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December 13, 2003

Hyperglycemia and DKA

Question from Brackley, Northamptonshire, UK:

I've had type 1 diabetes for 30 years, and have been using an insulin pump for about the past 15. My question is about DKA. This past weekend, I had a very serious DKA episode, which I believe, having ruled everything else out, may have been the result of heavy stress. I was testing my blood sugar almost hourly during this stressful time, and the insulin I was taking seemed to be having little or no affect. The highest level my blood sugar reached was about 275 mg/dl [15.3 mmol/L] (which I don't think has EVER produced high ketones in me), which I was able to finally bring down, after a few hours, to a normal range. My blood sugar remained in a range between 120 and 180 mg/dl [6.6 and 10 mmol/L] for the next 24 hours, however I was spilling large amounts of ketones. Currently my blood sugar is 100 mg/dl [5.5 mmol/L], but I'm still showing moderate amounts of ketones. I can't seem to shake them! What could cause such high ketones with normal blood sugar, and how do I go about correcting it? Would stress play a role in this particular problem? I'm also wondering if it could be because I had no access to water or any kinds of fluids during that weekend. Any insight would be much appreciated.

Answer:

You may want to consider this a false positive test. Some medications or conditions may cause reaction with the urine ketone strip but are not really the result of high ketones. Were you on any other medication? Had you been drinking alcohol in large amounts? To diagnose diabetic ketoacidosis, you need the clinical laboratory. I would not consider the circumstance you described as being diabetic ketoacidosis without additional information regarding your serum bicarbonate level. If you fasted for a prolonged period of time, this can also cause ketone elevations without resulting from DKA.

JTL