[mark-TN]

They don’t specify what “highly elevated blood sugar level” means. Even though his blood sugar was “highly elevated” (what ever that means in this case) after who knows how much time had elapsed, this does not mean that his blood sugar was not dangerously low at the time of the incident. For example he may have gone low from a meal bolus that was a bit too high, or maybe his food had not digested yet because the meal was delayed in some way. Anyway, he becomes low (for what ever reason) and extremely disoriented causing the erratic behavior and the accident. The shock of the incident would release large amounts of stress hormones. If his meal bolus was wearing off, and with the stress hormones being released, this would set up a situation of a low level of circulating insulin. When this happens the pancreas will release glucagon causing the liver to release glycogen, raising blood sugar uncontrollably until insulin levels are brought back up to normal. A low level of circulating insulin can cause extremely high blood sugar levels as the liver holds about 100g of glycogen. In a average person 1g glycogen will raise blood glucose by about 5 mg/dl, so this could account for a 500 mg/dl rise in blood sugar from the glycogen alone. With low insulin gluconeogenesis would also occur, which would raise blood sugar even more. Like others have said, barring other medical issues, his behavior sounds much more like a low blood sugar than it does a high blood sugar. The high blood sugar explanation just does not make a whole lot of sense to me.

Mark