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November 1, 2004

Hyperglycemia and DKA

Question from Wolfe City, Texas, USA:

My dad just got admitted into ICU for DKA. He has had diabetes for over 10 years and has never had this. They said that his blood sugar was 670 mg/dl [37.2 mmol/L] and he had began vomiting with ketones. Well, this scared my sisters and me. We have never heard of this and, all we were told, is that he could go into a coma and die from this. Well, we live in Texas and he lives in Missouri. At this time, they have his blood sugar to 98 mg/dl [5.4 mmol/L], but he is very out of it. Is that normal? Will he recover from this? They say he had the flu a week prior to this episode. My dad also has neuropathy in the hands. I have never heard of a blood sugar being that high. I know that it is dangerous. Is my dad lucky to still be here with his blood sugar that high and in DKA?

Answer:

Are you sure it is DKA or the condition “hyperosmolar nonketotic state?” The latter is the uncontrolled form that occurs with type 2 diabetes whereas the DKA occurs primarily in type 1 diabetes. When older people have that high a sugar, it can be several days before neuro status returns to normal. These cases are generally caused by some other underlying illness that causes the stress hormones to rise. Treatment is supportive and directed at the underlying precipitating event.

JS