Hi Dr. Cogan,
My type 1 son has had high sugars (in the 300- and 200-s) for about a month now; we have increased his insulin dosage considerably, both day time and night time, and check all the time, but he still has high sugars. I am very concerned; no keytones at all, but he has grown for a few inches for the past 3 months. He is 12, and is showing a deeper voice and other pre-adolesent changes.
I am worried that he is developing some kind of insulin tolerance. He was diagnosed 10 months ago; what a difficult illness it is for young children.
Yes, it appears that your son has the insulin resistance of puberty. You should also check the simple stuff: like making certain that he is not injecting insulin into puffy spots on his body (hypertrophy) which would decrease absorption and thus result in higher blood sugars as well as making certain that the insulin has not expired. Assuming none of the above, I have seen insulin doses up to 1.5 units/kg in adolescent kids. I would also make sure that he is not eating HUGE amount of carbs (>100 gm) at meals as it seems that no matter how much insulin you throw at them they will still be high. Try to get him to bolus his rapid acting insulin before meals as much as possible and make sure that he is not running particularly high between 2-5 am (Dawn phenomenon) as he may need more basal insulin.
Lastly, if all these measures fail, check with your endo and consider doing a 7 day continuous glucose sensor to figure out what is going on. I wish you the best of luck: you are right- it is very tough for these kids.
DrC
A barely know fact is that most admissions for DKA are not type 1 but type 2. These are Ketosis Prone Diabetics. You might know it as "Flatbush Diabetes". This was once thought to be uncommon but it is rife amongst people of color in the United States. We don't show antibodies yet we will have little to no insulin secretion. After we are stabilized by insulin our pancreases will generally come back and we can be treated as a type 2. I am such a diabetic and I am writing this also to lessen confusion about DKA.
Michael Barker
http://ketosisprone.blogspot.com/
Can you tell me what kind of affect does DKA have on eyes?
DKA often causes dehydration which may affect vision and the eyes may become blurry or scratchy. Because of the dehydration, the eyes may also appear sunken and may have less tears. After DKA is treated, the eyes may still continue to be blurry due to fluid shifts secondary to improved hydration and insulin. I hope this helps,
Dr.Cogen
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Tim was always bragging about his numbers in the 70-80`s and saying the boy`s aren`t going to get this nasty disease. We got a call one night, my sister and I, from our sister Sherry telling us that our baby brother was in the hospital emergency and was being admitted. His sugar was 1000 but had come down to 600+. The doctor the next day said he had Diabetic Ketoacidosis, DKA. He was stunned. But I had told him he needed to lose weight. 400+lbs on a 6`2" frame will not cut it. I was and am worried. I think he listened to the doc, but we`ll see. I`m the oldest of six. The first with type 2 and 56 yrs. old in a week and one day. 4 out of 6 of us with this disease. I pray the other two don`t end up this way. I`m the smallest of us 6 at 168lbs on a 5`6" frame. We`re all over weight. We need suggestions and prayers.
Susan: I am sorry to hear of this diagnosis. My best advice would be to have your baby brother see an expert specializing in diabetes so that he can get the best medical treatment available. It is also possible that DKA can occur in someone with type 2 diabetes as well as type 1. I wish your family the best of luck.
Thank-you. He is home and telling me I have to go with him to some dietary meetings and learn stuff with him.
Of course I`ll go. Who knows, maybe someone can help both of us.
Hi Susan: Write a list of questions for the doctor/dietician and make sure they answer everything. Get a contact number in case you have further questions so they can clarify and follow-up. It IS good to have another person present at the visit so they can pay attention..