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August 31, 2007

Hyperglycemia and DKA, Insulin Pumps

Question from Buffalo, New York, USA:

I was recently hospitalized for the stomach flu. When I went to the Emergency Room (ER), my blood sugar was 50 mg/dl [2.8 mmol/L] and I had moderate urine ketones. They made me suspend my pump and gave me I.V. glucose. I had my pump suspended for eight hours and my blood sugar only went up to 200 mg/dl [11.1 mmol/L]. My understanding of ketones is that they won't go away without insulin, even if the blood sugar is low. Was making me suspend my pump a poor choice on the ER physician's part?


It is not clear to me whether you were in ketoacidosis. However, there is clearly another explanation, that you had starvation ketosis. I would not normally think that you would be in DKA with such a low glucose. Other information needed to be evaluated before this consideration could be made. Additional information would have included whether you were indeed acidotic, in addition to other things. We try and work hard with our patients so as not to overshoot with treatment and also not to give too much insulin. In the end, if you have type 1 diabetes, it is very concerning to stop insulin for eight hours. You can always give low doses of insulin with I.V. glucose.