6 year old daughter sick, Insulin not working

Hello,

My daughter who was diagnosed 4 months ago T1 has gotten sick, our son got the flu and she might have it now. It is the first time she gets sick after the diagnosis and I am waiting to hear back from our endo but I am kind of desperate.

She has been high since Saturday night. Saturday night she hit 310, sunday was a bit better in the 200s and shes been like that since except for dropping into the 60s in one random moment after a bolus.

she had moderate ketones yesterday, we’ve given her plenty of water but shes “Stuck” in 250 since yesterday. We have almost doubled her bolus units and even that isn’t doing anything to bring her down.

any recommendations will be greatly appreciated, we are giving her tons of water but not sure if we should just give even more insulin until she comes down…I would rather deal with her being low and sucking on glucose gels a bit than the constant waiting for the BG to come down and nothing happening.

Thank you,

LB

I am so sorry to hear that. I don’t have a kid so it’s unknown territory for me. So scary!
Hopefully someone will come along that can help you better.

I can just tell you when I was sick it was a real challenge to deal with my blood sugars. They just like to stay high when sick. I stayed stuck around 250 a lot too. But before I was properly diagnosed I know 250 and 300’s were normal numbers I hit in a day with no detriments, but I didn’t have any ketones either.

Sometimes it’s just safer higher than lower? Don’t get me wrong, we all don’t like highs, and healing is better at more “normal” levels. But the problem with just keep giving insulin until you drop can mean a very nasty drop when it all decides to finally work. Out of stupidity I just did that last night with a dexcom arrow headed straight down and my number saying 65. It hit suddenly and fast. No fun!!!

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If someone has ketones and is running high, high is not safer. Ketones are a sign the body needs more insulin, and this is actually kind of typical for being sick. Often it’s hard to adjust for sick days without adjusting basal insulin, so you may either need to do that (and then keep an eye on it to reduce immediately once she starts getting better) or you’ll likely need to do a lot of extra injections around the clock to correct and compensate. If you haven’t increased basal insulin, more doubling the doses for corrections is not outside the norm.

As long as her sickness isn’t preventing her from eating, if it were me and I were dealing with high BG and ketones, I’d keep putting more insulin in (giving it time to work before stacking more) until she comes down, at the risk of needing to treat later lows and just being vigilant for those. That said, that’s why stomach viruses are so tricky—if she’s like that and can’t keep anything down, it’s much harder (and then I recommend seeking medical care sooner rather than later).

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When I get sick or when something drives my BG up (like last week after I had a shot of pneumonia vaccine) I crank my basal up to 120% or higher. Also give myself extra bolus at mealtime. Worst case it it is coming down too fast and you have to eat or drink something. I find this is much better than giving a normal “correction” and have to wait for four hours to see the effect and it probably doesn’t even come down nearly enough. Very easy and safe if you have a CGM. A little trickier if you only have pump or use shots. I have reduced my ave BG to 115 from 160 by eating fewer carbs, giving more insulin than I may need and if it starts to go low just eating some carbs which is always a treat.

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Thank you, we are going to increase the basal tonight…

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I feel terrible for you and her! I know when I am sick I have to take my basal to 2.5X normal, and add 30 - 40% to every bolus. It is a fight for sure, but it is the only way I can keep my numbers down. Hopefully she feels better soon!

(I would try # 1 for sure. #2. Probably not applicable to you. #3. Unlikely to be the cause, but anythings possible.)

Troubleshooting List:
1.) It is possible to buy a NEW bottle of insulin? (Has it overheated in a hot car or hot weather that just hit? Did it freeze in a refrigerator thats running too cold?)
2.) Are you using any tech (insulin pump)? If so, change the infusion set immediately.
3.) Is there any sugar/vomit on her finger tips before she tests? Make sure her hands are clean-ish. Are the blood sugar strips working correctly? If you use a different machine and a different set of strips, so you get the same number?

Does she look severely dehydrated?


Generally, people give pediatlye to kids without diabetes because they can get very dehydrated quickly compared to adults. However, pedialyte has sugar and will raise her blood sugar, so maybe try some sugar free Gatorade (Gatorade zero) or sugar free Powerade (Powerade Zero). This should help restore electrolytes.
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Important Note:
Diabetic symptoms of hyperglycemia OFTEN get confused with the flu. If she is not running a temperature, then I would take her to the ER tonight.

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thank you, I will read up on gatorade, we are not fans of those types of drinks (even before the diagnosis)…

The point is to restore electrolytes. Thats how you do that until they become unconscious. Then, its IV fluids. Its about restoring natural blood chemistry. Your blood chemistry can get out of wack if you give too much water. Nothing with sugar, though. Just some, not excessive amounts.

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I am also not a big fan of these types of drinks but like @mohe0001 stated, you should have some in the house. I have 4 bottles that are hands off bottles. Everyone in the house knows, don’t touch.
I am hoping your doctor has gotten back to you with directions. It is kind of amazing with all the instructions we get at diagnosis, ketones are a side note.
Fluids, insulin and some carbs are necessary to get the system back into sync. The insulin levels need to be increased dramatically, fluids increased dramatically and carbs are needed to stop the body from burning fat. The body needs glucose but not much.
I know you are probably on major alert and are testing all the time. If you feel things are getting worse, get to the hospital. Better safe than sorry! Once a person gets to a DKA state, it is so much harder to pull things back into line.
I am hoping for a fast resolution for all of you. And hopefully there won’t be a next time, but if there is, you will be better able to handle it!

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Please be careful with increasing basal, because if she suddenly recovers then you could be dealing with serious lows.

The best approach during sickness is to use bolus insulin and corrections to bring sugars down.

Please feed her lower carb while she is so high to minimize the impact of foods on bg.

Monitor BG closely as things can change quickly when sick, and also during recovery.

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Hopefully you either got it under control or got medical help.

It’s maybe too late for this event, but these sick day rules will stand you in good shape next time

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How is she doing?

thank you for asking, she is still sick. The DR asked us to increase 1 unit of tresiba and a bit of the humalog. I did buy her Gatorade Zero to make sure she stays hidrated and she thinks of it as a treat because shes sick (I never let them drink that kind of stuff).

she came down to 118 last night before dinner time which was a releve, it happened when her fever went down. I wonder if the body temperature/fever actually ruins the effectiveness of the insulin or if it was just a coincidence.

she came up to 264 in the middle of the night and now at 9am shes 221, we are going to correct her and give her breakfast. Its definitely the same Influenza B her brother had…crazy because we actually sent her brother to his aunts house to fight it off (which was sad for us-sending a kid away to not get the diabetic one sick, kinda like choosing one over the other but thats a whole other conversation).

Her brother was down 3 solid days and came back home on the 4th feeling fine so I am sure this will pass by the end of the week.

Thank you everyone for such good information, this site is really really helpful and helps a great deal with my peace of mind.

thanks again everyone.

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Thanks for posting this link, Jack. I learned a few things about sick day treatments and avoiding diabetic ketoacidosis, DKA. This caution about uninformed medical professionals looks like great advice.

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I also learned that adding insulin separately with a syringe using 5-10% of usual total daily dose (basal + bolus) if high BG and low ketones and 10-20% total daily dose if high BG combined with elevated ketones. This dose is recommended every 2-4 hours as long as BGs remain high. They even say that delivering the insulin intra-muscularly is desirable.

Another thing I learned is that the reduction of urine ketones can lag reduced BG by 24 hours or more. Blood ketones, however, are much more sensitive to blood glucose dropping back to more normal levels. Depending solely on urine ketones levels to gage increased insulin treatment can lead to over-treating insulin and hypoglycemia.

I strongly encourage readers spend some time carefully reading this sick-day guideline paper that @jack16 linked above. It’s well done and you’re likely to learn something important that you didn’t know before.

@lbmiami - I’m happy to read that your daughter is feeling better. Thanks for the update.

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I disagree, when the basal is insufficient it can require multiple larger and larger boluses before they are effective, which can lead to a huge crash. Increasing the basal slightly can make a huge difference and can actually be safer. However, it may be different on a basal like Tresiba where the effects can last for a long time vs. a pump, Lantus or Levemir.

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I agree that basal adjustments are usually necessary. Also while basal-driven lows are super annoying, they are usually slow and what I call “drifting lows” where you have a lot of warning (especially if using a CGM), vs bolus insulin-caused “driving lows” where blood sugar plummets quickly and needs urgent action. Also with Tresiba, if you need to quickly re-adjust, best bet is for the next dose, to underdose (so if you usually take 15u, you went to 16u, she’s clearly improving/blood sugars going down, do the next dose at 14u, then go back to 15u) in order to compensate for the very long tail and minimize lows (tho still keep an eye out and safest bet would be to go to bed that night a bit higher).

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Also, if you want a less artificial option for increasing electrolytes, a mug of broth with plenty of sea salt works just fine, if she’ll take that. I have a condition where I regularly need extra hydration and electrolytes, and I prefer that to sports drinks etc.

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The flu has been relentless this year. It’s still coming in the summer?!?! This was the worst flu year ever.

I also dislike sports drinks. I think they taste gross - medicinal. I only drink them when my BG is super high.

Hi,
I have a 7 year old daughter who was diagnosed when she was 3. I’m sorry your daughter is sick. Honestly that is one of the most stressful times for a parent with a diabetic child because its very difficult to normalize blood sugars. I saw all of the advice and it was very good advice the only thing is children’s bodies are very different from adults when it comes to insulin dosages. Pay very close attention to her when you increase or decrease dosages. When my daughter is sick I do increase basal and bolus but I do it in 1/2 unit increments. Even though she is 4 years into diagnosis she still produces small amounts of insulin so 1 whole unit can drop her from 250 to 60 in 2 hours depending on what she ate or how strong her virus may be. Fevers tend to make my daughter’s sugar increase and I definitely give her lots of water. As far as electrolytes go I have never given her Gatorade 0 but I did make the mistake of giving her pedialyte the first time she got sick after diagnosis and it definitely raised her sugars so I cut her measurements in half and added water. Now I use a brand called goeverly which are very good for diabetics because their drinks have electrolytes in them and are sweetened with stevia and no caffeine. My daughter drinks them a lot and loves the different flavors and they definitely come in handy when she gets sick. I also give her baths to combat the sickness and put a little Epsom salt and eucalyptus oil in her bath. The best way to help is to make the child as relaxed as possible . I hope she gets better I’m quite sure she will the virus just has to run its course but until then just keep her as comfortable as possible.

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