April 30, 2014
Question from Omak, Washington, USA:
Our daughter struggles with getting ill with large ketones. This occurs randomly and lasts a week or two. We think she gets overactive and then, in the evening, comes down with ketones. We double the dose of her insulin per protocol and she tries to consume extra water, eat extra carbohydrates and take extra insulin. However, the ketones continue to persist. Her blood sugars are up and down and are higher when she gets ketones. She often consumes over 100 grams of carbohydrates and we often double her corrective insulin amounts. I do not believe she is intentionally skipping insulin. She misses school for a couple of weeks at a time. At school, she checks in with the nurse before and after lunch. Her provider attributes this to not getting enough carbohydrates but we tend to disagree. Anything else that could be causing this?
I’d encourage going back to your diabetes team to problem solve this. There are many possibilities but illness and almost all other interfering illnesses do not do so in this intermittent fashion over and over. However, surreptitious insulin omission would produce exactly this effect as would diabulimia with eating disturbances, a form of anorexia nervosa or bulimic behavior in people with diabetes.