I am a LTC nurse and sent a pt to the ER today she has ESRD, Type 1 DM, non compliant with diet. Yesterday was fine. FSBS are up and down. This am she was SOB, face swollen with periorbital edema, pale and tachy all other Vital signs were stable. She said she was in DKA because this had happened several times before. After she left the facility for the ER we found 2 dirty needles/syringes with suspicious brown material that looked like Heroin. My question is could the Heroin(if in fact that it is heroin) cause DKA or hyperglycemia?