December 8, 2000
Hyperglycemia and DKA
Question from Sugar Land, Texas, USA:
My 14 year old daughter, who uses an insulin pump and is normally in good control, can get a “liver dump” — i.e., a large amount of glucose drives her blood sugar up to the 400s [mg/dl; 22.2 mmol/L]. I believe it is caused as a side effect of a medication she is taking. It is definitely not caused by a low. When she is at 400 mg/dl [22.2 mmol/L], which is for about an hour or less, she feels sick. Then, when she is coming down she gets a headache. The whole incident spans about four hours. Is the headache due to the rapid reduction in blood sugar? Was her brain swollen from the ketones and high blood sugar even for that brief time? Are those symptoms caused by ketones? If she has “sick” symptoms, is that a sign that her situation is more serious than a high number without sickness? She never gets to the point of throwing up. Is it just that, in a child with normally good control, that a 400+ mg/dl [22.2 mmol/L] makes that child feel badly because she normally doesn’t see a 400 mg/dl [22.2 mmol/L] sometimes for months?
Answer:
I expect the 400 mg/dl [22.2 mmol/L] itself makes her feel sick, and the ketones certainly will. It is unlikely for there to be brain swelling. Many kids complain of a headache with the fall from a high. Why the 400 mg/dl? Every now and then, they just do that, and every now and then a teenager forgets insulin.
LD
