Back to Ask the Diabetes Team Ask the Diabetes Team

From Necedah, Wisconsin, USA:

My daughter was diagnosed with a sinus infection three days ago. She was having highs quite frequently with no obvious reason before we took her in. She typically does not have a lot of highs. She was prescribed Cefdinir, 300 milligram suspension, 6 ml twice a day for 10 days. After two full days of doses, her blood sugar has been 200 to 300 mg/dl [11.1 to 16.7 mmol/L] consistently. We lowered her insulin to carbohydrate ratio from 1:20 to 1:15 for the time being. Should we be dosing insulin for the antibiotic? At her last clinic visit, her A1c was 6.3, down from 11.4 at diagnosis. Her urine has been negative for ketones.


It is not a problem with antibiotics but with the underlying infection. This often produces what is called insulin resistance and thus the need for higher insulin doses on "sick days" to bring the hyperglycemic values downward. Most of us recommend about a 10 to 20% increase in dose based on 24 hour insulin dose usually taken. This is then added to the bolus at meals. If on a pump, then it may require a boost in basal dose, too. All such decisions should be made according to positive or negative ketones; moderate to large ketones would suggest using the 20% booster rule while negative to small ketones, using the 10% booster. This is usually needed for several days but very variable depending on the actual illness, severity, etc. The antibiotics should start to clear the infection within two to four days but only if bacterial; if viral, then antibiotics don't work and the illness just must run its course. Following the sugar and ketone levels and the sick days rules should work. If weight loss, persistence of the hyeperglycemia, please give your diabetes team a call for more specific advice.


[Editor's comment: Some general sick day guidelines are available in Dr. Peter Chase's Understanding Diabetes. If you do not have a sick days plan from your own endocrinologist, please ask for one. BH]

Original posting 26 Mar 2017
Posted to Sick Days and Hyperglycemia and DKA


  Back to Ask the Diabetes Team Return to the Top of This Page

Last Updated: Sunday March 26, 2017 19:19:58
This Internet site provides information of a general nature and is designed for educational purposes only. If you have any concerns about your own health or the health of your child, you should always consult with a physician or other health care professional.

This site is published by T-1 Today, Inc. (d/b/a Children with Diabetes), a 501c3 not-for-profit organization, which is responsible for its contents. Our mission is to provide education and support to families living with type 1 diabetes.
By using this site, you agree to our Terms of Use, Legal Notice, and Privacy Policy.
© Children with Diabetes, Inc. 1995-2018. Comments and Feedback.