June 27, 2004
Sick Days
Question from Martinsville, Indiana, USA:
This winter my daughter was ill twice with infections. The first time was a sinus infection followed a month later by an ear infection. Both times caused her blood sugars to go very high. We adjusted her basal rates up, tested often and were in constant contact with her diabetes team, but it was still very scary. The actual infections were treated by her pediatrician, and I had to fight to get her antibiotic changed after 72 hours of no improvement with the sinus infection because her pediatrician wanted to give it another day. The sinus infection was treated with only 10 days of antibiotic. I wonder if her pediatrician had treated her sinus infection more aggressively, with a longer term of antibiotics, the ear infection would not have followed. I understand the current need for not throwing antibiotics at every child with cold symptoms, but shouldn’t a pediatrician have a more aggressive set of protocols for treating infections of a child who has diabetes?
Answer:
I understand your frustration, but I don’t think your argument is logical. Any child with a significant invasive bacterial infection should be treated properly (perhaps aggressively is not the right word). However, there is much room for clinical judgment here and both sinus and ear infections are often caused by viral infections which will not respond to antibiotics. The fact that a child has diabetes would not influence me one way or the other in my choice of, duration of, or need for antibiotics. Correct management of blood sugars throughout is, I freely admit, often very difficult.
KJR
