Two nights ago, my 11 year old daughter was diagnosed with type 1 diabetes. Out of nowhere, her blood sugar level was at 706 mg/dl [39 mmol/L], and she was in DKA, practically in a coma-like state. It was extremely shocking to all of us, and the doctors have informed us that ketoacidosis isn’t something that takes time to appear. In children, it can come one time and then you have it for life.

However, I have read and spoken with several nurse friends who have informed us that ketoacidosis doesn’t work this way, and that it takes time for the pancreas to stop functioning — maybe years. I’m just looking for an honest answer to know the truth and further help my other children who have and still get symptoms like their older sister has had in the past (nausea, vomiting and dehydration).

My father, grandfather and I have sugar problems. My father and grandfather take insulin, and I am diet-controlled. Please help me in finding the truth.

Type 1 diabetes usually does not start in several hours but occurs when the pancreas gets damaged, perhaps by inflammation or a virus. When this happens, insulin is no longer produced in sufficient quantities and the blood glucose levels raise. If insulin deficiency continues, then dehydration can occur and with it, DKA [diabetic ketoacidosis]. DKA does not happen very quickly under most circumstances so it would be reasonable to assume that several days or weeks of symptoms preceded the actual diabetic ketoacidosis. Once the insulin is deficient and the sugar levels are high, DKA can occur quite rapidly. However, this is usually associated with an illness. It is difficult to know how to answer your questions without more specific information but you should ask this same question to your diabetes care team and expect that they could give you better and more individualized answers for your child.

I hope that you are working with an experienced pediatric diabetes team so that you can learn about diabetes and what will need to be done to keep your child healthy and in optimum control. The initial days and weeks after diagnosis are very scary and worrisome. Learn as much as you can and ask a lot of questions so that you can feel comfortable and then also help your child also be comfortable with the management tools available.

SB