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May 7, 2002

Daily Care

Question from South San Francisco, California, USA:

My two and a half year old son, diagnosed about a year ago, was recently hospitalized for six days due to severe gastroenteritis (rotavirus). During his hospital stay, his blood sugar ranged from the 40s mg/dl [2.2 mmol/L] to the 400s mg/dl [22.2 mmol/L], and since coming home two weeks ago, his blood sugars are all over the place (40s mg/dl [2.2 mmol/L] to 500s mg/dl [27.8 mmol/L]). He is on a two shot regimen of Humalog, NPH and Ultralwnt, and I've increased his dose several times, but just when I think it's getting better, something happens and we're back to where we started. Does it takes this long to get back to seeing blood sugars remotely near normal? I am close to insanitybecause his diabetes was in tight control prior to the illness (A1c about 6.5%).

Answer:

This is s simply due the waning of your son’s residual endogenous insulin secretion which quite often happens after an infection. The previous insulin scheme is not appropriate anymore, and I’d switch to an intensified insulin regimen. Talk to your son’s diabetes team (or if he’s being seen by a pediatrician, about the possibility of a referral to a pediatric diabetes team).

MS