My 17-year-old son, who was diagnosed five years ago with type 1 diabetes, uses a pump for insulin management. He was diagnosed with mononucleosis today. His blood sugars have been elevated for the last few days, not extremely high, more around 180 mg/dl [10.0 mmol/L], or 120 mg/dl [6.7 mmol/L] to 130 mg/dl [7.2 mmol/L] in the morning when he usually is much lower. Is there anything else we should be worrying about? We did not look for ketones since his blood sugars have not been over 200 mg/dl [11.1 mmol/L]. Should we check for them anyway?

I think that as long as you stay on top of his hydration and keep up with insulin, you’ll see okay results. If he has a bad sore throat, he may not be drinking so much. Certainly, with the lethargy that accompanies mononucleosis, he will likely be much less active. Both of these can contribute to higher glucoses and you’ve got the tools to “fix” them.

I do recommend ketone checking during sick days, especially when there is vomiting. Remember that he can have “starvation” ketosis if he is not eating well.

DS

[Editor’s comment: Be sure to inform your son’s diabetes team if he does develop ketones, especially if they are moderate or higher, even with in range blood sugars.

BH]