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May 30, 2004

Hyperglycemia and DKA, Other

Question from Bethpage, New York, USA:

My dad, age 63, became a diabetic recently due to removal of the tail of his pancreas. He had a endocrine cell tumor. Almost immediately, he began needing insulin. He is careful with his diet. He does eat white bread and is under a lot of stress since he is not fully healed from surgery, is retiring, and is moving all at the same time. His blood sugar ranges from 150 to 350 mg/dl [8.3 to 19.4 mmol/L]. Twice this week the ketone message came up on his monitor. He still has a drain at the sight of the surgery that causes fever at times. He has been advised, at this time, to give insulin injections only if his blood sugar is over 200 mg/dl [11.1 mmol/L]. Last night it was 350 mg/dl [19.4 mmol/L], and had really not gone over 250 mg/dl [13.9 mmol/L] since this began. The prior few days, he had extreme stress. Could that raise your blood sugar, and have a delayed effect? We have an appointment with a diabetic counselor in a week and a half.

Answer:

It is true that the stress of surgery, mental stress of situation, and mental stress of worry can increase blood sugars. However, in the case of your father, he has had the removal of the tail of the pancreas. The tail has the highest concentration of islets, which produce insulin, in the pancreas. I am concerned he has lost the ability to make enough insulin to respond to his needs. Sugars should always be under 200 mg/dl [11.1 mmol/L] during the recovery phase of a surgery. Values above this mark indicate an inability for the body to heal well and an inability to fight off infection well. I anticipate he will need to be on insulin. This is the best treatment as it will restore the insulin he needs and allow him to eat appropriate calories for recovery.

JTL