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February 11, 2010

Hyperglycemia and DKA

Question from Wisconsin, USA:

Our friend's 13-year-old son, type 1 since he was three, died from DKA. It happened very fast. He was sick in the morning and passed away in the afternoon. The family, paramedics, and Emergency Room could not get his blood sugar down. I have a 16-year-old son, type 1 since he was nine. I am scared this could happen to him. We know how DKA happens, but how long before it is irreversible? Why can some walk around in DKA yet it killed our friend's son in hours?


You do not give enough information to answer the question specifically. It is rare for DKA to do this so suddenly. However, if this child were in poor control for a long time, omitting insulin – perhaps without family knowledge, had very high A1c levels, then his ability to buffer and compensate would be severely compromised. If he had some other illness or severe virus infection, even that would be a possible explanation, but it takes quite some time to get so dehydrated and acidotic that one can die. Causes of death are sometimes brain swelling called cerebral edema and this can be contributed to by poor sick day management, omitted insulin booster doses, drinking wrong fluids (i.e., only water and not salt containing liquids like soup or broth) when ill, etc. Usually, death in DKA occurs from several such errors – almost always avoidable – that can be avoided by correct monitoring so that early hyperglycemia is recognized, ketone testing with illness so that proper extra insulin and fluids are supplied and contact with the diabetes team when the monitoring does not go the way that is expected. Your best defense against something like this occurring in your own child is proper surveillance, honest and appropriate supervision, and knowledge of sick day rules/guidelines since this avoids such unfortunate events.