December 8, 2000
Question from Sunny Isles Beach, Florida, USA:
My six year old daughter was diagnosed with type 1 diabetes three months ago. Last month, we had our first experience with fevers and colds. She woke up one morning with a temperature of 102.5 F, and the endocrinologist on call said her blood sugars would go up even without eating. Well, she had high readings for three weeks after! We’ve had to increase her baseline insulin dose. Did her illness knock out more of her pancreas function? Does this happen whenever someone with diabetes gets ill?
Either hypothesis may apply to your daughter’s case. Cytokines produced during infections with fever could ‘knock out’ some of the still functioning beta cells resulting in an increased need for insulin. On the other hand and perhaps more important, is that during an infection — especially one with fever — blood glucose raising hormones (mostly cortisone and glucagon) are secreted, effectively causing high blood sugars and the need for more insulin. This is especially true during the honeymoon phase, as must be true in your daughter’s case. Insulin doses often need to be increased considerably when a person is ill. A child will usually need up to 1 Unit per kilogram of body weight and sometimes more. The rapid increase in need for insulin is due to the fact that your daughter’s pancreas can no longer contribute the needed increased amounts of endogenous insulin.