Treatment of Pseudonormoglycemia
Pseudonormoglycemia is diabetic ketoacidosis (DKA) with falsely normal glucose readings due to severe hypertriglyceridemia, and treatment requires standard DKA management with intravenous insulin and aggressive fluid resuscitation, not glucose-lowering therapy. 1
Recognition and Diagnosis
The critical first step is recognizing this rare but life-threatening condition:
- Check acid-base status, urinary glucose, and ketones in all diabetic patients who present unwell with normal blood glucose levels 1
- Severe hypertriglyceridemia interferes with glucose measurement, causing falsely normal readings despite actual hyperglycemia 1
- This condition has been reported in both pediatric and adult patients with type 1 diabetes 1
Acute Treatment Protocol
Immediate Management
Treat as standard DKA regardless of the glucose reading:
- Initiate intravenous insulin therapy immediately - this is the cornerstone of treatment 1
- Provide aggressive intravenous fluid resuscitation 1
- Monitor blood glucose every 1-2 hours initially, then every 4 hours once stable 2
Key Treatment Principles
- The acidosis and hypertriglyceridemia resolve with insulin therapy and rehydration 1
- Do not withhold insulin based on the falsely normal glucose reading - the patient has DKA and requires standard DKA management 1
- Continue insulin infusion until ketoacidosis resolves, following standard DKA protocols 3
Critical Pitfall to Avoid
Never delay or withhold insulin therapy based on a "normal" glucose reading in a patient with clinical DKA - the glucose measurement is artifactually lowered by severe hypertriglyceridemia, and the patient requires immediate DKA treatment 1. Assessment of urinary ketones and acid-base status takes precedence over the blood glucose value in this scenario 1.
Post-Resolution Management
Once the acute episode resolves: