From Edmonton, Alberta, Canada:
Although I'm a new diabetes parent I've had to learn quick. My stepdaughter's life depends on it. She has been classified as a level 1 brittle diabetic. She is 5 years old, her health has been fine and she is very cheery and happy go lucky, now she has always shown high levels 20+ even 30's or more (300-550 for those of you not in Canada), but lately she has been showing ketones of 2+ or black on the stick. She has no classic symptoms, and we hydrate her with juice and water which temporarily relieves the ketones, but with in 12-18 hours they are back. We have also increased her R by up to 20% of her daily dose. She is receiving 2 shots daily of NPH and R insulin. This has me and my wife and the diabetic team at the hospital perplexed. Any help would be appreciated, or at least the direction to head in.
All diabetes teams have patients like your stepdaughter. Sometimes it can get a bit depressing with nothing seeming to work for very long. But don't despair; it will come right in the end. Sometimes you can do too many blood tests and make too many changes to insulin which just causes confusion.
Agree on a plan with your team, stick to it and review progress regularly. At this stage the main aims should be to keep your stepdaughter feeling well, out of hospital and growing normally with reasonable blood sugars.
Additional Comments from Lois Schmidt Finney, diabetes dietitian:First of all, when her blood glucose levels are high and you hydrate her with juices, that will just push her levels even higher. Plain water is all that should be given. Sugar-free sodas might be used but water is best. The sugar in the juices can result in higher blood glucoses later on.
As far as the on-going high glucose values, is the insulin out of date? Who gives the shots and are you sure it is all going in? Are the sites being rotated? Have you seen a dietitian for a nutrition assessment and diet instruction? Is there any on-going infection? We had tried and tried to bring down a child's blood glucose and found she had a dental infection that caused havoc with their control, so when in doubt, check the mouth. Finally, I would keep a notebook that documents what is eaten and when, exercise levels, etc and discuss that with your team. Once you discover what is going on, I would agree that it is best to back off, but I think you want to know what you are dealing with.
Original posting 8 Mar 1999
Additional comment added 24 Apr 1999
Posted to Hyperglycemia and DKA
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