June 8, 2002
Hyperglycemia and DKA
Question from Brisbane, Australia:
I am a concerned mum after hearing that a year 12 student recently died from severe diabetes since I have never heard this term used before. Could you explain the differences between type 1 diabetes and severe diabetes, if there are any?
The terms ‘severe’ and ‘brittle’ are euphemisms for situations in which the diabetes has been difficult to control and do not imply specific forms of diabetes.
In Australia, by far the great majority of children and adolescents have type�1A (autoimmune) diabetes which is insulin dependent. It is due to a disorder of the immune system in which some of the white blood cells destroy specific tissues that are ‘self’ over many years. In the case of autoimmune diabetes, these are the beta cells in the pancreas.
About 5% of Caucasian children have type�1B diabetes. The cause is not yet well understood and eventually insulin may not be needed for control.
The most likely explanation of the case you describe is that in a new onset case some acute infection precipitated DKA [diabetic ketoacidosis] in which cerebral oedema developed. This is a complication that is often not recognised and appropriate treatment is not begun early enough so that the outcome is often fatal.