December 17, 2001
Hyperglycemia and DKA
Question from Burley, Idaho, USA:
My nine and a half year old son has had type�1 diabetes for almost two years, and his high blood sugars are continually 300s -600s [mg/dl, 16.7-33.3 mmol/L] with large ketones in his urine. He has been in the hospital for intravenous therapy numerous times over the last month. He has shown no other signs of illness. He can go from a blood sugar of 180 mg/dl [10 mmol/L] with no urine ketones to a 600 mg/dl [33.3 mmol/L] level and large ketones in a matter of two hours. We have tried everything including new bottles of insulin. He even does this in the hospital. He is not under any stress that has been detected. Do you have any suggestions as to what can cause this?
Answer:
I’d be sure that you are working with experienced pediatric diabetes team since what you describe is highly unusual. Omitted insulin, leaking insulin injections, and lipohypertrophy at injection sites are the usual explanations although there are some other very rare explanations as well. If you are not closely working with a pediatric diabetes team, you need a referral to one.
SB
[Editor’s comment: If your son is giving his own injections, I suggest that you give them for a while and see if the problem persists.
SS]
