Fever and ketones

Hi all, my 4 year old is newly diagnosed and has a 101.5 F fever with moderate ketones while she is asleep. BG is 213. What do I do? Tried pushing water if she is dehydrated. Do I wake her up to eat a snack and bolus? ANy experience is much apprecaited!!

My thoughts? She needs insulin to bring down the high number. If you are afraid to do that at night, wait unntil morning, so you can keep an eye on the process. Ketones will come down pretty quickly as her glucose levels regulate.

As newly diagnosed, please be aware that being ill can have dramatic effects on blood glucose. Most diabetics on insulin will require additional insulin when sick.

Did the doctor provide a correction ratio for you, i.e. 1 unit of fast acting insulin reduces glucose by 50 points? That is the number used to calculate how much insulin to use as a correction. Also, I find that I like to avoid food when correcting, especially when ill. The food really can interfer with the results.

Let us know how she does.

I don't know to care for younger kids with diabetes, but I do know that if she's ketonic, that means that she doesn't have enough insulin in her system. I'd suggest giving some insulin and keeping her hydrated, but I don't know about giving her a snack.

Being sick and dealing with diabetes is the worst. I hope she starts feeling better soon.

In addition to insulin and fluids, you should call your child’s doctor.

I am a T1 diabetic x 54yrs. When I was a kid and became ill, my doctor would push fluids to help with the ketones. What your daughter is experiencing is very common and it is hard when you don’t feel like eating and the sugars are slightly high (hers are 213 and still manageable). If you are afraid to give her insulin at night, let her be and check her at midnight. I would not push food since she can get sick and vomit. A couple of units of fast acting insulin would be fine before bedtime since her sugars and the ketones are going to be high due to the illness and the insulin helps to keep the sugars below 250-300. T1 kids tend to be very “brittle,” that is, unstable. Also, relax and be calm, kids can feel when one is tense. You need to be OK so she can be OK emotionally. Remember that what is happening will happen everytime she becomes ill.

Hope this helps!


Keep pushing fluids. You should call your endo. Most kids have a "sick day" plan for lowering blood sugars during times of illness.

Is she on a pump? If so, there is a setting that allows you to temporarily increase her basal rate to help clear out those ketones. On Medtronic pumps, you'd find it as the first setting in the "basal" menu — I don't know about other pumps, I've only ever used the Medtronic pump. Try increasing her basal insulin by, oh, 10%, and see if that doesn't help. I would do it during the day so you're not up all night worrying about whether it's going to make her low. Otherwise, keep the fluids going and call your doctor (endocrinologist, not pediatrician) to see what they want you to do. Snack & bolus if she says she's hungry, but if not, don't push it — giving her insulin only to have her throw up is a whole lot worse than having a mild high like the one you're describing. If they have not given you a sick-day regimen for increasing insulin to meet her needs during an illness like this, now is definitely a good time to ask for one.

You are all amazing, thank you so much!! Ketones are neg today :slight_smile: really appreciate all your wisdom.

Glad she's better! Water really aids lowering ketones & to a lesser degree BG. Know it's scary. Just FYI in case you test her for ketones in the morning--most everyone has low ketones in the morning simply from fasting overnight. Low ketones are of no concern.

Not sure why you'd want to wake her to eat with high BG.