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Question:

From Illinois, USA:

My daughter was diagnosed with type 1 a couple of years ago when my parents were watching her (while I had surgery). Thinking she had a flu, they kept watch on her at home until one morning, she was gasping and unresponsive. In the Emergency Room and then ICU, the team worked on her for hours to stabilize her. She came in with a glucose of > 1200 mg/dl [66.6 mmol/L] and Co2 of < 5. She eventually turned around and is doing well, but has never been the same. She cannot focus well anymore, suffered long-term memory loss, and regressed academically. She had to repeat first grade right after diagnosis. Is this from post-traumatic stress, or could she have suffered brain damage during her critical period? I thought she would have regained her old self by now, but has not.

Answer:

This is a great question, but impossible to answer with examining her, knowing the details of her DKA and coma, treatment response, how fast things changed, etc. It is possible that some of these are directly related to brain injury during her treatment especially since her glucose was extraordinarily elevated. I would suggest arranging a special consultation meeting with her diabetes team and seeing if they can review all of this ahead of time to be able to give you some more specific answers.

Separately, now so long after the diagnosis and DKA/coma crisis, if she is still not doing well, could she have some emotional component dealing with diabetes? This is quite common, but sometimes very subtle. Also, did she already have any neurologic or learning problems prior to her diagnosis that may just be showing up now or exaggerated because of having a second chronic illness like diabetes? And lastly, what is her glucose control now? Excessive hypoglycemia can cause some of these same problems as can excessive hyperglycemia. An A1c goal should be at least less than 7.5% if not less than7%. We often were willing to blame hypoglycemia on such emotional and/or learning problems but hyperglycemia turns out to be an even more important factor based upon research work from Professor Eugen Schoenle and his colleagues at the Children's Hospital in Zurich.

SB

DTQ-20070904224159
Original posting 21 Sep 2007
Posted to Other and Hyperglycemia and DKA

  
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Last Updated: Tuesday April 06, 2010 15:10:12
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