Honeymoon Hyperglycemia 8 yr old

[Walt1]

Hi Everybody ,
     Need help.  Son 8yrs diagnosed type 1 last May.  He has been over 500 for almost a week now.  Working with ped., endocr. & their office is calculating doses each day we call in.  Cant get it back down below 140 and always goes up to 4-500.  Son is out of scholl & sleeping a lot.  I thought if the doctors did not get it stabilized in a couple days he would be hospitalized.  He still home.  What should I expext ? Shouls I do something different ?    Any help appreciated very much. Thanks in advance,   Walt

[JDRF-Team-sgg]

I attempted to load this response Friday night, but something happened and my comment never appeared. I am a long-time diabetic, a healthy one who has been on insulin for 35 years since childhood with no damages, so I want to encourage Walt. If your son's honeymoon phase is ending, and his pancreas is ceasing its last functions, this is not a real problem once the new insulin regimine is set up properly. He may need more insulin, but this does not mean that he is "worse"... Just that he may need to inject more insulin to cover the carbs he eats than he used to. Keep working closely with his doctor to get the balance correct, and he will be fine. If keytones are high, you may want to talk to the doctor about hospitalization, but i do believe that nowadays most doctors feel that insulin adjustments for children or adults are better done at home with normal activity levels unless other health issues such as large amount of keytones force it to be done in a hospital. So you are doing absolutely the correct thing.

Has the doctor checked your child for possible other underlying causes for the high readings? Infection is a possible cause for highs, either viral or bacterial, and a blood test can determine if either are at work here. Also, allergies can cause some diabetics' glucose levels to rise sharply when exposed to allergins. I have an identical twin (also a type 1 diabetic) who suffers from allergies (I do not, oddly enough), and she comments that her glucose levels rise sharply when she is outdoors on high-pollen days, and she sometimes suffers sharp drops and becomes low when she finally comes inside the house and showers to remove pollens from her person. This is probably not the problem, but I thought it was worth mentioning. In my sister's case, Allegra has been resommended by her doctor and this over-the-counter medication seems to help keep her allergic reactions minimal and also her blood sugar more normal during allergy seasons.

Ups and downs will happen as your son grows to adulthood. Hormones, stress, illness, and a multitude of other things will cause glucose levels to change at times during his maturing years. So don't panic, but do keep close watch, and I encourage you to handle each situation just as you are doing now -- keeping close communication with your son's doctor and LEARNING from each experience. People who seem to live healthily as type 1 diabetics are people who eventually learn to adjust their own insulin doses to meet the requirements of life. At some point later on in his life, your son will be able to do a glucose test and figure out for himself exactly what his insulin needs are for the next three hours. This life with ups and downs does get easier as your knowledge of your son's body and how it reacts to different stresses in life grows. It will get better for all of the family! We do wish you the best.

[JDRF-Team-sgg]

I am not a doctor, but AM a long-time type 1 diabetic with an identical twin who is also a type 1 for 36 years, diagnosed at the same time, but with some different issues that cause highs for her at times. My twin suffers from allergies that I do not have -- she has horses and lives in a totally different part of the country than I do, and allergins to certain things cause her glucose levels to roar upwards while she is exposed to the pollens. This, and other things can cause sudden rises in glucose, and I believe that any long-timer who is highly educated about diabetes will tell you that things like this can cause highs (or lows) that appear seemingly out of nowhere. In time, we learn how our individual bodies react to things such as illness, stress, allergies, etc., and learn how to adjust our own insulin doses to cope with these fluctuations. Listen to your doctor's advice, take careful notes about what does and does not work, and if your child's ketones are hight, the ER is defitely a good suggestion.

While this sounds like the first time your child has experienced a rash of highs that don't seem to respond to the insulin, there is probably some underlying reason such as allergies or stress or virus that may be causing it. Also, your child may be ending his "honeymoon phase" of diabetes whereby his last pancreas cells may be ceasing to function. Don't panic, for once the dose is adjusted properly, he should be fine. You are doing absolutely what you SHOULD be doing --checking in with his doctor frequently and adjusting the insulin doses according to glucose reading. Unfortunately, increasing insulin doses takes time... you cannot simply increase by a large amount immediately, but need to adjust slowly in order not to overdose, which is more of an immediate danger than slightly elevated readings. If the glucose levels are lowering and then rising again, then keep working to try to get it within normal ranges as often as possible. If it is staying at 400-500 without any response whatsoever, then he may indeed need more medical treatment. He could have some sort of bacterial or viral infection which is causing the elevated glucose readings, and your hospital can do tests to find out whether he is attempting to fight off infection of some sort. If allergies are an issue, keep him indoors, and keep windows closed.

You will find in coming years that life as a diabetic or as a parent of a type 1 child is a constant learning process. There WILL be ups and downs, and you and your doctor are doing absolutely the right thing in communicating and working from glucose reading to glucose reading to try to lower the sugars. Obviously, if glucose readings are staying high, you may want to feed him a few less carbs than usual in order for his body to have less carb input to have to metabolize with the insulin. Your doctor should be the judge of this also.

Life after the end of the honeymoon phase is not so very different from before. If this is the cause of the high readings, then he should level out soon with a higher daily dose of insulin. As he grows and goes through puberty, there will be other very normal ups and downs. You must simply take each as it comes and try to normalize as soon as possible.

My twin and I both are very healthy long-timers with no damage from the disease, and I state this to offer you hope that your son can grow up to be healthy, too. Keep your chin up and keep checking and treating. And if ketones are high, don't hesitate to go to the hospital to help lower them and get him back on track. This is not a "last resort" means of treatment, for diabetics do frequently need to have medical help that parents at home just are not experienced enough to offer. Each year will teach you and your son more about what works for him and what does not, and it will get easier. One day, this routine will be just that: a habit that doesn't take up much of his daily focus at all. Please keep us posted as to how he is doing.

[jdrf team dm]

Dear Walt,

I am not a physician and am not qualified to give out medical advise, but I am a mom of a son that was diagnosed at 8 and who is now 27. We do depend on our doctors to help us with this disease and while I do not know all of the particulars of your son's case, if he were mine, I would take him to an E.R. sooner than later. Sometimes parents learn more about our children diabetes than anyone. I was told this by one of my son's first doctor's and have taken it to heart. This is only my personal opinion.

The fact that he is running such high blood sugars for even a week is problematic. When a person runs blood sugars this high they can experience ketoacidosis, which is an excessive amount of glucose in the blood. The results can be very damaging to his system and if continued can be life threatening. I truly do not mean to scare you, but these are pretty high blood sugars on a consistent basis that needs to be addressed. If you decide to take him to a hospital, please have him checked for ketones.

Please let us know what you find out. I know that your caring attitude and love will bring him through this. Type 1 can be managed and we are here for you. Keep in touch!

dm

[JDRF-Team-LRS]

As DM and Mr. Gatorade pointed out, 400-500 are dangerously high bg levels.  The issue is more the buildup of ketones in the blood stream (the ketoacidosis that dm mentioned).  

From your msg I cannot tell if his BG stays at 400-500 or if it gets there and then you can gradually bring it down.  BUy some urine test strips & do test for ketones.  If his level is high, get him to the ER ...

I would also question your insulin vials at this point.  It is still summer and is hot in many areas.  Just to rule out insulin that's been degraded by heat, you might try getting brand new vials of insulin.  Try to give him copious amount of water and onther non-calorie, non-caffeine soft drinks.  The water will help flush his system of any ketones.

Please do check back.  Oh, I'm also not a physician (none of us is, here) but have had diabetes for many years.  It's important to keep working with your doctor(s) now.  When the crisis is over, you can evaluate whether your current doc is the best one for you & your child to work with.

[Mr_Gatorade]

His blood glucose level is five times what it ought be.  He should most certainly be in the hospital.

Nick