Question:
From Garland, Texas, USA:
My 13 year old daughter was diagnosed almost 4 years ago. She has been in
the hospital twice in the past 3 months with DKA. Both times she got sick,
she spent the night away from home. This past time, she was fine on
Saturday when we dropped her off her blood sugar readings were stable and
she had no ketones. On Sunday morning when we picked her up, she got sick
and had a blood sugar reading of 477 and large ketones. She told us she had
a horrible time and that her Grandmother was continually yelling at her.
Can stressful situations cause her to get DKA within a 24
hour time frame? I have read that when a diabetic gets stressed and if it
builds up to much acid that it can happen. Is this true?
Answer:
It is true that emotional stress can raise the blood sugar, but it is
unlikely that arguing with a grandmother could put someone who was in
control into ketoacidosis in less than 24 hours.
I would be concerned that your daughter either didn't take her insulin
or didn't take the right amount the night she slept at her grandmother's
house. It is not uncommon for teenagers to show their parents they
either aren't mature enough to control their diabetes away from home on
their own, or don't want to stay away from home by not taking the
insulin or not taking the right amount.
I suggest you speak to your child's doctor about seeing a therapist with
experience treating adolescents with diabetes. Ketoacidosis is very
serious and can even be fatal. I suggest you not let your child stay
away from home without close supervision by someone knowledgeable in
both drawing up and administering insulin until you have this issue
under control. If you feel your child may not take her insulin or the
correct amount at home when she is upset, you may want to supervise her
insulin drawing up and administration at home too. Explain to her you
are concerned and that you want to help her so she doesn't get
dangerously sick. Even is she doesn't want supervision, most likely in
the long run she will appreciate your concern and care. Make sure she
actually injects the entire amount drawn up. It is not uncommon for
teens to squirt out some insulin before injected, even when supervised.
You will want to of course sort out what the issues are that causes your
daughter to get so upset away from home. It is not uncommon for teens
to let their diabetes get out of control as a way of letting their
parents know they need help.
TGL
Original posting 17 Jun 97