Recently, I took my 13 year old daughter to the hospital for what I thought were flu symptoms. Her core body temp was down to 97 degrees, and they admitted her into the PICU. She was responding to the questions they was asking her to insure she was still awake. I didn’t ask what type of diabetes she had, but I was told she had “acute diabetes”. She was put into a coma because her brain was swelling. When she is brought out of it, is there anything that can be done to reduce the swelling if it hasn’t gone down during her coma state?

I think that all we can do through e-mail is to give you some ideas about the questions to ask your daughter’s doctors. From the story that you give, it sounds as though your daughter has been developing type 1A (autoimmune) diabetes for some years. This is a usual pattern, but at some point, this became insulin dependent clinical diabetes. The slow destruction of the insulin producing cells in the pancreas reaches the stage at which these cells only marginally meet normal demands and are unable to cope with the additional burden of any additional stress such as an infection. When this happens a child may develop what is called DKA [diabetic ketoacidosis], an uncommon, but very serious complication of which is swelling of the brain called cerebral edema. In point of fact, CAT brain scans have shown that some degree of cerebral edema occurs in nearly all cases of ketoacidosis, but it is still difficult anticipate the ones that will be severe enough to produce a coma. It is mostly likely to happen in children when they are first diagnosed,and the risk seems to be increased if a bicarbonate solution is given intravenously to counteract the acidosis. The treatment, and a very effective one if given early, is to give a sugar called mannitol intravenously. This is certainly a life threatening complication, but, if treated early and successfully, the lasting effects are minimal.

DOB