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November 13, 2000

Hyperglycemia and DKA

Question from Lawrenceville, Georgia, USA:

My 19 year old granddaughter, who has poorly controlled diabetes, had her wisdom teeth out last week. She was running over 300 mg/dl [16.7 mmol/L] at the time and generally runs that or more. She also often has insulin reactions. Anyway, she has been in terrible pain since the surgery and will not eat. She is not drinking much either. Today, her mother took her back to the dental surgeon who could find nothing wrong with her gums. Finally, she called the endocrinologist and read him the blood sugar record and described her symptoms. The doctor says she is in ketoacidosis, and, if she doesn't drink and eat and get her blood sugar down with extra insulin, she will have to go to the hospital to get fluids intravenously. Please explain how serious this is, what really causes it and what is going on with her body when this happens.

Answer:

When there is insufficient insulin or where insulin is ineffective then glucose cannot be metabolised within the body cells to provide energy. Fat stores are then used for this purpose and produce ketones as a by-product. The unused glucose has to be excreted in the urine which leads to excessive loss of water and dehydration. With insufficient energy supplies, acids like lactic acid accumulate and hence the collective term “ketoacidosis”. This is always a condition that needs prompt treatment. In your granddaughter’s case, it sounds as though she has been in poor control for some time, and the stress of the dental surgery possibly accompanied by a mild infection was the precipitating factor. She needs to re-establish contract with her diabetes care team.

DOB