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February 1, 2001

Hyperglycemia and DKA

Question from McComb, Mississippi, USA:

My 10 year old daughter was diagnosed with diabetes about a year ago. Lately, her blood sugar level has been increasing and increasing, but the doctors can't seem to get it down. I watch what she eats constantly, and she has a dietitian at her school, but this is not helping. She is currently in the hospital now with a blood sugar of over 1000 mg/dl [55.6 mmol/L]. It will not register on the meter. I need a doctor who specializes in children with diabetes. No one in this area can offer me any help.


There are several things to consider here, especially if blood sugar levels are able to be brought down in the hospital.

Could there be a problem with the insulin you are using at home? Opened vials of insulin need to be discarded monthly, and unopened vials should be kept in the refrigerator. Discard the vials of insulin you are currently using and change to new ones that have not expired.
Look at her injection sites carefully. If there are puffy or indented spots, this means your daughter has some lipohypertrophy or lipoatrophy. If this is the case, insulin injected into these areas will not work properly. You’ll need to use other sites.
If your daughter is currently giving her own injections, I think you should do them for a while to see if this makes a difference in her control. If it does, you will then need to explore why the insulin does not work when she self-injects.
I agree that a face-to-face visit with a pediatric diabetes team is needed. If you cannot locate one in your immediate vicinity, I’d suggest taking a trip to a center somewhere to get to the bottom of the problem.


[Editor’s comment: Also, see Finding a New Diabetes Doctor for some hints on finding a diabetes team nearby.