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July 23, 2004

Diagnosis and Symptoms, Hyperglycemia and DKA

Question from Connecticut, USA:

When my 13 year old daughter was admitted to the hospital recently, she was diagnosed with type 1 diabetes. Her blood glucose reading was 750 mg/dl [41.7 mmol/L]. Although all of the typical symptoms of diabetes, thirst, peeing a lot, leg cramps (from dehydration, I believe) were present, she insisted she felt fine. I wonder why she wasn't in a coma or at least feeling very ill. Her A1c was 11.5 one month after her diagnosis. Now, it is 6.8.

Answer:

One of the mysteries of diabetes is the variety of presentations. We have seen DKA and coma in people with very short histories and others who have severe symptoms for a long time but who walk in. It may be something to do with the body’s amazing ability to compensate if given time to adjust. There is almost certainly also an association with other illnesses such as viral infections which precipitate the onset of “decompensation” because of increasing the demand for insulin.

KJR