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Hyperglycemic Crises
What They Are and How to Avoid Them

by Robert S. Dinsmoor

A common cause of DKA in children is failing to take insulin. This can happen for any number of reasons, including having poor organizational skills, not understanding the consequences of skipping injections, or disliking or resenting the unrelenting regimen, the sense of being different from other children, or the discomfort of sticking oneself with needles. Children and adolescents may also skip injections because they seek to lose weight or gain attention. A parent’s support and understanding can help a lot in these situations. Consulting a mental health professional who specializes in children with diabetes or other chronic diseases can also be a big help, for both the child and the whole family.

Weight issues. When people start taking insulin, many notice some weight gain, and typically they blame it on the insulin. The fact that skipping some insulin doses causes weight loss seems to prove the theory, and some people take to habitually skipping insulin to control their weight. This is a risky practice that can lead to short-term, acute complications such as DKA, and long-term complications of the eyes, nerves, and kidneys.

The weight-gain culprit when starting insulin therapy is not the insulin alone. When blood glucose levels are high, excess glucose is lost in the urine. When insulin therapy is started, the glucose is used or stored by the body instead of being dumped into the urine. The storage of glucose as fat is what causes the weight gain.

A person who uses insulin can safely lose weight without skipping insulin doses. This is best done with the help of a registered dietitian, who can design a healthy, reduced-calorie diet that doesn’t compromise blood glucose control. Since exercise is key to maintaining weight loss, a person wishing to lose weight should ask his physician for advice on starting an exercise regime or ask for a referral to an exercise physiologist.

When a child or adolescent desires to lose weight, parents should not hesitate to consult the diabetes care team. Even in a child who is overweight, weight maintenance, not weight loss, is often the preferred approach. But often, body image is the real problem, not body weight, and it’s a problem that should be taken seriously since it can lead to eating disorders and to both acute and long-term diabetes complications.

Safe alcohol use. Alcohol can cause dehydration, which can contribute to DKA and HHS. However, alcohol can be consumed safely in moderation by many people with well-controlled diabetes. In most cases, “moderation” is defined as no more than two servings of alcohol a day for men and no more than one serving of alcohol a day for women.

To prevent hypoglycemia, do not drink after exercise or on an empty stomach. To prevent weight gain, remember to include the calories in your drink in your meal plan. People who take certain medicines, including metformin (brand name Glucophage and others), may need to limit their alcohol intake to prevent liver problems.

HHS. HHS typically takes much longer to develop than DKA. Studies have shown that HHS most commonly affects older people who either live alone or live in a nursing home, where their confusion may go unnoticed. Unfortunately, decline in mental status in an older person may be mistakenly attributed to “senile dementia.” Once considered an inevitable consequence of growing old, dementia is now known to be a pathological condition. Therefore, any impairment in memory, thought processes, reasoning, or language or any personality changes in an older person should be brought to the attention of that person’s medical provider. It is also important to take note of any symptoms of hyperglycemia or dehydration in an older person with diabetes.

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