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From Canyon Lake, California, USA:

My 5 1/2 year old son has had type I diabetes since age 2. About once a year, he gets a nasty flu in that he has a sore throat, cough, runny nose, and then vomiting. His ketones are always large when this occurs. Last time this happened his endocrinologist gave him phenergan to prevent him from vomiting. He is currently experiencing this flu and finally, after 24 hours, his ketones have gone from large, to medium, to small, to none. But it terrifies me when he can't keep any liquids down, or absolutely refuses any liquids. What else can I do to get rid of the ketones quickly? It makes me want to get trained for administering an I.V. His doctor does not help much (we have an H.M.O.).


Illnesses like the flu put a stress on the body, especially when someone had diabetes. Most of the time, this stress will require that the person have more insulin than usual. This is true even if your child is not eating. There are some general sick day rules that most people with insulin dependent diabetes should follow. They are:

  1. Test more often. Blood sugars should be checked more often during illness; also check urine ketones each time your child urinates.

  2. Take your insulin as prescribed. As a matter of fact, extra insulin may be required.

  3. If not able to eat, try to get down approximately. 1/2 cup of liquids that contain sugar every hour. Examples are Sprite, ginger ale, etc. This does two things: it keeps you hydrated, and replaces the calories that you usually eat. If you have trouble keeping liquids down, try a spoonful every 2-3 minutes.

From your question, it is hard to tell if your child needs more insulin when he's sick (if his sugars are running high during this time, he does), or if he's getting ketones from "starvation" or not taking in his normal calories. If this is the case, really encouraging fluids with calories should help. Sorry your doctor is not more supportive.


Additional Comments from Stephanie Schwartz, diabetes nurse specialist:

Regular popsicles work especially well on sick days and go easily. It is extemely important to replace carbs on the meal plan. Pedialyte also now comes in tasteful freezer pops to use on these occasions. You need to talk with your diabetes care team and get guidelines for extra insulin on sick days if blood sugar levels are extremely high. If ketones are present and the blood sugar is in the low or normal range that may be caused by starvation.


[Editor's comments: See Sick Days for more information about what to do on sick days.

If you are getting no help from your physician, say so. If you get nowhere with explaining your concerns to the doc, change doctors! WWQ]

Original posting 6 Jan 98


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Last Updated: Tuesday April 06, 2010 15:08:56
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