February 20, 2010
Hyperglycemia and DKA, Other
Question from Paris, France:
I recently needed hospital treatment for an abscess at an old pump site. Whilst waiting for the operation, I was instructed to remove my pump, which I did. The operation was then unexpectedly delayed so I had no insulin at all from 6 a.m. until 3.30 p.m. During this period, I also had nothing to eat or drink, but received some glucose via drip. As I would have expected, my sugars rose but then stopped rising at 15 mmol/L [270 mg/dl] and stayed around there for some hours. Why did this happen? The nurses had been instructed to give me insulin if my sugar went over 20 mmol/L [360 mg/dl], which it never did, I finally insisted they give me some as I believed ketoacidosis could be occurring after that long without insulin regardless of my sugar readings. Was I right or worrying unnecessarily?
Answer:
The period of stable, but high glucose levels was probably the result of the glucose being lost through the kidneys and into the urine. If you would have tested your urine, I would expect you would have had very high glucose and high ketones. This would only have been for a finite time until you became volume depleted and the glucose would have continued to climb. You are correct to have been concerned. This was not a good way to handle your insulin management.
JTL
