From Greeley, Colorado, USA:
My 10 year old daughter was diagnosed at age seven, uses a pump and is doing great on it.
My question is about her treatment at the time of diagnosis. Her blood glucose was 859 mg/dl [47.7 mmol/L]on arrival at the ER. Her labs indicated she was not in DKA [diabetic ketoacidosis] (negative ketones in urine, no acetone in the blood, all electrolyte values in the normal range). She was given 10 units of Regular pushed IV. Her blood sugar came down to 59 mg/dl [5.5 mmol/L] in two hours and her potassium was also then low. She began vomiting, shaking, sweating and had a severe headache. She was then given IV glucose and potassium. It took her a few days in the hospital to get her strength back after this episode. As she didn't feel too bad before going to the hospital, this was a confusing experience for her. Several doctors informed us that she was "extremely sensitive to insulin" and that's why the bad reaction. In the two and a half years since, her insulin needs have been very normal for her size, with no further indications of this "extreme insulin sensitivity".
If she's not overly sensitive to insulin why did her blood sugar drop so quickly? What is the significance of the accompanying low potassium?
It's difficult to provide any specific answer to this question. If the blood glucose level was elevated mostly because she just had a large amount of juice to drink, this would mean that the 859 mg/dl [47.7 mmol/L] was really lots lower and thus the rapid response to intravenous Regular insulin. It is often very easy to say that someone is insulin sensitive when high sugars and negative ketones are present -- and you see, in retrospect, what actually happened to the glucose level.
Potassium levels can be high, normal or low with initial diagnosis of type 1 diabetes and probably reflects how long sugars were elevated previously -- not just how much insulin was provided at the moment.
You should discuss this directly with your daughter's health care team so that they might review it with all the data available. One would need to know lots more info about blood glucose levels over the first day or two, as well as other tests including potassium levels, bicarbonate levels, and pH levels.
Original posting 12 Apr 2001
Posted to Hyperglycemia and DKA
Last Updated: Tuesday April 06, 2010 15:09:19
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