis occurs as a result of a severe medical emergency, such as infection, trauma, etc., the outlook is tied to the treatment of the underlying medical problem. As physicians, we are always looking for the precipitating cause of the ketoacidosis. Unfortunately, DKA is often caused by poor compliance with therapy is preventable.
JTL