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Re: [IP] DKA question--please help!!

In a message dated 5/12/98 3:04:49 PM Eastern Daylight Time,
email @ redacted writes:

<< he is really worried about going into DKA.  I told him
 that I don't think he could go into DKA at 250 but I would like to offer him
 more reassurance.  Do any of you know if there is a "threshold" at which DKA
 can occur??  I suspect he is feeling bad because his body isn't accustomed to
 that high of blood sugars and he's worrying about it and mentally making the
 problem worse.  About 30 minutes after his last injection, they checked and
 his blood sugar had come down from 250 to 230 so I think he's going to be OK.

Mary Jean....I will be lectureing about this in the AM to a group of nurses,
so i hpoe this helps:   Surgery creates a lot of stress to the body and stress
hormones will rise and increase his insulin needs.  You are right that he will
probably not go into DKA, but a hyperosmolar hyperglycemic state can make him
feel terrible, along with the anesthesia effects, and the fact that he is not
eating.  The extra doses of insulin are to keep him out of a hyperosmolar
state where the BG could go as high as 800+.  For his own peace of mind, you
could have the staff check his urine for ketones, but that is not always
necessary if other lab work is being done, ie, electrolytes, hematocrit,
osmolarity.  It is however, recommended that the best healing takes place with
the BG under 180.  Now, don't get me into trouble with the medical staff for
telling you this, but it is well documented in medical books.  He may be
somewhat dehydrated from the surgical procedure.  You did not mention his age,
but aggressive IV fluid therapy would not be indicatedif he has any heart or
kidney problems.  the surgery has likely increased his insulin resistence and
he simply needs more of it.  Some elderly type 2 patients often need to take
insulin on a daily basis after major stress events like this,  when their own
insulin production deminishes over time. I hope this is helpful.  Keep us
posted on his progress.  My prayers for his recovery.

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