October 11, 2006
Daily Care, Hyperglycemia and DKA
Question from New Freedom, Pennsylvania, USA:
My 14 year old son was diagnosed with type 1 diabetes five and a half years ago and has never been able to get his A1c and blood sugars under control. He runs high quite often and his A1cs are 14s quite often. He takes insulin four times a day and tests his blood sugar quite often. He counts carbohydrates for each meal and takes his insulin according to the amount of carbohydrates, plus additional insulin for any blood sugar level which is above his target range.
He has complained over the past year of stomach pain, heartburn, diarrhea, leg pain, and tiredness (sleeps a lot). He has been in DKA many times, hospitalized with large ketones and lots of vomiting. He lost 10 to 25 pounds over the last year and is only 108 pounds now.
The doctors keep saying he isn’t taking care of himself, that he can’t possibly be doing so and still have sugars out of control. We keep telling them that we monitor him daily, as does his school nurse. Just this week, he missed four days of school with severe stomach pain, on and off ketones, on and off high blood sugars, vomiting/heartburn and fatigue.
What should we do next to help our son before he becomes worse? He can’t keep feeling good for a week and then sick for week. It has been going on for too long now.
Answer:
I’m sorry, but an A1c of 14 almost always means missed insulin. I know you won’t like the answer, but that’s it. You could ask the doctors to check for celiac disease, but I don’t expect an A1c of 14 with that problem. It can make the stomach hurt, but so do ketones.
This is a situation where an adult needs to manage the diabetes. All blood tests and all insulin needs to be given, not supervised, by the adult until his team and you feel he is ready to resume these tasks properly.
LD
