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Question:

From California, USA:

I have a nine year old son who for the last two days has been showing large ketones in his urine in the morning. His blood sugar in the morning has been elevated for the past two weeks (200-360). I give him extra Regular and am basically "chasing" the ketones away. I don't like doing this but am forced into the position because my insurance doesn't take effect until Feb. 1 [one month from now]. He is on three shots a day. He takes NPH and Regular in the morning, Regular at dinner and NPH at night. His blood sugars are normal during the day. Last night he had a reading of 44 at 10 pm, but when he got up this morning it was 360 and showed large ketones. Any suggestions?

Answer:

The most probable explanation for the changes you describe is that your son is getting hypoglycemic in the middle of the night and that the high blood sugars on waking reflect a rebound. Without knowing what his weight is, it is hard to be sure; but it looked as though his total dose of insulin was in the upper range of normal anyway so that if he has recently become involved in vigorous exercise this could explain the change.

You need to talk to his diabetes team about this as soon as you can; but in the meantime there are some things to do.

First of all, you need to set the alarm clock and do a few blood sugars between midnight and 3 a.m. Then at bedtime see that he has a substantial snack that contains protein as well as carbohydrate say cheese and crackers. There are some proprietary products like Nite Bite and others that you could use; but they are relatively expensive. If these steps don't solve the problem within a week you will need to change the insulin, if it hasn't been changed already: Perhaps the nurse-educator on the diabetes care team will talk to you even if the insurance is not yet in force.

It is still all right to use a sliding scale for the Regular insulin in the morning but hopefully major adjustments will no longer be needed.

DO'B

[Editor's comment: I'd urge you to definitely call your future Diabetes Team, even though the new insurance isn't yet in effect. If it's a Diabetes Team that your son has been followed by previously, they should be willing and able to give you some simple advice over the phone about changing insulin doses (that isn't appropriate for us to give over the Internet).

If he's new to their program, you might need to schedule a "brief new patient visit" (which is a technical term for billing purposes) that you'd have to pay for out-of-pocket, unless they're nice enough to see him at no charge. WWQ]

Original posting 6 Jan 97

  
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Last Updated: Tuesday April 06, 2010 15:08:52
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