May 19, 2008
Hypoglycemia, Insulin
Question from Canal Winchester, Ohio, USA:
Born in March 2003, my son was diagnosed with type 1 diabetes on April 18, 2005, directly after a very serious viral infection involving vomiting and diarrhea which lasted for about 10 days. Like most children with diabetes, when my son has been sick with a cold or sinus infection, ear infection, etc., his blood sugars skyrocket, except for the two times he had viral gastrointestinal infections.
The first was in July 2007. At that time, he was receiving 12 units of Lantus once a day for his basal and we were covering his meals with Humalog at a 1:15 ratio. He became sick with vomiting and diarrhea, which lasted about five to seven days. During the time that he was actively sick, his insulin usage went down because he wasn’t taking anything in, but we had continued to give him the Lantus. Then, he started crashing on us. He went as low as 20 mg/dl [1.1 mmol/L] at one point. We ended up cutting his Lantus to four units and he received no Humalog for the duration of the illness. For about 10 days after the illness, once he was eating regularly again, he received no Humalog and we were still having to watch him closely for lows on only the four units of Lantus. He slowly began requiring more insulin, but it took him over a month to get back to his regular dosage amounts.
After that, he was sick at different times with cold, sinus infections, etc., and each time his blood sugars were high. So, we thought that one incident was just a fluke.
Now it has happened again. About two weeks ago, he became sick with vomiting and diarrhea and his blood sugars started going low. We are now using an insulin pump with NovoLog and initially I had to cut his basal rates by half and he received no additional bolus with meals. It has now been several days since he has been actively sick. He has been eating regularly and we are back to regular basal rates but still not needing to bolus for meals.
How is this possible? How can he go with so little insulin? Could his pancreas be trying to work?
Answer:
This is a very unusual report and makes me wonder if he has a non-classical type of diabetes. I would check with your diabetes team and see if they have checked for some MODY types of diabetes. These are blood tests that look at different genetic determinants for non-autoimmune types of diabetes. Also, you should find out whether or not he has been checked for adrenal insufficiency (Addison’s) disease and celiac disease since sometimes these will also be associated with such dramatic change in insulin need.
If all these come back negative, then these are just odd responses to gastrointestinal illnesses with slower than usual recovery. As long as you watch the blood glucose levels and have a high index of suspicion, you will then know when to cut back on insulin doses more dramatically – i.e., future gastrointestinal compared to respiratory illnesses – and then when his insulin needs rise once again.
SB
