June 12, 1999
Question from Maine, USA:
I have a 4 year old that has been experiencing problems with low blood sugar at the onset of an illness. He gets the ketone breath and pale and lethargic. Any suggestions? His doctors says just to give orange juice at this time. Anything else we should be concerned with?
This is a common problem that sometimes requires some rather careful balancing. The initial low blood sugar is because his caloric intake has gone down in relation to his insulin dose. The problem is that you need to maintain or even increase the insulin in order to deal with the ketosis so the answer is, as your doctor suggests, to keep the glucose up with orange juice or glucose gel into the cheek pouch. Besides that, lots of blood sugar estimations and ready telephone access to a diabetic team are what matters.