DKA and A1C


Are there any parents in here who had their child diagnosed while in DKA? If so what was the A1C on diagnosis and how long did it take you to get your child's A1C into the safe range of 7.0 - 8.5?



My 14yr old was diagnosed 2 years ago in full DKA. BG was over 900, A1c was 12.1 At his 3 month check up his a1c was down to 8. Then 3 months after that he was 7.1

Eric was in DKA. His BG was 567, and A1C at diagnosis was somewhere around 9.6 — his onset was pretty sudden, so he probably had only had high blood sugars for about 2 months before he started showing significant symptoms. We were using MDI for the first 10 months because of insurance issues, and given that he was so little (18 months old) we had to dilute his insulin to be able to give him the doses he needed. At his first 3-month endo visit, he was in the neighborhood of 8.6, if I'm not mistaken, but his endo had warned us that it would take some time to reduce his average BG level using diluted insulin & MDI. At his 6-month, we were at 8.1. We could not get it below 8 until he was put on the pump (he was about 2 1/2 at that time), but since then we've steadily held him between 7.5 and 7.9, and in recent months he's been slowly declining toward 7.0. Our best (and most recent) A1C was 7.2, and I'm hopeful that we'll get it down even further at his next visit in March.

I was really, really surprised just how much of a difference the smaller increments of dosing made with his upgraded pump, which we got last summer. You wouldn't think that being able to fine-tune a dose to 1/100 of a unit would have such a significant effect, but it has been since we got the new pump that we were able to break through the 7.4 mark, which had been our lowest A1C for the better part of 4 years of therapy. And since we did, we've seen slight decreases in A1C at each visit (WITHOUT excessive lows, that's a key point).

I'm curious as to why you're connecting DKA with A1C, though. They really don't have much to do with one another. DKA isn't something that happens because blood sugar goes high, it's something that happens when there's no insulin to shut off the "starvation response" of burning fat. And yeah, granted, it *most often* means you have high BG, but not always. A person with diabetes can develop DKA if they've got low blood sugar — say, if they have a GI bug and can't keep any food in them and have to back way off their insulin to avoid going low, then you have the really crappy situation of ketones + low BG, where you can't give insulin to stop the ketones because you would trigger a nasty low that you then can't treat because of barfing. [That's happened to Eric once or twice. It's why I always, ALWAYS get him vaccinated for the flu and keep a supply of Zofran in the house.]

Oh wow, I am glad your child is OK and very glad that the A1C is good! Very encouraging, thank you for sharing, and congratulations on the7.1. :)

Hi Elizabeth, I know they aren't connected. My son went into the ICU and that's when he was diagnosed. His A1C at diagnosis was 10.5 and his blood sugar was 880.....he was 17 months old. Our last endo visit (January 2014) his A1C was 9.3. We have another endo visit at the end of March. I was just wondering what people experienced after a DKA hospital situation with a high A1C. I am just seeing if I can gauge a pattern. I was curious if there was a trend...I know it's all relative. I am happy that your son has had such positive experiences with the pump! Your readings are amazing, congratulations!