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Sick and Puking

Discussion in 'Parents of Children with Type 1' started by lcblk27, Dec 5, 2011.

  1. lcblk27

    lcblk27 Approved members

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    This is the first time that Ethan has been really sick since his diagnosis in July. I know in the hospital they talked about sick days but I really dont remember what they said.

    So, how do I deal with this? He hasnt eatten since lunch today, he started throwing up around dinner time and has done so about 4-5 times. I gave him his usual lantus but Im unsure about novalog. I checked him before bed and he was 209, should I treat that? Im scared that since he's not eating that if I do he'll go down too low. He was low, 69, before lunch which is unusual. Also, when he's done throwing up and starts eating again, should I cover that food (depending on his BG of course)?

    So, I realize that its going to vary from child to child and illness to illness but I would appreciate any advice you can give.
     
  2. karen_rodney

    karen_rodney New Member

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    Hi there

    It is really scary when your child gets sick even worse when they have diabetes. When my son was sick I was told not to make him eat only when he feels like it. Just to keep a close eye on blood sugars and make sure he drinks heaps. If they go to high and you can't get them down seek medical attention.
    Hope this helped.

    Karen
     
  3. MamaLibby

    MamaLibby Approved members

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    You'll need to check for ketones if he's vomiting. The issue with tummy bugs are more lows...but he can also develop ketones from not taking insulin. Popsicles are what we always use on my daughter, because they're easy to eat, and get fluids and carbs into them, so you can bolus for the carbs and clear the ketones. If he can't keep that down, try small sips of regular soda every few minutes, and then bolus for those carbs once he's kept them down. Another option is mini-glucagon dosing. Using a regular insulin syringe, give one unit per year of age. you said he's 5, so you would give 5 units. this is a quick way to raise BG to get insulin in to clear ketones. Do you have a blood ketone monitor?
    Basically, keep an extra close eye on numbers, keep him hydrated and keep carbs and insulin in him. Hope that helps! I know how scary it is dealing with illness and D...I've been doing it this week and we've been at this for years! Hope he starts feeling better soon :)
     
  4. wilf

    wilf Approved members

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    209 is a good place to be if he's sick - if his Lantus pulls him down a bit you have a buffer. So don't give insulin unless he goes up significantly from 209.

    He should not go low as there is no bolus insulin working. He may drift down overnight from the Lantus, but as said at 209 you have a good buiffer and can keep an eye on things. For sure measure overnight (say 3 am) to make sure things are on track.

    Once he starts eating again, be aware that with a stomach upset it can lead to problems with absorption for days after he is feeling better. What that means is that if he eats some amount of carbs, only a small fraction of them will get absorbed. So if this is happening and you bolus normally he'll go low.

    Have him start with small portions and bolus very cautiously. Be prepared to even reduce the Lantus if there seem to be absorption problems..

    There is a good section on this in Type 1 Diabetes by Hanas..
     
  5. obtainedmist

    obtainedmist Approved members

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    Also, does your endo have an after hours number? I would check in with your team just in case so you know how they'd like you to deal with this right now.
     
  6. lcblk27

    lcblk27 Approved members

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    Thanks for the responses so far. We do have a blood ketone meter (just got it, yay) but we dont have glucagon.

    I will check his ketones and blood again and I was thinking about checking in with the on-call endo to get their oppinion too.

    Thanks again.
     
  7. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

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    Throwing up is complicated. You have to balance the lack of food, which causes "starvation" ketones with the risk of DKA starting ketones which can only be fought with insulin.. Generally speaking folks talk about the first puke being "free" but anymore requiring physician input. At the low 200's you obviously aren't in crisis, but you need to keep a watch on the bgs and the ketones. Do you have a bg ketone tester? Or do you have pee strips?

    Do you have a "sick day" sheet from the endo?

    Most of all you really want to look at the whole kid. Is he hydrated? Is he acting normally sick? is he able to drink and keep down liquids?

    Things to have on hand ... flat full-sugar soda, popsicles, honey, saltines...

    Not fun. If you can, call the endo for direction. Good luck!:cwds:
     
  8. lcblk27

    lcblk27 Approved members

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    We do have a blood ketone meter, he's at 1.1 and his BG is 158. I talked to the endo and she said there seems to be a 12 hour bug going around so hopefully by morning he'll be able to keep things down. He just had some water so Im hoping that stays down. He just kicked me out of his room so he could go back to sleep, lol, dont blame him.
     
  9. buggle

    buggle Approved members

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    The Pink Panther book is online -- here.

    Take a look at the sick-day management chapter.

    If his ketones rise, there's a chapter for that too.

    As a heads up, lots of kids' insulin needs fall way off with a stomach flu. Some kids go nearly completely off insulin after a tummy bug. Just keep an eye on BG over the next few days. If his BG drops, one thing that we've found helpful is hard candies. The child can slowly suck on them and get some sugar absorbed through the mouth and tummy and it can help to settle the stomach too.

    I hope everything goes ok.
     
  10. lcblk27

    lcblk27 Approved members

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    Thanks Rella, that looks to be a great resource, off to read. And thanks for the heads up as well, very good to know.
     
  11. roo'smom

    roo'smom Approved members

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    When they're sick with a stomach bug it's best to try to give fluids with carbs - regular soda and juice, gatorade, etc. This will help with the lower blood sugars and allow you to continue to give insulin to help with the ketones. Regular jello and popsicles are also good for this. Low blood sugars and ketones are a pain to deal with.
    Hope he's feeling better soon!!
     

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