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September 23, 2001

Hyperglycemia and DKA

Question from Algonquin, Illinois, USA:

With the recent terrorist attacks, a few questions have come to mind dealing with my 12 year old son's type 1 diabetes. How long can a person with diabetes go without insulin? Are there any emergency procedures that should be followed for someone with diabetes? Would being on a pump have any additional benefits in times of emergency?

Answer:

People with type�1 diabetes can usually last for several days to several weeks without insulin when DKA [diabetic ketoacidosis] would occur. Every individual would be somewhat different depending upon their own stress response, whether they were in good or poor control prior to the loss of insulin, whether or not there were any other illness, access to salt-containing fluids, etc. Being on an insulin pump would be the same without except that ketoacidosis would likely occur faster since there would be absolutely no background basal insulin when the pump supply stopped.

Most diabetes teams advise keeping an extra bottle of insulin (about a month’s supply) on hand for emergencies. If there really were absolutely no insulin, cutting back on carb intake drastically like in the pre-insulin era and making sure there was plenty of salt-containing fluids would likely slow down the DKA process.

By the way, in many parts of the undeveloped world (that is, where there is poverty or governmental chaos, or civil or other wars), this is exactly the situation and newly diagnosed or already diagnosed people with type 1 diabetes, go into DKA and die.

SB