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August 15, 2008

Aches and Pains, Hyperglycemia and DKA

Question from West Chester, Pennsylvania, USA:

My eight-year-old son was diagnosed with type 1 diabetes last fall. His sugars have been running high off and on for the past two weeks. I spoke with his diabetes nurse last week and she recommended he be given an extra unit of NPH insulin in the morning since his late morning and lunchtime numbers have been high (his highest was 498 mg/dl [27.7 mmol/L]). He was okay for a few days after his changed dose but now is running high once again. Just last night, he started complaining of chest pain. He has never complained of this before. I got him calmed down and got him to sleep, but the pain woke him up a few hours later. I thought may be it was indigestion so, at first, I wasn't to worried. But, today, he has been complaining of this pain as well. I am concerned because he also has been having these high blood sugars. Do you have any idea what might be causing this?


There are many, many, many causes of chest pain in children and almost all have nothing to do with diabetes.

To get a better sense of the potential seriousness of this discomfort, your doctor will want to know the quality of the pain (e.g., “stabbing like a knife” or “pressure” or “pinprick,” etc.), the duration of the pain (“how long it lasts before it goes away”), what brings it on, what gives relief, if there is a change in breathing pattern or development of cough, whether it interferes with eating, etc.

Strictly from a diabetes perspective, the presence of ketones can certainly lead to chest pain. As you should know, higher glucoses can lead to the development of ketones and can progress to the serious “diabetic ketoacidosis” (DKA). This is why blood or urine ketones should be checked when the blood glucose is over 240 mg/dl [13.3 mmol/L] or so (although some clinicians will say check if glucose is more than 300 mg/dl [16.7 mmol/L]). So, check for ketones. If present, call your diabetes doctor. If not present, call your primary pediatric provider to talk about the chest pain.