May 29, 2003
Hyperglycemia and DKA
Question from Christchurch, New Zealand:
My nine year old daughter, who has had diabetes for three years, has never had great control (A1c:10%), even though she is on multiple daily injections (twice daily pre-mix with Humalog at lunch, tea, etc. as needed). She weighs only 26 kilograms (57 pounds), seems to produce ketones really easily, and can go into DKA [diabetic ketoacidosis] really fast. Yesterday, she was in a lot of pain and was found to have a large amount of blood in her urine. Could there be an underlining problem with her kidneys that is making her become dehydrated faster and produce ketones so quickly? Do you think an insulin pump would help her control?
Answer:
A hemoglobin A1c 10% most frequently comes from missed shots. Just to be sure, have an adult supervise, better yet, give them.
A weight of 26 kilograms (57 pounds)at nine years old makes me wonder if she doesn’t have coeliac disease. Ask her diabetes team to check.
LD
