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December 2, 2007

Hyperglycemia and DKA

Question from Bani Jamra, Bahrain:

My daughter was diagnosed with type 1 diabetes just over a year ago and has just turned 13. She has had three monthly blood sugar averages of between 7.9 and 7.3 since she was diagnosed. Because of these good results, she seems to feel she has it under control. However, on a daily basis, her blood sugar levels can go to extremes. For example, yesterday, she had a low blood sugar in the morning at school when her sugar was 2.9 mmol/L [52 mg/dl] and, then, in the afternoon when she came home from school, she ate some food without taking insulin and her sugar level before her evening meal was 22.9 mmol/L [412 mg/dl]. She ate her meal then took her insulin. Can you advise how long the sugar level has to be high before it starts to affect the body, eyesight, etc.? She argues that by letting it go high for a couple of hours is not going to affect her. Can you confirm this is this case?

Answer:

You are right and your daughter is incorrect. Any high sugars are dangerous and potentially damaging to all parts of the body. The higher the sugar, the worse problem; also, the longer duration of high sugars, the worse the problem. Most complications of diabetes are related to long-term high sugar damage, but this is a cumulative effect. So, if she is sloppy and that is why she does not test her sugar levels or take insulin before she eats, this will come back to harm her in later years. It is critical to ask why she is being so sloppy if she knows better and not let her make excuses for the sloppiness. Of course, day-to-day glucose control is difficult and there are many factors that go into control, including the inexactness of replacing insulin, food absorption, insulin absorption, stress, growth and hormone factors, etc. But, frequent blood glucose testing and analysis of blood glucose results is the best way to gain control and to have feedback to minimize such large excursions. Perfection is not possible, but learning from one’s choices/errors allows for improved control.

SB