I don’t know if it was a 24 hr virus–or food poisoning…but myself and my 2 boys (ages 1 & 4) have been vomiting about 24 hrs. This happened around Saturday through Sunday. Everything seems to have subsided except for the fact that my T1 4 year old hasn’t had a meal spike in days. This is despite drinking sugary drinks, bananas, cereal, etc…(which would normally send him very high). He is eating meals now–but hasn’t required any bolus whatsoever! In fact, we have to keep shutting his basal off from his Omnipod to keep him from going too low. His target is 180 (due to his young age) but we are having trouble keeping him about 80’s.
don’t hesitate to seek medical support, is there any Dr that could help?..what you are doing sounds right, reduce the insulin and increase the glucose/food.
you need proper medical help, The T1 people my be away from here.
if he hasn’t been eating he will have some diet ketones… I would not cut the basal totally as that will cause non insulin ketones, you may need to give more glucose to get the BG up and then give more insulin to clear the ketones and blood glucose. refer to the sick day rules. till you can get to a Dr. learning about this in a crisis is too risky
dehydration could be an issue too so give constant sips of sugar in water, so he doesn’t vomit it up
So, does this mean that you’ve had BG excursions below 70 mg/dl? It seems the intestinal virus has altered your 4-year-old T1D’s metabolism – to a hypo instead of hyper-BG bias.
If I had this problem, a T1D treating myself and not a child, I would mix up an emergency glucagon kit and inject small doses of glucagon to counteract low ranging BGs. I would not be concerned about numbers in the 80’s or even 70’s if they were moving sideways instead of down.
I’ve never parented a child with T1D but I think in general the recommendations to vigorously treat “anything under 80 mg/dl” as a threatening hypoglycemia can create more unneeded trouble. A CGM would be a valuable asset in this case as you could then reach some conclusions as to the trend of the BG.
I think shutting off the basal in the Omnipod is a viable tactic. The best thing you can do is check the BG a lot, every half hour if you have reason to be concerned. I would also stock some sugar ginger ale for your young one to sip on when trending low. Good luck!
Don’t worry about your child falling off of a metabolic cliff when this significant change in his insulin needs restores to his former status. Whenever I’ve dealt with viral and bacterial infections the restoration to normal needs has been relatively slow and gentle.
It is not prudent to suspend all basal in someone who is sick. DKA can set in quickly when there is no circulating insulin, you want to make sure there is some level of circulating insulin.
There may be any number of things going on. He could still have messed up digestion. He could still be dehydrated. He may still be somewhat in a honeymoon and the “rest” from being sick let him store up insulin in his islets. If he is going low (< 70mg/dl) then you certainly need to treat that, but simply being in the 80s isn’t a concern into itself.
Thanks for the replies. He has dipped down below the 60’s a few times–but it seems as though any amount of carbs doesn’t bring him up like it normally would–only reducing the basal seems to work. He goes up to 80’s but continuously falls (until we shut off basal again). I usually wait until low 70’s before doing so. We use a Dexcom CGM and has been T1 for a few years now. I know DKA is a real concern and is not ideal to shut off insulin. Our endocrinologist has just said to keep giving carb liquids and cover when he raises high enough be able to–it just seems to be quite difficult as this point.
I haven’t tried protein because I wasn’t too sure if his stomach would handle it well, but maybe a bit of peanut butter will do. Thanks! I’ll give it a shot.
@Bradford1 can you reduce the basal rate on the pump by 50% or more? it will be easier and better than turning it off and on.
a real hypo is under 50 (kids it’s actually 40), so 70-80’s and even in the 60’s is within the safe zone.
I’m glad you got the endo and I would follow his advice and up the glucose
It’s not uncommon for kids with T1 to have issues absorbing carbs after a stomach bug. It can last from a few days to 2-3 weeks. You should contact your endo team for help with adjusting basal. Never completely shut off basal. If he’s tolerating food well, push carb foods & liquids along with protein.
yes, 70 or under is considered as a hypo and treat it. ( simple term to avoid confusion) children tend to have a higher safety range recommended, so they minimise the numbers of hypos. and I wouldn’t be surprised if endo’s set 80 as a min and treat it. they also set higher upper numbers. OP has 180
we use 70 for insulin T1,and to treat that number… so there is a safety margin and they don’t get down to true hypo levels
OP was concerned about the 70-80 level, I was telling him I would treat with glucose and seek medical help…I tried to reassure him that although low, it wasn’t severe. The fact is a true medical hypo is 50 for a male, 45 for a female and 40 for a child.
I’ve never heard this, and I really don’t believe it is that simple. People have much different needs and reactions. Could you please cite a reference for your statement?
Are you saying that a reading of, say, 41 in a kid is not a true hypo? I don’t think this is true at all. People can pass out at those readings. For someone who uses insulin a 70 can turn into a 40 within a matter of minutes.
A hypo is any number where your sugar stores go too low and you’re not getting enough glucose to your brain. It can be various levels for different individuals. But if I’m at 90↓ and I’ve been doing chores–there’s gonna be trouble–even more so at 90↓↓!
I agree, hypo symptoms are always treated and it doesn’t matter what number it is.
though getting the shakes at 90 doesn’t mean you are having a true medical hypo.
however.
( Medical) Hypoglycemia is defined according to the following serum glucose levels:
< 50 mg/dL in men
< 45 mg/dL in women
< 40 mg/dL in infants and children
If the cause of hypoglycemia is other than oral hypoglycemic agents or insulin in a diabetic patient, other lab tests may be necessary.
As Seaquist et al have noted, the ADA standard of ≤70 mg/dL (3.9 mmol/L) is an alert value, intended to provide a margin of error for the limited accuracy of glucose monitoring devices at lower glucose levels. Because this value is above the threshold for symptoms, it allows sufficient time for corrective action to be taken.
hypoglycemia
In principle, diagnosis requires verification that a low plasma glucose level (< 50 mg/dL [< 2.8 mmol/L]) exists at the time hypoglycemic symptoms occur and that the symptoms are responsive to dextrose administration.
A 4 year old boy should not have a bg less than whatever the doc, the parents, or most importantly the boy can tolerate. Hypo is defined for anyone who is suffering symptoms or is impaired. Kids are more likely to not be able to report symptoms or feelings. I’ve seen a kid bounce on hypo…NOT GOOD!
I’m tossing up some hope your kid is on the mend Bradford1.
lets read what I wrote @Bradford1 can you reduce the basal rate on the pump by 50% or more? it will be easier and better than turning it off and on.
a real hypo is under 50 (kids it’s actually 40), so 70-80’s and even in the 60’s is within the safe zone.
I’m glad you got the endo and I would follow his advice and up the glucose
and
yes, 70 or under is considered as a hypo and treat it. ( simple term to avoid confusion) children tend to have a higher safety range recommended, so they minimise the numbers of hypos. and I wouldn’t be surprised if endo’s set 80 as a min and treat it. they also set higher upper numbers. OP has 180
we use 70 for insulin T1,and to treat that number… so there is a safety margin and they don’t get down to true hypo levels
OP was concerned about the 70-80 level, I was telling him I would treat with glucose and seek medical help…I tried to reassure him that although low, it wasn’t severe. The fact is a true medical hypo is 50 for a male, 45 for a female and 40 for a child.
