High Blood Sugars & DKA—Spells Danger


Editor’s Note: This piece was verified by Dan DeSalvo, MD, an assistant professor of pediatrics in the Section of Diabetes and Endocrinology at Baylor College of Medicine/Texas Children’s Hospital. He sits on Beyond Type 1’s Science Advisory Council.

It’s been seven years since I lost my 13-year-old son, Jesse, to type 1 diabetes, yet I’m still asked often “what happened” so that other parents can somehow wrap their head around what happened to me to somehow prevent it from happening to them.

A standard statement is issued each time—a true statement—until I learn otherwise. The statement is, “You already know how to prevent death due to type 1 diabetes. Avoid extreme highs; avoid extreme lows.” Anyone living with type 1 diabetes knows it is not exactly that simple because as much as we try to manage this angry disease things can and will go wrong.

I remember the day my son was diagnosed and meeting with the certified diabetes educator (CDE). I remember all too well hearing the words, “You’re son won’t die from this.” I can also remember as I would guess most parents do that there is a significant amount of fear associated with the low blood sugars occurring and quite specifically while the person with type 1 diabetes (T1D) is sleeping. “Dead in Bed” looms for all parents and of course all individuals living with T1D. And yes, I do recall being told diabetic ketoacidosis (DKA) is also dangerous and that if my son were to have a sick day (ohhhhhh those diabetes sick days where I would religiously sit with my “Pink Panther” bible from the Barbara Davis Center—and thank you very much Peter Chase) to please do call them for help and go to the emergency room if need be.

As I trudge through the valley known as T1D one thing has become alarmingly clear—DKA is very dangerous. A high blood sugar mixed with a high A1C and ketones and you have created a very dangerous scenario. And even though we dread going to the emergency room for countless reasons, do you go to the hospital knowing it’s the best place to treat DKA? And I wonder … do you even know you are in DKA? Do you know how to test for ketones and own strips?

In my professional life I work with many adults with T1D. And the one thing I found most alarming was the fact that most of them have never checked for ketones when they are sick, nor do they own keto strips or any device capable of testing for ketones when in fact you can have a perfectly acceptable blood sugar reading and yet be in a dangerous physical space due to ketones being present.

The dreaded word “ketone.” How many of you have a clear understanding of it?

I give you three very real scenarios to think about it from my own personal experiences.

My friend Lauren recently embarked on yet another team trip for her ski team to Austria for an extended amount of time. Armed with her continuous glucose monitor (CGM) and a “share” link directly to my phone back home, she battled a rollercoaster of highs and lows over a few days. I’m not talking about a carnival rollercoaster. I’m talking Six Flags worthy coasting. From high back to low, Lauren responsibly (and yet reluctantly) continually checked her ketones. While her A1C is in range, she knew all too well that if she couldn’t keep eating and drinking to allow herself to take insulin, there was no way to get her ketones down and flushed out. With a gentle nudge from me she took a deep breath and had a friend drive her to the hospital—the last place she wanted to be, yet the only place she should be. She was treated with IV fluids and went home the next day. Her knowledge of DKA and ketones may very well have saved her own life.

Meet John. Diagnosed with T1D at the age of 19 and an active snowboarder, he never thought to own keto strips until just around his 30th birthday and only because of a conversation we had about adults not looking for ketones when their blood sugars were high and/or vomiting was occurring. So while we were on a ski trip recently on top of dealing with high altitude sickness he was battling the beginning of DKA. His blood sugars were on the lower end, yet he was throwing up and spilling ketones. I received the text, “I don’t know what to do.” I spent the evening coaching him on hydration and slowly bringing those blood sugars up so he could bolus insulin and bring those ketones down. He knew if he could not do that he would need to go to the hospital. His A1C is also in range and, therefore, with proper management he was able to bring it down safely.

Now let’s be real and talk about a teenager who has had T1D for 10 years. He’s burned out and he is sick of it. He just wants to be normal for a day. He’s been riding an A1C of 13 … or 14. The endocrinologist tells him (and his mom) that they need to bring that A1C down. Maybe the endocrinologist tells them too gently—or maybe too harshly. Either way both parent and child don’t take it seriously. After all they really only worry about those lows. They return home and his pump kinks a few weeks later. He ignores the “no delivery” alarm on his pump. He’s now 500. He is spilling ketones.

You see, what the endocrinologist failed to tell this mom …. What she failed to tell this son … is that the cocktail of a high A1C mixed with a high blood sugar and large ketones can literally put you on a faster track to the worst end result—death due to T1D.

Yes, it happens.

How many people are walking around right now with a blood sugar that is alarming “HI” on their CGM or meter and shrugging it as a bad diabetes day? When will we acknowledge as a community that type 1 diabetes is dangerous at times—so dangerous in fact that at it’s very worst, it can take your life?

I learned a long time ago—from School House Rocks in fact—that knowledge is power. Don’t be afraid to learn more and take good care of yourselves.

Read more about DKA and Ketones – The 6 Must-knows.

WRITTEN BY Michelle Bauer (Alswager), POSTED 02/10/17, UPDATED 10/06/22

Michelle has been a strong advocate in the “d” world since her son, Jesse, was diagnosed with type 1 diabetes in 2000 at the age of 3. After the sudden loss of her son at the age of 13, 16 years later she continues to advocate, educate and push the envelope in her son’s name. Michelle is the founder and executive producer of the documentary The Science of Inspiration: Diabetes and Athletes—otherwise known as “Triabetes”—about 12 athletes with diabetes completing an Ironman triathlon. Her diabetes credits include working as a moderator on the JDRF Online Diabetes Support Team, as an executive director for two diabetes organizations, as the executive director of the org that created Riding on Insulin with Sean Busby, and she also participates each year in the JDRF Ride to Cure Diabetes. She is currently a columnist for dLife, the number 1 diabetes-advocacy website as well as a new contributor to A Sweet Life. In addition to spending a lot of time on her road bike, Michelle is a two-time IRONMAN finisher (in fact she raced with the ROI Endurance Team at IRONMAN Wisconsin 2015). In her spare time she also works with other families across the world who have lost their children to type 1 diabetes. Michelle resides in Madison, Wisconsin with her children Samantha and Joey.