"We Can't Kill Your Mother" and Other Stories of Intensive Care
by Lawrence Martin, M.D.
Table of Contents

NOTE: "We Can't Kill Your Mother" and Other Stories of Intensive Care can be downloaded in its entirety as an e-book from 1st Books Library ($4.95). The book can also be ordered in trade paperback format for $13.50. For purchasing the e-book or print versions, please go to 1st Books Library and enter part of the book's title or the author in their search engine. Below are the first few paragraphs of TOO MUCH SUGAR, TOO LITTLE HISTORY

On morning rounds Peter Mance, one of the interns in MICU, presented a 30-year-old woman admitted the night before with diabetic coma and ketoacidosis. The patient had developed gastro-enteritis two days earlier and stopped taking her daily insulin injections.

Dr. Mance had stayed up with his dehydrated, acidotic patient most of the night, balancing her blood glucose and acid levels with the proper amount of insulin and fluids. Before the insulin era she would probably not have survived hospitalization. Now modern medicine and a conscientious intern had changed her condition from critical to stable in less than 12 hours.

In diabetes the body's normal supply of insulin is either absent or deficient. Without insulin, a hormone made by the pancreas, glucose cannot enter the cells and be used as energy. Without insulin glucose accumulates 'outside' the cells, in the blood. Depending on the severity of diabetes the blood glucose level may range from normal to over 10 times normal.

Ketoacidosis, the most extreme state of uncontrolled diabetes, results from a sudden and severe lack of insulin; glucose builds up rapidly in the blood, to dangerously high levels. To forestall starvation the cells turn to abundant fat as an alternative fuel. Metabolism of fat, less efficient than that of glucose, causes a buildup of harmful acid products called ketoacids hence the term diabetic ketoacidosis, or DKA. The hallmark of DKA is an excess of acids and glucose in the blood.

DKA patients are very dehydrated because the extra blood glucose spills into the urine along with a large amount of the body's water. Glucose, a type of sugar, is not normally present in urine. 'Tasting the urine' was an early way to diagnose diabetes (not a test of modern medicine). The full name of the disease is from an early description in Latin that referred to the urine: diabetes (to pass through) mellitus (honeyed).

Dr. Mance's patient was a 'textbook' case of DKA. Not every MICU patient has to have triple organ failure or present ungodly ethical dilemmas. This patient, at least, presented a straight-forward problem amenable to therapy. She also provided an opportunity to teach some medical history.