I want to share an experience my family (including 9 YO T1D) and I are just recovering from: stomach virus with nausea and vomitting. My daughter picked up a bug somewhere and had a night of bad stomach cramps, nausea, and vomitting. A couple days later, my T1D son, non-T1D son, and wife got it. We were in regular contact with the endocrinologist who taught us a lot about what to do in this situation. I wanted to share our experience so someone might benefit from it. But please note I am NOT making any recommendations. Check with your endo and review their sick-day protocol sheets, if they have one.
1. Endo had given us a prescription for Zofran (anti-nausea/anti-vomitting) a while back, so we had it on hand. If you know that a stomach virus is going around and is likely to strike your T1D kid and they show the early signs of it, ask Endo if it's time to give Zofran as a preventative. The vommitting and stress hormones can spike the BG, and the person can get dehydrated. The Zofran makes their stomach feel better, and then you can slowly hydrate them and later feed them without worrying about them throwing it all back up. Zofran was a life-saver and may have prevented a trip to the hospital for rehydration.
2. What seems to have happened is that the stomach held onto the food, and for whatever reason (maybe disturbance in stomach lining?), the carbs were not absorbed. By the time we realized this, he had had afternoon snack and dinner, and he was bolused for both! Later, his BG's kept heading down into the 60's and 50's because the carbs never got into his system! It was basically like giving insulin with no food! What's worse is that because of the gastric interference, it's then hard to get the BG's back up with the normal juice/glucose tabs, etc. that they put in their stomach. We did not realize this until we had given him 2 or 3 doses of soda/juice/shot blocks over 45-60 minutes. It's a very helpless feeling and was the scariest part of all of this for me.
a. Ways to avoid this: Since you can predict this might happen, doctor told us to be conservative with food boluses. Don't bolus right away after they eat. Let them sit for a while to (i) make sure they keep the food down, and (ii) make sure that their BG's are rising from the food. If both happen, then bolus. Maybe only bolus part of the recommended dose and re-check to see how it's going. We're on the Animas Ping and last night, after he ate a little, we used a combo bolus: we gave a little up front and the rest over an extended period. It actually paid off, because when we checked him an hour after bolusing, his BG's were dropping low. So we just terminated the remaining bolus that was not yet given to minimize the hypoglycemia that followed.
b. How to treat lows if they do happen in this situation: Because of the gastric problems, no matter what we gave him: soda, juice, glucose shot blocks, etc., his BG's did not come up. Other approaches were needed that did not involve the stomach. Other things that worked: turning off his basal insulin altogether for a brief period until the hypoglycemia is reversed. Endo also suggested the following: rub insta-glucose on his gums, so the glucose could be absorbed via the buccal mucosa. No swallowing necessary. Also, could give a small dose (calculated by MD) of glucagon subcutaneously. We actually had the above scenario happen twice - at night! Last night, we mixed the glucagon, used a regular insulin syringe, and injected 10 units of it under the skin on his upper arm. His BG went from 64 (with 1 unit insulin still on board) to 234 in 15 minutes! In retrospect, we might have even cut that does in half! We then dealt with the highs pretty well, and he woke up at 104. He's feeling almost back to normal. We had thought glucagon was only for emergencies when passed out and had to be given with that giant syringe in the thigh. It is an expensive option, but one that worked in a pinch. The hands-on experience mixing the glucagon makes me feel more confident if I ever have to do it in a more severe emergency.
3. Staying ahead of the lows and highs. Regular BG checks (every 2 hours) and checking for ketones every 2 hours. Feeding is really important to prevent "starvation" ketones as well as really low BGs. Keeping him in the upper range of normal (180 - 200) makes for more smooth sailing until the gastric issues resolve themselves. We just explained to our son that as annoying as the 2 hour checks were, we needed to do it to help us get him feeling better. He was very agreeable with the whole protocol.
I hope this helps someone if you ever have this happen to you.
For what it's worth . . .
WOW. Very helpful- thank you! We have only been dealing with this for about 5 months, and the stomach bug has worried me. When it happens I will feel better prepared. Funny how we have turn into medical personell. A lot of problem solving.
I do worry about how this works when they go to college, but by then hopefully they have the skills.
Thanks, this is really helpful. I haven't dealt with a stomach bug since my T1D son was a toddler, and we invariably ended up in the ER for fluids. (I couldn't keep him hydrated enough and the dehydration caused high ketones even though his BG was not high). But I will keep these ideas in mind! I didn't know about most of them.
Thank you so much for sharing. Our 6 and a half year old has had T1 for 2 years and we have not yet had to deal with a stomach virus. I plan to print this out and share it with my family. I will add it to our emergency instructions given to us by our diabetes team. These things often happen in the middle of the night! I now have a better understanding of how the Blood Sugars can be affected during the stomach virus. I always assumed that the lows would be the issue. The care that you provided is very similar to what our endo has outlined for us (via flowchart). The only thing that I have not heard of is the Zofran. We live in Canada so I am wondering if it is the same as the Canadian product "Gravol". I will check with our endo next visit. Hope you are all well and thanks for taking the time to share. This was a valuable read for us.
Oh, one more thing. Zofran, also called ondansetron, comes in an "ODT" or orally-disintegrating-tablet form. They hold it in their mouth until it dissolves. It must speed absorbtion and prevent a pill just sitting in the stomach, doing nothing.
Wow...some good advice...hopefully won't need it, but great just in case...just one more thing to add..many years ago (before diabetes) my pediatrician said that a spoonful of the syrup from canned fruit can really help with nausea...of course it has carbs too...it really does help...use every couple hours...
Thanks for sharing! My daughter was diagnosed last February and goes to preschool, so of course they pick up everything that goes around there. Last May we dealt with a stomach bug for nearly a week. And yes, I had to break out the glucagon at bedtime - twice in 3 nights! Both times her BG was heading south and she absolutely REFUSED to eat or drink anything. I was panicking and called her endo, who said to give the glucagon in precisely the way you described. She was only 3 at the time, so I think we used 1/3 of the vial with a regular syringe. But let me tell you, using it the first time was the scariest thing!
We weren't on the pump at the time, so if we ever have to deal with this again, hopefully we can control the highs and lows better with her pod. She was on NPH at the time for her "long-acting" insulin (I know, it's really only intermediate, but that's what our endo had her on) and I was so frustrated with it. When it was peaking, it was darn near impossible to get her BGs up.
I don't know if the diabetes prolonged the bug, but I can say it was the second worst week of our lives. I ended up in tears, drinking a glass of wine, both of those nights I had to give the glucagon. So there's tip #4 - as a parent - medicate yourself with wine to get through your child's sick days! :-)
Very helpful. Thanks! I'm dealing with this now with my 3 year old T1D. Not a fun experience and this bug seems to be hanging on! It's been 5 days and the poor guy is still vomiting! We were told about the glucagon but have not had to use it.. yet. At first he was refusing all food and all drink. We had a hospital trip, gave hi Zofran and that helped. We are checking him frequently and trying to stay ahead of the bug. He is on the Humalog pen so we have not had to give him insulin for days! He has gotten his Lantus in a smaller dose each day though.
The info above will help me with my T1D daughter who is on the Ping. She's relatively new to the pump so we are still learning its capabilities. :-)
Oh boy. That's really rough. Thankfully, our bug lasted 24-48 hours. I will say, though, that the pendulum has swung in the opposite direction. Whereas he seemed pretty insensitive to insulin, now he seems sensitized. He's back to normal with eating, but he drops low from the usual doses of insulin following meals and corrections. Hope things will level off soon. Good luck with yours.
How long has it been since he's been sick? I've heard that we can battle lows for about 2 weeks afterwards! Uggggh!
It's been about 5 days since he felt back to normal. I think the trick is to (1) make sure that their BG's go up with food. If they are reliably once the bug is gone, then (2) be conservative at first with your boluses, both correction and food. Maybe even dial back the basals if your endo is in agreement. You can always give more insulin if needbe on a follow-up check.
Thanks for sharing your experience.
What is insta-glucose that you rubbed on his gums and where can I buy it. I want to be prepared.
I just found insta-glucose here: www.instaglucose.com Looks like 24 grams of carbs- pretty high and good when needed. I keep store bought cake frosting in my pantry as a "stick in his cheek if needed" thing (haven't had to use it yet, but we are pretty new at this"). The insta-glucose is higher carbs and I bet absorbs faster.