Chickenpox

[Tom1982]

Hello all.
Daughter has chickenpox at the moment. It’s sent her BG levels a bit erratic. Anyone got any experience of this?

 

[Inka]

Were you given Sick Day Rules @Tom1982 ? Are her sugars high or just a bit ‘odd’? Is she eating and drinking ok?

 

[Tom1982]

Yeah it’s all confusing me a bit. She’ll go to bed with a BG of 8.0 for example and when we check in the night it’ll be 15. Don’t make sense. If her ketones are for example, 1.4 but her BG is 6.0 do we still correct???

 

[Lily123]

Illness has a habit of making BG numbers skyrocket - ketones of 1.4 are raised and I would recheck the BG and ketone level if you can

 

[Inka]

Any illness will often put blood sugar up @Tom1982 As she’s recently diagnosed, I’d phone for advice. Phone 111 and explain the situation, then, if necessary, speak to her team on Monday when you can.

 

[Inka]

Make sure she’s staying hydrated, and if she can eat that’s good. Let her eat ‘easy’ foods rather than insist on meals. If she’s not able to eat, what are called ‘starvation ketones’ can be formed (don’t worry - it doesn’t literally mean she’s starving) and they can confuse things.

I don’t know what Sickness Rules are appropriate for such a young child. I’ll tag @Sally71 and @Thebearcametoo as they’re both parents of children with Type 1 and are very knowledgable.

 

[Thebearcametoo]

You should have sick day rules (we have a printed sheet) but if you’re in any doubt at all give your out of hours diabetes team a call and they can talk you through it. It’s likely that you’ll get raised glucose levels so keeping an eye on ketones is a good idea (for BG over 16 at a time you would usually test such as before a meal, don’t worry too much if it’s an hour or so after eating whilst the insulin is still onboard). If ketones are over 1.0 you will have a guide for how much insulin to give to treat the ketones. Don’t forget insulin will go first to treating ketones and only then to reduce BG so you may still get high BG even with what feels like a lot of insulin going in. If you have ongoing issues with ketones then you may get the stage where BG is in target and you still need to treat the ketones. Just do the insulin suggested for the ketones and if necessary treat hypos as usual but as I said the insulin will go first to deal with the ketones so it’s only if you have prolonged ketones that you may come up against that. It’s likely that you’ll just be dealing with erratic high BG and ketones will remain low enough so don’t worry but do get a reminder of sick day rules specific to your child’s weight before you need them. Your team will be totally happy to have a call from you and it’s good for them to know that chicken pox season has begun.

For the actual pox there are various salves etc that can help and antihistamines can be useful.

 

[Tom1982]

You should have sick day rules (we have a printed sheet) but if you’re in any doubt at all give your out of hours diabetes team a call and they can talk you through it. It’s likely that you’ll get raised glucose levels so keeping an eye on ketones is a good idea (for BG over 16 at a time you would usually test such as before a meal, don’t worry too much if it’s an hour or so after eating whilst the insulin is still onboard). If ketones are over 1.0 you will have a guide for how much insulin to give to treat the ketones. Don’t forget insulin will go first to treating ketones and only then to reduce BG so you may still get high BG even with what feels like a lot of insulin going in. If you have ongoing issues with ketones then you may get the stage where BG is in target and you still need to treat the ketones. Just do the insulin suggested for the ketones and if necessary treat hypos as usual but as I said the insulin will go first to deal with the ketones so it’s only if you have prolonged ketones that you may come up against that. It’s likely that you’ll just be dealing with erratic high BG and ketones will remain low enough so don’t worry but do get a reminder of sick day rules specific to your child’s weight before you need them. Your team will be totally happy to have a call from you and it’s good for them to know that chicken pox season has begun.

For the actual pox there are various salves etc that can help and antihistamines can be useful.

That’s brilliant info thanks. Does a high BG cause Ketones or are there other factors at play?

 

[Inka]

The simple answer is a lack of insulin @Tom1982 As I explained above, you can also get so-called ‘starvation ketones’. How’s your daughter today? Did you find/get Sick Day Rules?

Information on ketones here:
https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ketones-and-diabetes

.

 

[Tom1982]

You should have sick day rules (we have a printed sheet) but if you’re in any doubt at all give your out of hours diabetes team a call and they can talk you through it. It’s likely that you’ll get raised glucose levels so keeping an eye on ketones is a good idea (for BG over 16 at a time you would usually test such as before a meal, don’t worry too much if it’s an hour or so after eating whilst the insulin is still onboard). If ketones are over 1.0 you will have a guide for how much insulin to give to treat the ketones. Don’t forget insulin will go first to treating ketones and only then to reduce BG so you may still get high BG even with what feels like a lot of insulin going in. If you have ongoing issues with ketones then you may get the stage where BG is in target and you still need to treat the ketones. Just do the insulin suggested for the ketones and if necessary treat hypos as usual but as I said the insulin will go first to deal with the ketones so it’s only if you have prolonged ketones that you may come up against that. It’s likely that you’ll just be dealing with erratic high BG and ketones will remain low enough so don’t worry but do get a reminder of sick day rules specific to your child’s weight before you need them. Your team will be totally happy to have a call from you and it’s good for them to know that chicken pox season has begun.

For the actual pox there are various salves etc that can help and antihistamines can be useful.

That’s brilliant info thanks. Does a high BG cause Ketones or are there other factors at play?

The simple answer is a lack of insulin @Tom1982 As I explained above, you can also get so-called ‘starvation ketones’. How’s your daughter today? Did you find/get Sick Day Rules?

Information on ketones here:
https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ketones-and-diabetes

.

The simple answer is a lack of insulin @Tom1982 As I explained above, you can also get so-called ‘starvation ketones’. How’s your daughter today? Did you find/get Sick Day Rules?

Information on ketones here:
https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ketones-and-diabetes

.

So lack of insulin makes

The simple answer is a lack of insulin @Tom1982 As I explained above, you can also get so-called ‘starvation ketones’. How’s your daughter today? Did you find/get Sick Day Rules?

Information on ketones here:
https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ketones-and-diabetes

.

Nice one. Why does insulin need go up when ill? We found the sick day rules. When it says check ketones every two hours, is that at night too?

 

[Thebearcametoo]

Insulin is like a key that unlocks the cells in the body so that glucose can get into the cell and be used as energy. Without sufficient insulin the body looks for energy elsewhere and breaks down fats as fuel which is acidic. The body then tries to flush this out of the system (which is why one of classic symptoms of diabetes is excessive thirst). If the body can’t flush them out quickly enough the person will become very ill.

When poorly the body is less efficient at unlocking the cells with the injected insulin so more is often required (other things impact on sensitivity to insulin too like heat, hormones, exercise, stress). High blood glucose is a sign that the body isn’t able to unlock the cells to use the insulin and it may lead to ketones. Ketones aren’t inevitable even with a high BG but are more likely. If you estimate the carbs in a meal wrong and end up with high BG it’s less likely to lead to ketones as you’ll correct it at the next meal for example.

Sick day rules are in two parts
- additional insulin to deal with the rise in blood glucose
- what to do if ketones (above 1.0) are present

We keep a close eye on glucose if my kid is ill and will check ketones but not as often as two hourly. So far we’ve only had ketones high enough to need any treatment once.

It’s worth letting you know that with covid certainly in the early months people were reporting ketones at lower blood glucose levels so if your kid gets covid it can be worth checking ketones even if BG is only 10+ if they’re symptomatic with covid.

Mostly when a diabetic kid is ill it’s just about remembering to do the adjustment for additional insulin and maybe checking more often than just meal times if they’re feeling rough. It’s honestly fine to call your out of hours number for the diabetes team if you want reassurance or to check something. It doesn’t have to be an emergency. Ours have always been helpful when we’ve called them at the weekend.

 

[trophywench]

Re the Covid thing with lower BGs - I actually thought they'd said even with bg meter tests under 10 ketones could happen, with no lower limit specified?