DS is feeling really poorly, Type 1 diabetic.

[frangipan]

Hi, My DS is 10 and was diagnosed with type 1 diabetes last week (slow onset). I have already had some great advice and support from MN's, however, as this is all new to me I need a bit more advice if anyone can help.
DS came home from school early as he felt unwell, sore throat and lethargic. Dosed him up with some paracetamol and tucked him into bed. His glucose reading tonight is 30.2mmol, he has had 8 units of Lantus. How on earth do I get his glucose reading down, and should I test him through the night?
Any help is gratefully recieved.
xxx

Did to take him to hospital with unwellness and high sugar. Need to exclude ketones in urine

Sorry should have been Need to take him hospital

YY blood sugar of 30 he needs to go to hospital

You are taking him to hospital aren't you. Hate to be melodramatic but ketosis is a real and serious risk in Type 1 diabetics with unwellness and high sugars

Thankyou for your replies. I tested his urine with Ketostix and they were negative, I gave him a large glass of water and tested his glucose again 1 hour later, it was down to 20.3mmol. I tested him every 2 hours through the night and this morning we are down to 10.7mmol. which is as good as it gets at the moment. Ds is still eating and drinking but has black circles under his eyes like hasn't slept in a week! My DH is staying with him this morning so going to keep checking glucose levels and see how he goes , if they shoot up again we are off to the hospital! Once again thankyou xxx

Hello. I'm a type one diabetic and I'd say what happened to your son is completely normal and nothing to worry about.

When we get ill our bodies need more insulin to deal with the extra glucose our bodies are producing to fight the illness. Diabetics do not produce insulin on demand, but use injuected insulin. This means that when they are ill they need more insulin. Unfortunately, you only know this once your glucose is high.

High glucose in the blood is dangerous if it continues over a prolonged period o time. I mean, a reading of 30 is worrying, but not requiring an immediate visit to casulty. If it then gradually reduces things will be fine. If the levels do not return slowly to normal continue to rise for the next 24 hours, then it is appropiate to worry about ketones.

My advice would be to monitor your DS's glucose levels every hour for three hours after each meal then you can gage his reaction with some precision. If he consistently has high readings, you need to talk to your diabetes advisor about increasing his dose.

In time, practice will mean that you will be able to work out how much extra to give him by yourself. BUT since you are new to all this, you need to talk to your diabetes nurse about how to treat your son in this situation. For me, my experience is that I generally need 2-4 units more of insulin at each meal if I am ill. But I am an adult, your son will need much less. Don't just inject and see.

In the meantime, make sure he drinks plenty of water. And don't panic. Diabetes is horrible scary at first, but with time becomes merely humdrum.

hi frangipan, hope he's feeling better. Just wanted to say Lantus is a long acting insulin so no good to quickly bring down a high. Do you have some short-acting? Humalog, novalog etc? Presumably he is still in honeymoon so maybe you only have the long-acting. Definitely worth talking to your diabetes nurse about a "sick plan".

my levels go very high when i'm suffering from a virus...usually to the low 20s....the time to worry is if he's being sick and has high blood sugar as that could be DKA

agree with dilbertina, he needs short acting to rapidly bring down a high..i take novorapid which acts in minutes

his levels will settle down in time, it takes a while to stabalize

He was 31.2mmol last night but came down throughout the night to 12.1mmol this morning, we have Apidra for short acting insulin but wasn't sure whether to give him another dose as he'd had the 3 Rx'd doses already. Typical that it is the bank holiday weekend.
I'd like to thankyou for all of your help and advice, feels a bit like wading through treacle at the moment, mumsnet is brilliant. Did anyone feel a bit lonely/isolated when first diagnosed, even though it isn't me with the diabetes, I feel really down at the moment, not letting DS know obviously! He is happily stumming away on his electric guitar upstairs!

If he is not unwell then the high sugars sound like an issue wiht his regimen. When does he take his Lantus and his short-acting.
12 in hte morning - presumably pre-breakfast is still too high but it is early days and it can take a while to develop the right recipe.
If he is well I would continue to monitor sugars and ketones and the doses given and go along to gp on Tuesday with it all written day.

I would always take a child newly diagnosed to hospital if high sugar and unwell wiht or without ketones as ketosis can develop quickly.

If your DS has had another 30mmol reading or is constantly way above his targets when you test him this weekend, you ought to talk to someone qualified a not not us random strangers on the net. You're new to this and not sure what to do.

Since it is a bank holiday weekend, your best bet is to phone your out of hours surgery and ask the nurse for advice or ask him/her to get a doctor to give you a ring.

I hope it is a bit better now. I promise that you will get the hang of this soon. Try the diabetes UK website to see what support there is in your area.

I agree with most of what's been said. I've been a type 1 diabetic for almost 20 yrs and was diagnosed when I was 10.

I know you say your son has only been diagnosed for a week but I find it completely shocking that you were sent home without at least a diabetic nurses number. In the past 20yrs I have ALWAYS had a number of a nurse. I have probably never actually used it-but this is exactly the reason they are supposed to be there. Please bring this up when you do get through to someone x x

A blood sugar of 30 IS something to be worried about. It is true that the odd high reading will not do your son any harm and type 1's do (quite often) get high readings. A reading that high would make me feel absolutely awful. You are doing the right thing testing for ketones and giving your son (bucket loads) of water.

Lantus as has already been said, is a long acting insulin. I can tell from your posts that it isnot the correct dose/or even insulin for your son, regardless of his illness. It is supposed to have a 24 hr action, and I am guessing he takes his injection before bed. The reason your son is getting such high readings (apart from the illness) is the fact the lantus is running out towards the end of the day. This is a very common problem which again your doctors can help with.

Lantus is not supposed to help correct a high reading. This insulin is taken to keep blood sugars within range throughout the day if your son didn't eat anything. Apidra, as you know, is short acting. In fact it is A very new insulin and is VERY short acting. The best thing about it is that it is out of the system after about 2-21/2 hours. This is used to cover your sons meals. It is also the insulin he needs to inject if he needs to correct a high reading. How much does he roughly take with each meal? They (I hope!) will teach you and your son how to count carbs and calculate how much apidra to take and also a correction dose. For example, every unit of short acting insulin brings me down by 2.5mmols, so in my case I would need about 8 units to correct a reading of 30. (your son will have his own correction ratio and I'd guess it will be lower than this).

Personally (shoot me other mners) I would give your son an apidra shot if he gets a reading of 30 again. The poor mite will be feeling so poorly (in 20 yrs I have only ever had a handful of readings like that). I would give him just 1 unit of apidra and test his sugar every 20 mins for the 2 hours it'll be working for. This way you can SAFELY see how it is affecting him. If it drops below 5 in this time, or if it drops into single figures within an hour, correct his low by giving dextrose. I can promise you that if you test every 20 mins you will catch it. (I can also say that with a reading that high, the chances of your son going low on 1 unit are 0). He will probably need more than a unit but least you'll take the edge off the high.

Good luck! Type 1 is perfectly manageable-for me it's normal. I have just had a beautiful baby girl. Your son will adjust. There are some great websites out there thatcan help. Diabetes.co.uk and diabetes-support.org.uk are my favourite and full of helpful people. If you need anymore help please ask x x x

i still feel a bit lonely and isolated about my diabetes at times because i find there is a lot of ignorance about it...u know the idea that i can never eat sugar and the confusion with type 2

That said all my friends and those close to me are amazingly supportive...i never let it stop me doing anything and managed to survive school, uni, childbirth, major drinking sessions, sport, u name it!

Also i think cos type 1 is now much more common than when i was diagnosed in the 1980s there is much better support in place!

I think Windbags is probably right (abut injecting a couple of units). In the first version of my first comment that's what I advised. However, I then worried that as a newbie you wouldn't have the first idea about how much would be appropiate to inject (I never did). I didn't want to advise you to do anything that could cause you more problems. Plus, I have never come across the fast acting one you mention. I use Levemir and Novorapid. I did use Lantus, but hated the pen and -to be honest-it never got to grips with my system properly and I couldn't get my levels under control to my liking so I switched to Levemir.

In the long term my only advice is to get yourself informed. Read on line. Buy or get books out of the library on the subject. Encourage your son to do so too. Diabetes is scary when you don't understand what is happening or what to do. Once you do, it all becomes less problematic.

I am really surprised that you do not seem to have the number of a diabetic liaison nurse. When my DS3 was diagnosed at age 16, 3 years ago, the diabetic liaison nurse called regularly and altered his insulin doses. He is on Levemir and Novorapid. I got a lot of support here on mumsnet at the time. His sugars have never been in the 30s again - only at time of diagnosis. He was kept in a high range (19'ish) for a few weeks and gradually brought down. You definitely need to have access to RL professionals to manage the insulin doses appropriately. Eventually you will become the experts. My DS3 is 'too expert' at the moment. Very frustrating. He rarely tests but manages to keep his levels within an acceptable range when the hospital looks at his long term control. Even the consultant has given up asking him to test. He goes on how he feels at the moment and calculates his insulin doses. Consultant is baffled as to how he manages it.

Any update?

sorry I've not been back before now. I had spoken to our Diabetes nurse and his Insulin has been increased but his Glucose levels came down as he got better anyway. I was trying not to be neurotic and bother them every few hours especially as it was bank holiday weekend, which the nurse told me off for
Thankyou for your help, I now know what to expect when DS is ill now. He has an infection in the tip of his finger at the moment ( he has antibiotics) and even that sent his readings back up.

www.childrenwithdiabetesuk.org/news/ This group helped me hugely when my daughter was diagnosed Type 1 seven years ago. Loads of information on the site and a great support group. PM me if you want a chat, my DD is 10 and uses an insulin pump but has been on a couple of different insulin regimes in the past. I remember feeling overloaded and scared following diagnosis, things do get better.....hope your son is feeling better.

Hi, Summatontoast... please can you tell me more about the insulin pump.... my son was on twice daily injections and moved to as and when you eat and the doctor is now suggesting insulin pumps...
how is her hba readings.. his were fine for two years ( honeymoon period) and then slowly crept up to 10.8 and this month for the first time in two years have gone down to 8.8 need to reduce it some more. How is pump helping? Any problems with it?

Coming to this late after my hols, but I'd totally second the children with diabetes group advice. I found them when my son was diagnosed 3 1/2 years ago.
He is now 11 and has an insulin pump which means that he can eat and do what he wants, when he wants. It's so much more flexible than mdi. We are also paying for continuous glucose monitoring, which has opened our eyes to his fluctuating levels.
Ruby, the pump gave us our lives back, I would urge you to do what you can to access one. Come onto the children with diabetes uk mailing list and talk to us about it. I'd suggest you open a separate gmail account to deal with the amount of post though!