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September 19, 2004

Complications, Hyperglycemia and DKA

Question from Sauk Village, Illinois, USA:

We try to follow a very strict diet and we cannot regulate our daughter's sugar level. If she wakes up normal, we give her the normal insulin dosage, then feed her breakfast and her blood sugar will go up dramatically before it drops her low before the next meal. Even when high, she has no ketones. If she is high or low, she still acts normal and energetic. Do these swings in her blood sugar, mean that our daughter, will have long-term effects or should we expect some internal damage in the near future?

Answer:

Your daughter’s ‘brittle’ diabetes quite probably might depends on an incorrect timing, place and dosage of her fast acting insulin shots given before meals. You should find quite a lot of answers to similar questions at our Ask the Diabetes Team page on our web site.

About the role of these varying blood sugar levels towards long term complications, they are important and should be avoided. It is feasible to do so because of the modern concepts of intensified insulin regimens based on glargine (Lantus) as the basal insulin and lispro (Humalog) or aspart (NovoLog) before each meal. Furthermore, but not least, you must strive to avoid these wide fluctuations to improve the quality of life of your daughter and yourself. Nevertheless, the most important parameter to judge her metabolic control, and then the future risk of chronic complications, is her A1c, which should not be greater than 6.5%.

MS