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November 30, 1999

Hyperglycemia and DKA

Question from Harare, Zimbabwe:

My son was diagnosed with Type 1 diabetes when he was two and half years. He is now thirteen years old. However about 2 months ago he suffered severe brain damage the cause which is believed to be prolonged hyperglycemia. Although he is out of a coma, he has not been able to interact with his environment. Of great concern to me is that his sugar levels have not been stable ever since, constantly on the high side. He breathes using a tracheotomy and being fed on Ensure. He has lost weight and I fear further damage due to the high sugars. He also now has convulsions. Is there a physician you can refer me in South Africa who can help my son?

Answer:

Your son needs careful nursing and nutrition. Since he is being fed with Ensure, presumably by gastric feeding, it should be possible to monitor blood sugars frequently and to adjust the insulin dose accordingly. The seizures likewise should be controllable; but I sense that the long term prognosis for recovery is not very good.

DOB
Additional comments from Dr. Quick:

Although it is rare, there are complications of diabetic ketoacidosis that can lead to permanent neurologic damage, as might have been the situation in this case. Dr. O’Brien also gave the writer the name of a pediatric endocrinologist at a medical school in South Africa, as requested.

WWQ