# Advice re illness



## ruthelliot (Dec 27, 2010)

Hi Folks,
Ben's been unwell since a few days before Christmas. He's had levels frequently in the high teens and occ low twenties and only very occasionally been in single figures in that time.(though never any ketones) He's starting to get over it and levels have been better today (hypo'd once). My problem is he's still waking up higher than normal - been at least 12 each morning, he was 10 this morning but that was with a unit of novo at 1am - this is better than it was as it was high teens but my question is should I increase his levemir or sit it out. He gets his levemir at 5.30pm and only a week ago we increased it from 4.5 to 5 units. I'm worried as after he gets over things we tend to have a good few days with loads of hypos but i'm also conscious that we were told at his last appt 3mths ago to concentrate on improving night levels. He's got hospital on the 12th and I dreaed to think what his hba1c will be this time!


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## bev (Dec 27, 2010)

Hi Ruthelliot,

Sorry to hear Ben is ill. I wouldnt increase the levemir at all. I would just stick it out with the novorapid and lots of checking. I would check every two hours through the night to make sure levels are not in double figures. Dont worry about clinic - I am sure they meant when Ben is well and not ill - nobody can keep levels perfect when a child is ill - so just do your best. I hope Ben feels better soon.Bev


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## ruthelliot (Dec 27, 2010)

Thanks Bev, thought that myself but was just worried when I looked in his book and realised he'd been high 8 mornings in a row that I should be doing more - just needed a bit of reassurance! Hopefully the new year will bring some sleep! 
Ruth x


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## Ruth Goode (Dec 29, 2010)

Hope Ben is feeling better by now.  Just curious it is a question so can you give young children more than 4 narvorapids a day? I usually give Carly 3 narvorapids a day before meals and sometime another one if she is on high but Im just curious like when Ben or Carly is ill, can we give them every 2 hours if they are on highs?


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## ruthelliot (Dec 29, 2010)

Hi Ruth, we were told at one point I think that we could give 3 extra doses in a day following sick day rules. We've also given him the occasional extra dose to cover a treat (though we don't make a habit of it) for example at his nursery Christmas party when he would normally get 15-20g snack he got 45g so I went in and injected him for it and it didn't mess the rest of the day up at all though I do need to keep a close eye when I do that as we can get overlap of doses then. Not sure if there is a limit to the number of extra doses during illness but no doubt bev or someone will be able to clarify
Ruth


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## bev (Dec 30, 2010)

Hi Ruth/Ruth,

There is no limit to how much novorapid you can give per day - but you must be guided by the levels. If levels are high then more novorapid is needed or you have got the carbs wrong at a particular meal. BUT - what you must be careful about is 'stacking' of insulin. If you have two or three injections in a row then this can lead to stacking which means that levels can suddenly drop if all the insulin is absorbed at the same time - but this is quite unusual.

If levels are high and there is no IOB (insulin on board) from a previous bolus, then you can give a correction dose to bring levels down. Novorapid is supposed to last for four hours - but it rarely does and the peak is at about the two hour mark - so this might help to guide you as to whether you should give a correction dose or not.Bev


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## Ruth Goode (Dec 31, 2010)

Thank you Ruth and Bev, I was just curious  So far Carly have been well since she was dx apart from couple of colds.  Hope Ben is bouncing again - Happy New Year to you all


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## ruthelliot (Dec 31, 2010)

Thanks ruth he is indeed bouncing about again. Hope you all have a great new year. X


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