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Diabetes Bites Newsletter

children and dka

What is the Impact of Diabetic Keto Acidosis (DKA) on developing brains of children?

Small study results show long term impacts of DKA in children.

Diabetic Keto Acidosis (DKA) is the most life threatening complication of diabetes for young children.

What is Diabetic Keto Acidosis and how does it occur?

DKA is caused when the body has insufficient insulin, and therefore breaks down stored fats for energy. The bi-products of this process are called ketones and the accumulation of these acids in the blood can be damaging or even deadly.

In a recent small scale study the impact of DKA on the development of young brains was observed.

It was found that in children with diabetes (ages 4-9) who experienced a single moderate to sever case of DKA, leading to diabetes diagnosis, had observable difference in their brain structure and cognition vs. children who had experienced minimal ketone exposure. Children who experienced moderate to severe DKA showed increase white and grey matter, an indication of the body’s attempt to contain or repair damage structurally. These children also scored lower on cognitive, IQ and memory tests vs their peers who had not experienced moderate to severe DKA.

These effects highlight the critical importance of voiding DKA, particularly in children.

What preventive measures can people with diabetes take?

  • Monitoring for ketones routinely (Every 2-3 hours) when ill
  • Checking for ketones in times of unexplained high blood sugar
  • Monitoring for insulin pump site or occlusions
  • Avoiding dramatic reduction in insulin delivery or dosage (Often caused by severe carbohydrate restriction or secondary medication side effects) without physician approval and ketone monitoring and never skip long acting insulin doses unless directed to do so by your physician.
  • Seek prompt medical attention for the presence of moderate to large ketones and advocate for prompt treatment thereof from medical resources.

However another stark warning carried in these study results is that “diagnosis by DKA” is an unacceptable risk to the long term well being of children. At this time there are no required screenings for diabetes for children. Early symptoms such as weight loss, nausea or vomiting are often ignored by physicians or misdiagnosed as GI issues or the flu. Far too many young children are not diagnosed with type 1 diabetes until they are in the emergency room or ICU with DKA, and by that time the damage to their developing brain may already be done. Diabetes can be diagnosed in advance of such severe outcomes with routine random glucose testing and routine A1C screening. These are standard tests for adult physicals, particularly those at risk for type 2 diabetes. With risks so high for pediatric patients these screenings could easily be added to the routine physicals of children.

Fortunately the brains of developing children are amazingly resilient and their developing brains are able to build new pathways and correct for injury. Parents of kids who were in DKA at diagnosis should not view this data as a “sentence” of limited capabilities for their children. However, if children show difficulties in academic or social growth following an incident of DKA it may help facilitate getting them approval or coverage for added supports in these areas. What this data should do is remind us all that DKA prevention is important and that advocacy for improved screening and diagnostics must continue.

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