Our three year old daughter, who was diagnosed with type�1 diabetes over a year ago, has been doing very well up until last month when she got sick, and her sugars are way out of control. All we keep hearing is that when someone with diabetes gets sick, you try to control the sugars as best you can, and it is something you just have to deal with. Is there something to help keep her sugars within a better range when she is sick?

I have heard about some patch that is supposed to be coming out that you have another machine somewhere in the room that displays constant blood sugar readings. Do you know anything about this? Also, do you think her being on a pump would help during these time?

During illness, blood glucose control is more difficult and the same is similarly true during periods of growth. Stay in close contact with your diabetes team so that they can provide support and advice for your child.

There are two semi-continuous glucose monitors. MiniMed has a Continuous Glucose Monitoring System that will work for three days, but does not yet have a readable display of results. Cygnus has the GlucoWatch which will be available first for adults. Both are very early models that will be modified many times in the near future.

SB

[Editor’s comment: If your daughter’s blood sugars have continued to be out of control since her illness, it might be that the illness stressed her beta cells enough to end her honeymoon. It is not at all unusual, after the honeymoon ends, for insulin requirements to dramatically increase up to a total (on average) about 1 unit of insulin per kilogram of body weight per day.

In addition, if your daughter is not on an intensive insulin regimen using a basal insulin with Humalog or Novolog based on carb intake, you might want to consider this type of program. It works pretty much the same way an insulin pump works, and is worth exploring.

Sick days are difficult, because there is no clearcut standard way that someone with diabetes will respond, and each episode may be different. A continuous monitor would help only in that it would allow you to see whether the blood sugar is rising or falling, but, as Dr.�Brink has already pointed out, it really isn’t available. I’m not sure that it would really help a great deal because you don’t want to give subcutaneous insulin any more frequently than every three to four hours, and monitoring that often is not all that difficult using the newer meter such as the FreeStyle or ONE TOUCH Ultra.

SS]

[Editor’s comment: In severe illness, requiring not just hospitalization, but intensive care, it’s very common to change the insulin program so that the insulin is given directly intravenously, using a hospital pump, and very frequent blood sugars (sometimes as frequent as every hour) to adjust the dose. So, in a sense, yes, doctors might use “pumps” to provide insulin during illness — although it’s probably not exactly what you were thinking about when you asked the question!

WWQ]