April 20, 2007
Hyperglycemia and DKA
Question from Mechanicsville, Virginia, USA:
I am going through a divorce which is not very pretty. My 11-year-old son was diagnosed two years ago. He has been on a pump for six months. I have tried to make life as calm and consistent as possible, but his world has been turned upside down. He has been seeing his endocrinologist every two weeks for three months. His blood sugars were in the 300s mg/dl [16.7 mmol/L to 22.2 mmol/L] consistently. Now, he is in the 200s mg/dl [11.1 mmol/L to 16.6 mmol/L] a lot and some 300s mg/dl [16.7 mmol/L to 22.2 mmol/L] even with slow basal increases from 23 to 43 units at present. He will have normal blood sugars for a few days at tops. He has been seeing a counselor for the last three weeks. Does emotional upset of this caliber affect his blood sugars to the point that insulin is not enough? How much insulin is too much?
Answer:
The most likely thing that is occurring is that your son is forgetting to bolus his insulin before he eats. Many children forget to bolus, and with the emotional issues that he’s dealing with, he may be more distracted. Please be sure to bolus for him for the next two weeks and see what happens to his blood sugars.
JWB
