March 29, 2007
Hyperglycemia and DKA
Question from Florida, USA:
I’ve been doing my own little study and going online to find information about my child having problems with DKA during her monthly cycle. Frankly, I’m fed up with doctors telling me that she goes into DKA because she must be “missing doses.” Yes, she is a teenager, but very responsible. I decided to check for myself on every dose once a month (without trust issues between my daughter and myself now) and she did what she was supposed to do. I watched everything and she still had DKA during her period. So, this leaves me to wonder why instead of “blaming the parents for not properly watching their kids,” why doesn’t someone do a study on why this is happening to so many teenage girls? Something is up! Just Google the issue and see how many stories you find. Do not get me wrong. I’m am all for the doctors that take care of our children, but maybe you guys are wrong on this one. PLEASE JUST DO A STUDY and let me know cause my little girl will be the first one to sign up.
Answer:
The general rule in medicine, like in life, is that common things happen commonly. Or, to paraphrase Willy Sutton,”Go where the money is…” Omitted insulin doses are still the most common explanation for recurrent DKA, although there are other explanations such as hormone surges during phases of menstrual cycles. But, with close monitoring and adjustment of insulin, one should not see recurrent DKA if such adjustments take place. The actual metabolic explanation involves insulin resistance associated with such hormone changes. If you understand that such problems occur in your adolescent, then more frequent blood glucose monitoring during those parts of the cycle coupled with blood or urine ketone measurements should allow you to increase insulin quite dramatically and thus head off the insulin resistance and DKA. Your diabetes team should be able to work out such a monitoring and adjustment schedule.
SB
