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May 17, 2003

Hyperglycemia and DKA

Question from :

My stepson, just diagnosed with type 1 diabetes, had been running a high fever that later was to be a sinus infection and his blood sugar was labile. They released him from the hospital, and he has been eating the carbs that he is allowed, but ever since he got home, he has been around 260-280 mg/dl [14.4-15.6 mmol/L]. They just put him on a routine the night before so he was eating regular until then, and he has been very tired. Could being back home and the stress from the parents being nervous have an effect on this?

Answer:

This is a period when you have a particular need to be in very close touch with your stepson’s diabetic team either by telephone, e-mail or fax. The inevitable delays in turnaround make the Internet unsatisfactory for urgent decisions. However, I think that you can do a lot to reinforce your confidence in management by reading one of a number of texts.

DOB
Additional comments from Dr. Stuart Brink:

It sounds like he is not yet getting sufficient insulin dosage. His parents should be calling his diabetes team pretty regularly to report to them so that they can help make further adjustments. Sometimes takes a few weeks to “get” the correct insulin dosage shortly after diagnosis but lots of blood glucose testing and staying in close contact with the team will help to bring these high values in better range.

SB