Looks like Liam is sick. After being up with him until 4:30 this morning trying to get his BG’s under 200 (he was over 200 from 9PM - 4:30am…lots of extra insulin given), @ErinElizabeth and I have come to the conclusion that he’s sick - even though he isn’t acting sick right now. His usual TDD is around 5 - 6u. Yesterday was almost 9u and he was still high (over 160) over 10 hours, yesterday. After 4:30am, he went low, then rebounded high again for another 3 hours. I ended up going to bed at 4:30 and getting up every time the alarm beeped until 7:30, then got up for the day.
We’ve started up his “sick” basal profile and we’ll see how that goes. Here’s hoping whatever this is passes quickly!
Time to go reflect on those “rosey” posts I’ve made in the past as I lament the current situation.
Those sick days are awful! But I know y’all will get back to the normal eventually – and it always seems to happen quicker with each successive illness, at least for us.
Hope this winds up being a quick one.
Do you use a blood ketone meter? We were given the urine-based strips, but with a toddler–it isn’t always easy. I highly recommend getting one if you don’t have one.
Disregard - found it on Amazon. Thanks for the info!
We honestly don’t even test for ketones too often…maybe we should do it more frequently than we do? But the times that we have checked have been none to slight…maybe a few times moderate, but what do we do with this info once we have it? We know to give water and more insulin to bring sugars down, but the ketone strips really haven’t been something we’ve used all that much to date.
In other words…whether we test or not, we know what actions to take …when BG’s are high, he gets more water and insulin. What does testing help with really since we already take the corrective actions?
@ClaudnDaye, I’m a huge proponent of testing for blood ketones. We’ve had several periods where Samson’s blood sugar was totally normal but he had HIGH ketones after being disconnected from the pump.
If you see a moderate or high, at least at our practice, you are supposed to call the help line and they suggest an increased temp basal and beefed up correction schedule. Clearing ketones takes extra insulin above and beyond what it would normally take to lower a high of the same magnitude.
Personally I also think it’s really instructive to understand why sometimes they need SO MUCH INSULIN to bring down highs too – for instance, when Samson has had high ketones we need to run a 25% to 50% increased temp basal and tack on an extra 50% to corrections to bring down a high.
We test Samson anytime he’s over 300 for more than an hour, anytime he’s over 250 for more than 2 hours, or any time we have a pump snafu.
Oh also when they’re sick… we’ve never really found he tests positive for ketones with his ordinary sickness as of yet (knock wood). But it is reassuring to know he doesn’t have them. The strips are expensive, about $8 per strip – but if you are using them maybe 2 times a month I don’t see that as a huge expense.
You should definitely be checking ketones when sick or generally high BG’s (not always correlated). We actually got ours via prescription, so we don’t have to pay out of pocket. It has been a huge advantage–especially when sick since we can check while he sleeps.
This is the first time I’m hearing this. We were never given a “help line” number…we have our Endo team/hospital we could call I guess, but I just don’t see them giving me any helpful information that I don’t already know? Lots of water to flush out ketones and more insulin to bring down sugars. We have called before (with our old Endo team) and those were the directions we received…that was when Liam was first diagnosed and we were confused and frustrated with everything. Now a days, he doesn’t stay high for an hour because I bump, bump, bump until he comes down (and if a correction is necessary to stop the crash, that’s what I do.) I don’t settle for any high these days that refuses to come down. @ErinElizabeth is much more comfortable with Liam being high for a longer time…I just don’t see the need as long as he’s awake and I can correct on the way down if I have too.
Another one of those crazy expensive US healthcare costs… I pay about $26 for a box of 10 Precision ketone strips, making each strip $2.60 Canadian or about $2.10 American.
Like others, I highly recommend the ketone strips/meters. I think anyone at risk of DKA should have one on hand just in case.
I definitely have a box and keep them on hand, but I rarely use them because I fix Liam’s BG’s before they are a problem (prolonged high BG levels.)
Again, I’m not opposed to using them – I just haven’t yet figured out their function…because EITHER WAY (whether he has high ketones, or none at all), from my perspective…if Liam is high, I’m going to do two things…give him more water and give him enough Insulin to bring his BG’s down in a timely manner. I do those two things w/o knowing whether he has high or low ketones. I guess I’m just trying to figure out WHY the strips matter if the course of action is going to be the same whether you test or not.
well, so the amount you give for ketones is different from the amount you give just for highs and depends on whether the ketones are high or moderate… so I think it’s worth it to look through your handouts/pamphlets from the hospital at least and see if they have both “sick day” and “ketones” protocols, at the least. I mean in general, yes, the formula is “more insulin” but the amount will vary.
so, the thing about ketones is that they’re often (but not always) correlated with high blood sugars. For us, they are most strongly connected to a lack of insulin delivery and a lack of carbs. And one bad pump site can send someone into “HIGH” ketone territory very easily, with many starting to generate ketones with just 3 hours off pump-based short-acting insulin… So I think you should definitely get a ketone meter and get into the habit of checking if he’s high for any lengthy period of time or sick.
My reason is similar to @TiaG’s. I was always taught that if there are ketones you need to bolus more for corrections than if there are no ketones. I also don’t always drink water when I’m high, and I don’t always follow up with close monitoring, so for me it’s also a sign that this is a more serious high than usual and I tend to recheck BG and ketones every hour or so until things resolve. Since you guys are dealing with young kids, you probably monitor a lot more closely than I sometimes do after a correction.
So, let me give you a scenario and you tell me what you would do in both circumstances…I’m talking about the corrective actions you would take.
I have been sleeping, and slept through “high” alerts. I woke up at 4:30 when I finally noticed that his CGM reads 278 so I do a BG check and find that he’s 289. I also observe that he’s been above 250 since 1:30 (3 hours).
So, in my mind I have two options. I can check his ketones and THEN administer whatever amount of insulin it takes to bring him down (it will always be a guess whether I know his ketone level or not), or I can just give him insulin in the amount I think will be sufficient to begin bringing it back down w/o a crash (which I usually do)…this is usually a .15 to .25 bump, but when he’s sick, I do a .40 instead of the lower micro-boluses.
So, I guess what I’m trying to say is that even though there may be a science into the ketone levels, in my mind at least I understand that it’s really no different from normal boluses (plus a small additional bump to get that arrow moving down, and even more if he’s sick.) These are things that I already do w/o checking ketones, so I guess I’m just trying to understand the BENEFIT of having the knowledge that he’s got no/low/moderate or high ketones.
My protocol would be the same whether or not I know his ketone level. Get him to drink water. Give him insulin enough to get those sugars down. Again, I don’t let Liam’s sugars “hang” for any period of time and the only times that I have actually had these issues (in the recent past) have been when I’ve slept through high alarms because I don’t hear those as well for some reason as I hear low alarms.
I would say; however, that there IS a time when I would use a ketone strip. That time would be if I notice the high, I HAVE given what I think should be a good amount to have brought those sugars down and he still isn’t going down. To me, that’s a pump issue or some other issue like occlusion that may be preventing the insulin from entering his body and at that point Ketones are important to note as well as his trajectory of sugars so that I can take other actions as necessary such as changing POD, etc.,
After being up with him until 4:30 this morning trying to get his BG’s under 200 (he was over 200 from 9PM - 4:30am…lots of extra insulin given), @ErinElizabeth and I have come to the conclusion that he’s sick - even though he isn’t acting sick right now. His usual TDD is around 5 - 6u. Yesterday was almost 9u and he was still high (over 160) over 10 hours, yesterday. After 4:30am, he went low, then rebounded high again for another 3 hours. I ended up going to bed at 4:30 and getting up every time the alarm beeped until 7:30, then got up for the day.
