December 19, 2002
Hyperglycemia and DKA
Question from Dallas, Texas, USA:
My sister, who has had diabetes for about 15 years, has never really had it under control (under 200 mg/dl [11.1 mmol/L] is good for her). She is inconsistent with a timetable on taking her insulin shots. Last night after eating dinner, she became confused and disorientated. She is in a wheel chair due to diabetes-related foot problems, and she kept bumping into stuff and couldn’t maneuver it correctly. She complained my niece and sister that she couldn’t hear her.
My niece had given her usual shot just a few minutes before she called 911, but, when the paramedics arrived, her sugar was off the chart. When they got her to the hospital around 7 pm it was over 900 mg/dl [50 mmol/L], and her blood pressure was at 219/74. By 2:00 am they had it down to 211 mg/dl [11.7 mmol/L].
They say she still isn’t recognizing people, and, because of other pain, they have her on morphine so she is sleeping, and her vitals are under control. Including her sugar. They did a CAT scan which didn’t show a stoke, and they said she didn’t have a heart attack.
What are the potential problems of her sugar level having been so high? I know a few months back they had admitted her when she broke her foot and said that her kidney functions were not where they should have been.
Answer:
Unfortunately, your sister probably has complications from diabetes that put her at risk for such high sugars. She probably has some degree of kidney involvement. She probably has neuropathy which puts her at risk of developing foot ulcers. I would suspect she also has some degree of retinopathy. The thing about CAT scans and stroke is that it may take days for the findings of a stroke to appear on the scan. Therefore, I would not totally eliminate the possibility of a stroke based on only that result. Individuals can have neurologic problems following such a high sugar. They include small strokes or focal seizures. I hope she does not have those.
Finally, I would say she needs to have much better care of her blood sugars. Why did they get that high in the first place? If it was not a neurological event, does she have high sugars all the time? Is there an active infection to drive the sugars up? These are the kind of questions that need to be addressed.
JTL
