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September 19, 2002

Hyperglycemia and DKA

Question from Australia:

I am a support worker with people with intellectual disabilities, and I have a 33 year old client with type 1 diabetes whose blood sugar levels are very erratic. Throughout any one day, her levels can range about 3-32 mmol/L [54-576 mg/dl] with readings of 10-20 mmol/L [180-360 mg/dl] being most common. Although her food intake is monitored closely she will, if given the chance, steal food which she should not eat (cake, sugar, etc.). When she does, her high blood sugar can be explained, but there are times when I am certain she as not eaten anything that she is not allowed and her blood sugar level is still high. (Unfortunately, she can be very furtive.) Is there any other reason, apart from the wrong food, which will send blood sugar levels high? I have cross-referenced all her medication for possible interaction and found that this is not a factor. Your thoughts would be appreciated.

Answer:

With type 1 diabetes, not enough insulin would be a reason for her high sugars. In between meals, the liver puts out glucose. This originally was to protect the brain from lack of food between meals. However, in diabetes, this metabolic function is abnormal and too much glucose is exported from the liver. In addition, you can have an intermittent illness markedly increase her insulin resistance and raise her sugars. Finally, keeping track of her food intake sounds like it would be problematic.

JTL