I am a school nurse with a newly diagnosed 17-year-old diabetic female. She went into DKA before she was diagnosed. She has now gained approximately 20 pounds, but it is fluid retention. The doctors have said its from receiving so much insulin. Does that sound right? I’ve never seen this happen before. She has fluid retention in her feet, legs, arms, abdomen, and face. Along with dealing with her diabetes, she has to deal with this! It deems as though there has to be some other cause or something to help. She’s already talking Lasix, 40mg daily. Any ideas?

It is somewhat rare but well described. This usually occurs in patients – kids, teens, adults – with new onset type 1 diabetes who have had some diabetes symptoms for quite some time and then, when insulin is begun, life-saving, the body re-adapts. The good news is that you can advise that the fluid retention is usually temporary unless there has been some permanent damage to the kidneys during initiation of DKA management. It is not usually mismanagement, but again prior hyperglycemic damage to the kidney functioning. Under most circumstances, cutting back on salt intake and diuretics seems to work reasonably well – but it may take several days to several weeks. I suggest you talk directly to the diabetes team working with her to get their input and give you more specific advice so that you will best know how to support her while she re-adapts to school.

SB