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April 4, 2001

Hyperglycemia and DKA

Question from Barstow, California, USA:

Why do blood sugar levels remain in people with newly diagnosed diabetes? What are the pH levels of someone who has DKA? Why would they test the pH levels?

Answer:

It is difficult to answer your question precisely without knowing more of the circumstances which led to it because the answers depend on matters like age, what kind of diabetes, how high the blood sugar is and how severe the DKA [diabetic ketoacidosis] is. In general though, the rate at which elevated blood sugars are made to fall is due on the one hand to the amount of insulin given and on the other as to whether there is a countering stress such as an infection that tends to maintain those levels. Of course, with antibody testing, a diagnosis can be made of type�1A (autoimmune) diabetes, the most common form in childhood in the U.S, with rather minimal elevations of blood sugar. On the whole though, the tendency is to be cautious about restoring normal metabolism because small children especially can be very sensitive to short-acting insulins so that there is a risk of hypoglycemia, and, in severe DKA, too rapid a reduction in blood sugar may be one of the factors in precipitating cerebral edema (brain swelling). In any case, correcting dehydration and acidosis is at least as important as reducing blood sugar.

Blood pH is a simple and rapid way to measure the severity of acidosis and is means of judging the need for inpatient care and of assessing progress in treatment.

DOB