High Temperature - Sick days

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lozboz25

lozboz25

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Hello
I am just looking for a little bit of advice. My son (7 years old) has a high temperature of 38 and doesn't feel well. His blood sugars have been ok, but I've just checked him now and his bloods are 7.2mmol and his ketones are 0.4mmol. I know at the moment not to worry and to just keep checking on him - which I'll do. I'm just abit concerned as what to do if his ketones go up but his bloods stay in range? I know he will need insulin to help bring the ketones down but i don't want to make him go into a hypo if his bloods are on the low side. I've never had to deal with before. In the past when he's had ketones he's also had high blood sugars so I've given him insulin to bring both down.
His nurse also told me to get him to eat to bring the ketones down, but he doesn't want to eat as he feels sick, and I don't want to force him to eat.

Any advice is welcome. Any tips or tricks. I'm just trying not to panic.
Thank you if you do comment.
 
Can he drink OK? - thinking of a measured amount of sweetened drink. eg fruit juice.
 
@lozboz25 Do you have Sick Day Rules? Mine had a list of things to eat when ill eg normal sugar jelly, normal sugar fruit yoghurt, sugar Coke, sweet biscuits, etc. I even suck/chew sweets sometimes. It’s important to get the carbs in as they’ll help get rid of the ketones. I know it seems unkind, but you do need to persuade him to eat. Try explaining why - that it will keep him well and get rid of the nasty ketones. If his illness is a tummy bug, I find Coke best, sipped in small quantities.
 
Inka said:
@lozboz25 Do you have Sick Day Rules? Mine had a list of things to eat when ill eg normal sugar jelly, normal sugar fruit yoghurt, sugar Coke, sweet biscuits, etc. I even suck/chew sweets sometimes. It’s important to get the carbs in as they’ll help get rid of the ketones. I know it seems unkind, but you do need to persuade him to eat. Try explaining why - that it will keep him well and get rid of the nasty ketones. If his illness is a tummy bug, I find Coke best, sipped in small quantities.
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Yeah we have sick day rules, but he hasn't wanted to eat even sweets or anything sweet treats. He's managed to sip a sugary drink.
 
Hi @lozboz25 , I am glad that he is managing to sip sugary drink. That will help with the ketones and keep him hydrated. Let us know how he gets on.
 
lozboz25 said:
Yeah we have sick day rules, but he hasn't wanted to eat even sweets or anything sweet treats. He's managed to sip a sugary drink.
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The drink should be ok. I take it little and often and bolus after according to my blood sugar. It’s really important to keep the carbs and insulin going in. It will make him feel better too, as ketones just make you feel worse.
 
It’s rare to get ketones without high BG so try not to worry. Having a sick kid whilst also dealing with diabetes does add a level of concern (mine got sick the week after diagnosis and I was in bits) but it looks like he’s dealing well with it in terms of his BG so just try to keep his fluids up and if you can get some paracetamol and/or ibuprofen into him he will feel better for it.

FWIW we were always told that insulin goes to treat to ketones first before dropping BG so even if his ketones do go up you’re unlikely to get to a point where he’s not maintaining his glucose levels and if he’s ill enough for that to happen then hospital is the appropriate place for him to be.
 
SB2015 said:
Hi @lozboz25 , I am glad that he is managing to sip sugary drink. That will help with the ketones and keep him hydrated. Let us know how he gets on.
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His ketones reached 1.4mmol and his bloods was 8.8mmol. But this morning he has managed to have a nibble of some toast and managed to sip some apple juice. His ketones when down to 0.7mmol and now they are at 0.4mmol with blood sugars of 6.4mmol. His temperature was 38.4 but I've managed to get it down to 36.4 so we are heading in the right direction. He hasn't been sick and he says he feels ok in himself at the moment.
 
Inka said:
The drink should be ok. I take it little and often and bolus after according to my blood sugar. It’s really important to keep the carbs and insulin going in. It will make him feel better too, as ketones just make you feel worse.
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Thank you. I've explained to him that it's important to have something, even little sips and he's managed to have a few bites of toast and a sip of apple juice.
 
Thebearcametoo said:
It’s rare to get ketones without high BG so try not to worry. Having a sick kid whilst also dealing with diabetes does add a level of concern (mine got sick the week after diagnosis and I was in bits) but it looks like he’s dealing well with it in terms of his BG so just try to keep his fluids up and if you can get some paracetamol and/or ibuprofen into him he will feel better for it.

FWIW we were always told that insulin goes to treat to ketones first before dropping BG so even if his ketones do go up you’re unlikely to get to a point where he’s not maintaining his glucose levels and if he’s ill enough for that to happen then hospital is the appropriate place for him to be.
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I've never had him poorly where his bloods have been in range but his ketones are high, like you said he's always had high blood sugars with high ketones, so dealing with this situation was new to me. I wasn't aware that the insulin would treat his ketones first so thank you for giving me this information. I knew he needed insulin with ketones but I was concerned that I could make him go in to a hypo by giving him insulin when his bloods are in range or on the low side as it is, and him not wanting to eat isn't a good combination
 
lozboz25 said:
I've never had him poorly where his bloods have been in range but his ketones are high, like you said he's always had high blood sugars with high ketones, so dealing with this situation was new to me. I wasn't aware that the insulin would treat his ketones first so thank you for giving me this information. I knew he needed insulin with ketones but I was concerned that I could make him go in to a hypo by giving him insulin when his bloods are in range or on the low side as it is, and him not wanting to eat isn't a good combination
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It is a juggling act each day. Well done on getting the levels down. I hope that he feels a lot better soon.
 
lozboz25 said:
Thank you. I've explained to him that it's important to have something, even little sips and he's managed to have a few bites of toast and a sip of apple juice.
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Excellent. I hope he’s feeling better very soon.
 
Bit late to the party, I hope you son is feeling better now.

You'd expect some level of ketones if he's not eating (much), as long as he's taking basal insulin I'd not worry and I'd certainly not look to take additional insulin to reduce ketones, just control blood glucose to avoid running too high until he's able/willing to eat again.
 
SimonP said:
Bit late to the party, I hope you son is feeling better now.

You'd expect some level of ketones if he's not eating (much), as long as he's taking basal insulin I'd not worry and I'd certainly not look to take additional insulin to reduce ketones, just control blood glucose to avoid running too high until he's able/willing to eat again.
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Thank you
He is better today. No temperature and his ketones have been at 0.4 and 0.2mmol. His bloods have been on the higher side today also, but he is doing good! Thank you xx
 
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