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June 5, 2002

Hyperglycemia and DKA, Insulin Pumps

Question from Lincoln Park, Michigan, USA:

My cousin and I both have type 1 diabetes and have recently started using insulin pumps. Last weekend, my cousin ran out of insulin and didn't bother to fill his prescription right away. He said he got "busy" and went to bed without reinserting his pump. On Monday he, of course, woke up very high, but still didn't reinsert (He said because he was too tired; in other words, his sugar was so high he'd become quite lethargic and decided to sleep more instead). That evening he did finally call his parents to take him to the emergency room. Once he was there, it was determined that he was in DKA and had to be admitted. My aunt told me the ER doctor told my cousin it was actually a good thing he hadn't reinserted Monday morning. Why? I thought it would've been better for him to at the very least reinsert if not accompanied that with an injection for correction depending on his correction scale and so forth. I know they gave him an insulin drip but still, wouldn't it have been better for him to have at least attempted some correction at home?


You are right, and the report from the doctor is probably not a correct report. Any insulin when in DKA [diabetic ketoacidosis] would be helpful. Your cousin was very lucky since not taking insulin with DKA beginning is extremely dangerous. People die during episodes of DKA so it should always be taken very seriously.

When using an insulin pump, running out of insulin, insulin clogs in the tubing or pump malfunctions are usually the culprit. Any illness can be associated with the need for more insulin so that not testing means that one does not have the chance to recognize the situation is getting worse. Not testing for ketones (urine and/or blood ketones) is also part of this same problem.