May 29, 2006
Hyperglycemia and DKA
Question from Fergus Falls, Minnesota, USA:
My 11 year old son, who is on a pump, has been having some extremely high blood sugars lately. At the recommendation of his endocrinologist, I have made some large changes to his dosages to try to keep his blood sugars at a healthy level. Nevertheless, a couple of nights ago his blood sugar was above 600 mg/dl [33.3 mmol/L]. We don’t know how high since it wouldn’t register on the meter. I tested him for ketones and they were present, but low. I gave him extra insulin to bring the blood sugar and ketones down. A few minutes later, he began to feel extremely sick, started crying, and threw up, then felt better. I continued to monitor him, give him water, and give insulin as needed. Within about four hours, he was back to a good blood glucose range, although his ketones rose for a couple of hours before they came down. At what point should we not treat our child at home and head to a hospital? In hindsight, I wonder if I should have taken him in instead of trying to handle it on my own. I do not want to put my child’s life at risk and find out later that he would have been fine if we had been in a hospital setting. What is your opinion?
Answer:
Parents can be trained to deal with high glucoses — frequent small doses of insulin (you should have a formula for highs), frequent blood checks, etc. I also tell parents those sorts of numbers usually mean a bad site. I recommend an injection of insulin and a new infusion site. Also, make sure there are no air bubbles in the pump tubing.
As long as there aren’t severe ketones and vomiting, you can fix it at home. Indeed, you know more than most Emergency Rooms and your child is safer at home.
LD
