August 26, 2003
Hyperglycemia and DKA
Question from Cranston, Rhode Island, USA:
My eight year old daughter has type 1 diabetes, and couple of nights this last week, we have gone to our friend’s house for dinner where she has eaten nothing that she doesn’t eat at home. The problem is that whenever we go there, and she is playing with her friend, she runs in the high 200’s mg/dl [11.1 mmol/L] or low 300s mg/dl [16.7 mmol/L]. She never has ketones but does spill glucose in her urine. I am not sure if this is caused by the fact that they argue a little more (seems like a silly cause) and her emotions are running high or if it has to do with how cold their pool is. She is constantly complaining that their pool is too cold and will only spend 10-15 minutes in it. Her pool at home is usually around 80, and that doesn’t seem to affect her.
It just seems odd to me that she always runs high there and never runs high at home when her friend is over here. If this only happened a couple times it wouldn’t be so disturbing, but it happens every time. I should also mention that she is always within sight, so she is not “sneaking” anything there either, she is always in range when we get there, and she is on a Lantus with Humalog regimen. Any insight that you could possibly would be wonderful.
I would guess that you are correct: this is a “stress” response. The extra activities (does she drop low later, after the visits?) and mild tensions can lead to increased cortisol in the blood that leads to increased glucose. Also, cold is clearly a stress.
Your options certainly include giving a little extra Humalog on visits to your friend’s home. Certainly, you can do nothing and let things ride if these high levels are only occasional. The lack of ketones is very reassuring.
The glucose in the urine is not any big deal at all: once the blood glucose is more than 180 mg/dl [10 mmol/L], there is likely to be glucose spilled into the urine.