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August 6, 1999

Hyperglycemia and DKA

Question from Tennessee, USA:

My nephew is 21 years old. He has Type 1, discovered 3 years ago. He also smokes. He is in my care, and he is currently hospitalized for DKA. He is in total denial. Cannot keep a job, becomes sick and has to quit. He refuses any suggestions of support groups as well. His blood sugars run high, I know this because of his frequent urination and mood swings. Testing his levels is also out of the question. He is hospitalized 3 to 4 times a year for DKA. I am in desperate need of counseling for this young man. I love him, but the topic of his diabetes is something he won't listen to. Please advise, and tell me what to expect, based on his current health attitude.

Answer:

I have to fall back on my early training, when I was taught that “repeated hospitalizations for ketoacidosis in general have a psychological root.” My strong recommendation is therapy. However, at 21, your nephew is a legal adult and able to choose his own path.

The outcome sounds bleak without intervention. If his behavior is endangering his life, you can petition to have him committed for a psychological evaluation. It will not make you popular with him but it might save his life.

CMB