Son is having major BG issues after stomach bug & starting pump


#1

Hello Everyone

My son was diagonised on Oct 7th on this year, and is only 22 months old. The last two months brought us a cold and the stomach bug. The stomach bug landed us in the ER, and we soon found out that after the stomach bug your body does not absorb carbs and it can last for weeks. Even the docs did know that and were dosing my son way to high.

Before the stomach bug we had decent control 120-180 with a average BG of 150 per day. After the stomach bug it has been a little over a week, it has been a nightmare. We cant get him down at all anymore. We are slowly working back to our old I:C ratios (not there yet), but I really think his basal is off.

Before starting the pump he took 1.5u of Levemir in the AM and .5-.75u of levemir at night. We have increased the basal on the pump over the last few days since we cant bring him down to:

8am- 8pm - .09u per hour
9pm-7am - .035 per hour

He seems to drop a lot over night. Last night he was 201 at 11pm, and at 4am he was 115. This drop has always been like this even without the pump.

My question is, if he was on 1.5 + .5u of levemir any suggestions on basal setting. It is hard to get a > 2yr old to not eat. Just seems like nothing is working anymore. We have also noticed that the site on the upper butt seems to be slow to lower BG compared to injections in lower back and arms.

Could his too colds that he got back to back effected his honeymoon phase?


#2

When my son is sick his insulin requirement DOUBLES (at a minimum). If the BG is too high, just keep adjusting the basal/bolus rates until you get the sugars down…and don’t be shocked when you see the end result of how much insulin he needs while sick.

Regarding injection sites, some have indicated here that some sites on their body just don’t act as well as other parts when it comes to insulin saturation. Keep testing, if you find this to be the case then I’d say just don’t use the site.


#3

@T1DDad, so sorry to hear of your son’s diagnosis. Our son was diagnosed about 8 months ago, when he was 23 months old, so I feel your pain. It’s rough in the beginning, but it does feel more manageable over time.

I can’t give you specific basal settings but as to your last question – yes, it’s possible that an illness can disrupt a honeymoon. In kids as young as ours, the honeymoon typically lasts much less than in an adult – anywhere from 6 weeks to a few months is more typical, as compared to about a year in older people.

But I would also say not to count that honeymoon out – what you think is the death knell often isn’t. Soon after our son got on the pump, he had a ruptured ear drum. During that time, it seemed that no amount of insulin kept him below 250. We thought that was it, our honeymoon was over. But over the next two weeks his numbers dropped a bit, and then we were fighting lows about 3 weeks later and dropped way back on insulin requirements. Like @ClaudandDaye said, his insulin needs may double when he gets sick, only to drop back down. We’ve had a few other periods like that, where the insulin levels spiked for what seemed an eternity, and I was sure the honeymoon was over, only to have insulin needs drop back down again. They never quite go back down to the earlier levels, which I see as either evidence of the progressive decline of his beta cells, or as a marker that he’s growing and actually needs more insulin for that reason alone. But either way, we’ve been able to come back from all those periods with out-of-whack numbers and progressively get tighter control.

Other things to keep in mind: When running persistently high blood sugars, the beta cells can be stunned into inactivity, but some of them come winking back once blood sugar numbers are under control.

I know I cried buckets the first time it happened; I just mourned those little embattled beta cells so hard. Now I am able to be a bit more philosophical about it, but I still really really wish he could hang onto them just as long as possible.


#4

Also, what kind of pump are you using? The basal rates you indicated: 0.09 and 0.035 units per hour, would not be programmable on any of the pumps we’ve seen. For instance, the Animas Ping has increments as small as 0.025 units per hour but I think you can only go up by 0.025 unit increments, so neither 0.09 units per hour or 0.035 units per hour would be possible.

As a reference, the general rule of thumb is that basal insulin is often 50 percent of the total daily dose of insulin (TDD). This varies a ton from person to person, but as a first pass to start tweaking basal rates, I find it helps me make an educated guess for new basal rates. So I will often look at how much total insulin I gave over the day, divide it in half, then split it up for the day such that more of it is being delivered during the day and less at night.

An example for my son: a recent TDD = 8 units
so first gues: Basal = 4 units per day
First-pass basal guess:
6am to 7pm = .2 units/hr, 7pm - 9 pm = .4 units/hr 9pm - 6am = .05 units/hr

But as with everything, these are just examples of how we do it. Don’t take any of this as medical advice. Also, how aggressive you are at changing basal, ISF and I:C ratios depends on if you have a CGM. IF you are able to see his blood sugar levels in real-time, then it really does make it easier to make big changes without worrying about lows. Otherwise it makes sense to make changes very conservatively, always on the lookout for lows.


#5

Two big issues to be watching carefully when sick, especially a GI illness: Insulin resistance increases because of cortisol and other hormones that increase as a part of the immune response, and 2) digestion gets very wonky and unpredictable.

The consequence of #1 is it will take more insulin to do the same thing as before: Cover carbs eaten, correct elevate BG. The solution to this is just to keep correcting, correcting, correcting until the BG comes down. I personally would not advise changing IC or Correction Factor settings in a pump, because these issues are dynamic, so you could find yourself with the settings working today, but too much tomorrow morning, then proper again in the afternoon. Too much risk of too much insulin and going hypo. Better to fight the high down when you’re sick.

2 results in a different, and more serious issue that I’ve been posting about here recently. The time after eating before carbs start to hit blood can be all over the map, even never being absorbed but instead vomited up hours (even many) later. As such, pre-bolusing, or bolusing “blind” at all (that is, before there is some indication the carbs are being digested and absorbed) is risky. The risk is really serious, because if you bolus, and then find your not absorbing what you eat, you have no good way to get sugar into you if that insulin now takes you hypo – whatever you eat or drink to counter the low will not be absorbed!

So, when sick like this I always wait for my BG to start to rise before I bolus to cover the carbs I ate. The trade-off is I wind up with higher spikes, peaks, and average BG while I’m sick, but it’s not causing any damage or problems at all as long as I’m working to keep it controlled, and its just a few days or a week or two.

So, in summary, when sick sugar-surf, and don’t pay any attention to the barrels of insulin you have to use to do so. It’s par for the course.


#6

Thanks Dave26, don’t get sick often, but I’ve
flagged your post since it contains a excellent info. :+1:t2:


#7

My son was diagnosed in August 2018 at age 14 with Type 1. Ever since then he has done excellent at controlling his blood sugar using 20 units of Levemir each night and bolusing 1 unit for 15 carbs at mealtime with Novolog pens. He started wearing a Dexcom G6 in September and has done well with that. He also just started the Omnipod pump last Tuesday. He seems to still be in his honeymoon phase.

Well, last week the flu hit our household. He started feeling bad on Friday. He was really not eating much except for a few white crackers here and there and sipping on grape juice throughout the day. I was watching his blood sugar constantly to make sure he didn’t go too low. I temporarily suspended his basal rate while he was not eating much and he was not bolusing either because he wasn’t eating much at a time. His number stayed pretty much flat, reading between 80-115 the entire time. He started to feel better by Sunday and was eating regular meals. I had him on only 25-50% of his basal rate and at times no basal at all, and his numbers were not going up like normal after he ate regular food. I waited an hour, then 2 hours to see how much they would rise to see if we needed to bolus and they barely got to 120 from a starting before-eating number of 99. He also started taking Oseltamivir (Tamiflu generic) on the Wednesday before he started feeling bad as a preventive since he had been exposed to the flu through me. He also took Tylenol for 2 days when he was sick to bring a high fever down.

I cannot find much information on this online. I can find tons of information on T1D’s going really high when sick, but not much on going low and not needing insulin at all. I have talked to his diabetic educator about it and I am going to call his endocrinologist about it today just to see how this has been dealt with in other patients. I just wonder how long it will take for his body to need his regular doses of insulin again? Also, his body seems to be not going as high with the carbs he is eating as it used to. That just seems odd. I wonder how long it will take for his body to process carbs the same as well. I would love to hear from anyone who has been through this same or similar situation.


#8

Stomach bugs can affect BG’s differently than say a cold. He’s probably still a little sick even though he feels better. He may not actually be processing a lot of what he is eating which would explain his odd BG’s.


#9

Yes the thighs are slower absorption also. The stomach is the fastest. Drops over night are very common. It’s good to just keep records and make sure that you know everything will be okay. I’m sure you know this and do this. I also had a stomach bug or flu that was at least a few days and even without eating and taking much more insulin than I would if I wasn’t eating, my blood sugars were higher than normal. This can be tough, because I can’t tell you what to give because of his age. It would obviously be different than me. I think i understand what you’re saying about eating though. The doctor should explain how many units to cover this much and how much to add due to the illness. Insulin doses when I was beginning I was told not to adjust too dramatically but gradually day by day. Never adjust more than 4 units per dose of the bolus or basal in one day from the next. I also understood honeymoon period as something not everyone gets but if you do get then there’s at least a chance that the disease will get better and you may go back to being a non-diabetic. But if you’re giving him insulin then he is not in a honeymoon phase, because otherwise he wouldn’t need insulin. But perhaps it’s explained differently today. Everything though should be based on what he eats and how his sugar levels are though. The doctor would be best, rather than just guessing. I’m sorry you probably already know all this. I hope he feels better and is back to normal in no time.


#10

This is an older discussion with good info about sick days/stomach bugs.

In addition to the video linked in the discussion, here’s a link to a slide deck Dr Ponder used for a parents’ webinar several years ago. A couple of slides have good lists of foods/liquids to use during illnesses.

I don’t have links readily available to info on carb absorption during a stomach bug, but my daughter has had more than I can count over the past 10 years. We can see carb absorption affected not only during & after the illness, but also the day or 2 before onset of symptoms. Usually, she needs less insulin overall for 2-3 weeks after the bug. It’s fairly common, at least with kids.


#11

Thanks! This was very helpful!

Susan

tiaE

    February 6

This is an older discussion with good info about sick days/stomach bugs.

[Sick days, Pedialyte and correction questions?](https://forum.tudiabetes.org/t/sick-days-pedialyte-and-correction-questions/58911) [Type 1 and LADA](https://forum.tudiabetes.org/c/type-1-and-lada)

I have been working on improving our sick day kit for my 12-year-old T1D son. We have never had a bad sick day when he could not keep anything down yet. This prepping brought a few questions to mind. I am curious what people actually do in practical terms. These questions only apply to sick days when you are throwing up most or all of what you are taking in (common issue with kids of course). I am assuming you don’t pre-bolus before eating when you can’t keep things down? Stupid question I am…

In addition to the video linked in the discussion, here’s a link to a slide deck Dr Ponder used for a parents’ webinar several years ago. A couple of slides have good lists of foods/liquids to use during illnesses.

https://www.slideshare.net/slideshow/embed_code/key/b5SbVU6zpoWlyW

I don’t have links readily available to info on carb absorption during a stomach bug, but my daughter has had more than I can count over the past 10 years. We can see carb absorption affected not only during & after the illness, but also the day or 2 before onset of symptoms. Usually, she needs less insulin overall for 2-3 weeks after the bug. It’s fairly common, at least with kids.