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Suffering from Hidradenitis, diabetes and ketoacidosis. Uncontrollable sugar levels, repeated boils. Antibiotics not working

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Practicing since : 1980
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My daughter has severe hidrosadentis suppurativa and has been in and out of the hospital for the last two years. She also has diabetes that the infections trigger ketoacidosis. These last two rounds have been horrible. We have kept her blood sugar around 300 but the size, the drainage and the infections are just uncontrollable. This last time celluitis was noted on her chart. They changed her antibiotics but I do not think that they are working. Every 2-3 weeks either it is a topical boil (one that drains by itself) or one that she needs to go in and get drained. Any suggestions, recommendations, specialist that she should see?? We have been to infection specialists, dermatologists, gynocologists, etc
Posted Thu, 14 Jun 2012 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. Rahul Tawde 21 hours later
Dear AAAAA,
What I can gather from the details you have provided is that your daughter is suffering from type 1 diabetes and she is having repeated episodes of Hidradenitis suppurativa(HS) of axilla.You have not mentioned the age of your child and the tpe of medications or insulin she is on for diabetes. I have to confess that this condition is pretty complicated and may also be resistant to treatment.
There are some triggering factors for HS which you have to be aware of-like tight clothing,obesity, excessive sweating,application of deodorants and cosmetics, hot humid conditions and some drugs. There are some genetic factors predisposing to the condition and some times it can have an autoimmuune basis also. So detailed evaluation of the possible predisposing factors is mandatory. Presence of diabetes complicates the picture as infection becomes difficult to control in them. Your daughter needs to be on insulin and blood sugars will have to be kept below 200 unless she is very young.
Some lifestyle modifications can help- changes in diet avoiding refined carbohydrates, use of hydrotherapy, weight loss, warm compresses and maintaining good hygiene.
What we follow in our practice when the process becomes chronic and treatment resistant is wide surgical excision with removal of entire apocrine gland complex followed by an split skin grafting.
Management requires mutispeciality care including an endocrinologist, dermatologist, plastic surgeon and a physician who has expertise in infectious diseases and immunology. So I think you need to visit a tertiary care multispeciality referral centre and consult these specialists.


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Follow-up: Suffering from Hidradenitis, diabetes and ketoacidosis. Uncontrollable sugar levels, repeated boils. Antibiotics not working 2 hours later
We have done all of the above. Hydrotherapy is extremely painful to the open wounds. She takes Lantis and Novalog and her numbers are usually around 140, she has been on every antibiotics you can think of and percacet for the pain.

I tend to think that the stress this puts upon her is what is making it worse. Also, I was recently diagnosed with Spondyloarthritis which involves an arthritis gene HLA-B27. Do you think it could be related and should I have her tested for that? She had similar boils under her arms when she was about 14 or so. I am sure the diabetes contributes but is not a cause of unless it was triggered when she went into the diabetic coma (she was diagnosed two years ago). We are desparate for suggestions. Should she see an endocrinologist? The infection specialists basically said that there is nothing to do but keep treating the infections.
 
 
Answered by Dr. Rahul Tawde 12 hours later
Dear XXXXXXX,
She needs to be tested for autoimmune disorders, HLA B27 is one of them. HS could be related to autoimmune disorders - we have to test for them to confirm it. management will also change if it is related to autoimmune condition. She needs to be seen by an Endocrinologist. You need to discuss with him in detail regarding your concerns. Since you have tried almost everything I think now a more focused and aggressive multispeciality approach is required. Blood glucose levels will have to be brought down to lower levels.

Regards,
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Follow-up: Suffering from Hidradenitis, diabetes and ketoacidosis. Uncontrollable sugar levels, repeated boils. Antibiotics not working 2 days later
we have spent the last 3 days in the hospital. Her potassium levels are extremely low - 2.4, 2.9, 3.1 and now 2.3 again and that is with the potassium drip. How do I get the hospital to find out why rather than just fixing? She has surgery schedule to reopen 3 pockets (two from surgery and one drained by itself) but they say there is still too much infection and they need to cleaned out. Her grandmother died of kidney cancer. I am worried. Do hospitals have endocrinologists?
 
 
Answered by Dr. Rahul Tawde 15 hours later
They definitely have endocrinologists. It is very unfortunate that her condition has gotten so bad. Looking at her present situation its better you wait till infection settles down and she is out of this acute problem. After that evaluation for recurrent attacks can be done.
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