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October 8, 2002

Hyperglycemia and DKA

Question from Chesapeake, Virginia, USA:

My son, diagnosed with type 1 diabetes almost two years ago, was in DKA at the time, and he lost 25 pounds during the six to eight weeks prior to diagnosis. I am curious as to how long he was ill prior to going into DKA. Do children go from subtle symptoms such as increased thirst and urination to DKA in one to two months or was this more likely to have been going on longer? How long do symptoms have to exist before most children go into DKA or is this a very individual thing?

Answer:

I am surprised how variable the clinical presentation can be. Textbooks commonly described that the gradual destruction of the pancreas that leads to the eventual insulin deficiency progresses for at least six months before there is overt diabetes, which is usually manifested as the increased urination (due to high blood glucose loads “spilling over” into the urine) which then leads to mild dehydration, which then leads to increased thirst. Because of the inability to efficiently use glucose for energy, the body will use “stored energy” in the form of fat. The burning of fat leads to weight loss and sets up the scenario for ketone formation.

Typically, families note the change in these bathroom and thirst habits for two to six weeks before they decide to go to their doctor. Weight changes are generally seen over a similar period of time. However, as for the development of DKA [diabetic ketoacidosis], I’ve seen that at the six to eight week time frame, and I’ve seen it after what the family only recognized as two to three days of increased thirst, etc. Is that a variability in the disease? Or maybe a reflection of how observant (or unobservant) some families are? Or both?

DS