hyperglycemia with NO DKA

[worried57]

Hi,
I don't understand how my teen (diagnosed type 1 a year and half ago) can have a BG on average of 18 - 25 mml, sometimes higher, with symptoms of extreme thirst, weightloss, lethargy and never have ketones. These readings are way too high, yet no crisis arises to make him see he needs to be more serious about taking insulin when he eats.  He didn't have any ketones when diagnosed with a BG of 86 mml either.  I thought hyperglycemia and DKA went together. Can someone explain this?

[JDRF-VOL-RL]

Hello.  I'm not a medical professional, just the parent of a kid with diabetes.  Hyperglycemia doesn't always produce DKA.  There are lots of possible explanations for this.  If the person is still in their honeymoon stage, DKA is less likely to happen because their pancreas is still producing some insulin.  It could also be the type of insulin regimen he's on.  You are more likely to get DKA when you are on a pump as opposed to being on injections where you are taking a long acting insulin as well as a fast acting.  DKA can also be avoided because of the person's particular metabolism.  And sometimes DKA doesn't happen for no apparent reason at all.  

If he doesn't think he needs to take insulin when he eats, have him get with someone who has had complications from diabetes because they failed to properly manage their diabetes.  Understanding that he will get serious loss of quality of life with complications is often motivation enough.  With our daughter, we do our best to keep her around positive role models, who manage their blood sugars well and have quality of life because of it.

[JDRF-VOL-SG]

Some diabetic people seem to show ketones quicker than others for some reason. Some diabetic people (like myself) seem to NEVER have DKA... even when first diagnosed, I never had DKA and never have since, no matter what my glucose levels were or whether I was sick with spiking glucose levels. But JDRF-VOL-RL has hit the nail on the head that even if he is not having problems with ketones, complications can happen and can happen to very young people. I personally have corresponded with teens who have suffered with diabetic cataracts and gastroparesis and have read the correspondence from loved ones who have lost teens from kidney failure, and they all tell me that they would give anything to be able to go back a few years and tighten up glucose controls to preserve good health. Damages happen if glucose levels are high, and some of them ruin quality of life. He needs to be very aware of this.

The other incentive you could try is that he will FEEL BETTER when his glucose levels are normal. He will have more energy, and for most teens this is something they want to have happen.

[worried57]

Thanks for your reply. I'm certain his continued elevated levels of BG are doing damage, but he won't talk to a counsellor, or anybody with diabetes.  He doesn't want anyone to know he is diabetic (perhaps still in denial) At 15, he feels as if these things won't happen to him and if they do, he insists he doesn't care.  He won't go to school, can't get up or stay awake (I think from high sugars), gets very, very angry when I ask him to test. It's turning into a power struggle and he is making this about me nagging him, not about his health. Yet when I "back off" and give him some space, his sugars get even more out of control. Maybe this is what teenagers go through, before acceptance, but I'm really worried and wish I had some control. Also, how long will it take him to notice feeling better with better control of his BG?

[CharliesAngel77]

I can understand you being worried about you soon and his behavior towards the diabetes.  I was diagnosed with type 1 diabetes when I was 15 years old.  My blood sugar was over 1000 and I was very ill for a long time.  I was a freshman in high school and missed a couple weeks before I got out of the hospital.  My eyesight changed from being nearsighted to far sighted within weeks so I couldn't see straight (pun intended).  I had to be home schooled for the second half of my freshman year because I was so far behind.  As soon as I was released from the hospital, I got into diabetes education classes and went to support group meetings for people with type 1 diabetes (most other members were at the youngest in their 20's so it was hard to relate).  This was all at the recommendations that were given to my parents and myself.  I think I would not being doing as well as I am now  without these things.  It was by no means easy.  When I went back to school everyone had questions for me and I was always different.  I was very involved with the American Diabetes Association and attended the diabetes youth congress one year and a summer camp for diabetics until I was too old to go (16).  I worked with other young diabetics to start a teen support group in my area if just to meet up once a month and go out with other people that understanded what I was going through as well.

When I was in my teens my parents always reminded me to check my blood sugar and by that age, it started to annoy me.  I felt like I was old enough to control my own diabetes and remember to check my own blood sugar.  I do realize that it was done out of love and concern as I am sure is the case with you.  I am not sure if it is because your son is at an age where kids are more defiant.  I am sorry that he seems to be ashamed and embarrassed to have diabetes.  This is obviously not something he chose.  It is also very sad for me to hear he says he doesn't care if he has complications or problems.    I guess my reply more addresses his behavior rather than your concern with hyperglycemia without ketones.  Is there any sort of support groups in your area that specifically cater to teens with diabetes?  Has he gone to any education classes?  Does his doctor have any suggestions?  

I am sorry to make this so long and more about myself, I just wanted to share my story with you.  I have been living with type 1 diabetes for 14.5 years (I am 29 years old now).  I graduated from high school, college, have been happily married for over 3 years and have 2 amazing children with no complications from my diabetes.  While diabetes has been a huge part of my life, I have tried not to let it define who I am as a person.  I sincerely hope that he realizes that he needs to take care of himself soon for his own health and your piece of mind.  If you have any questions, please feel free to ask.      Julie

[boseephus]

Type 1 for 30 years no DKA even with high blood sugars only endocrinologist can give you an answer on DKA results they know the score and what to look for. Brake down proteins in the blood and examine the results. They will know.