Today, the BBC reported “a shocking number of children being rushed to hospital each year with potentially fatal complications of diabetes” in an article entitled “Better child-diabetes care urged.” The complication at issue here is Diabetic Ketoacidosis or DKA (which develops when you have too little insulin in you blood), and it is affecting more children than any other subset of patients affected by diabetes. There are an estimated 25,000 children with diagnosed type 1 diabetes in the United Kingdom, and the BBC reports that there were 13,465 cases of DKA from April 2008 through 2009. A quarter (3,300) of these cases were children and young people. Why?
What the BBC doesn’t tell us is what percentage of the 3,300 were undiagnosed when they were brought into the hospital emergency room. People with type 1 diabetes often recount diagnosis by discussing the blood sugar number which led to its validation. “850″ “700″ “1012″ are some of the blood sugar numbers that have been recalled by patients I know (mine was 960) who might not remember much about their first day of diabetes except for that number which may indicate DKA. The blood sugar level of a newly diagnosed type 1 child or adult can often hover around 1000, far above 250 mg/dl, the level at which DKA can begin. (Normal range is 70-120 mg/dl)
Just what is Diabetic Ketoacidosis? The Mayo Clinic is a useful tool for understanding diabetes and diabetes complications at a very basic level and offers patients a FAQ sheet explaining causes, symptoms and prevention. More weighty definitions can be found from other sources, such as medscape:
DKA is a complex disordered metabolic state characterized by hyperglycemia, acidosis and kentonuria…ketones are acids that build up in the blood and appear in the urine when your body doesn’t have enough insulin and are produced when fat cells break down in the blood. When the accumulated ketones exceed the body’s capacity to extract them, they overflow into urine (ie, ketinuria). If the situation is not treated promptly, blood serum levels become acidic (ketoacidosis) – this is when shallow breathing usually begins to offset high levels of carbon dioxide in the blood. Other symptoms include thirst, nausea, vomiting, abdominal pain, confusion and shortness of breath. If untreated DKA can lead to coma or cerebral edema. Anywhere from 1-10% of all cases are fatal.
There are a few issues here which the BBC hasn’t adequately covered: aside from the the report stating that many families find it hard to access diabetes specialist care, there is no mention of General Physician education and awareness about detection of type 1 diabetes, what the symptoms of diabetes are (although they do describe symptoms of DKA) and where to go for help.
Finally, it is harder to detect DKA in children because children (and teens) are undergoing normal physiological processes (growing), which may frequently require adjustments of clinical management of diabetes. Hormonal and psychological changes during puberty may be critical in conditioning management. Winter colds, flu and other common illnesses may also destabilize control. But essentially, vigilance and routine blood testing and insulin treatment for the diagnosed type 1 child with diabetes can and should help prevent diabetic ketoacidosis.
Diabetes UK, the charity who reported the figures to the BBC, was sited as saying that the rise “could be blamed on children being diagnosed later” (maybe too late is a better way to put it? or because diabetes was undetected?) or perhaps “a failure to manage their condition properly once a diagnosis had been made.”