At what point would you seek emergency help for high BGs?

[Lucyr]

So, I wanted to ask this question a few days ago, and probably should have, but to be honest, I was a bit nervous of judgment. So I'm asking now, post-hospital discharge, because I still have the same question. I'll try and keep it brief because it's going to turn out long whatever i do, but i'm happy to give more details if it would help.

Background: I've been ill for a couple of months and my blood sugars have been running high, about 10 (a1c 70). I'd been increasing insulin to help with this and was starting to feel better. Never really see BGs above 15, and I've only had mild DKA once and wasn't hospitalized. I've been diagnosed T2 for 13 years (since age 21), using MDI for at least 10 of those.

Friday: Felt fine, bg average 9.8

Saturday: Average BG 19.0. Was 10.4 when i woke up, felt okay and went out for lunch, over-estimated carbs and bolused as normal. The rest of day was in bed, feeling ill, upset stomach, BG shot up to 22.4 after lunch, highest check 26.8. I changed cartridge and got down to 16.5 after a large correction.

Sunday: Upset stomach, BG averaged 19.5, range 14.2 to 24.4, mainly no / trace ketones.

Monday: Felt a bit rough, pulse was 120 all day, and still an upset stomach. Left a message with DSN in the morning. My BGs in order were 15.6, 20.5, 22.3, 24.8, 26.6, 28.7, 25.6, 26.3, 28.0, HI, HI. Ketones mainly none/traces, though saw 1/2+ about once each.

Before dinner (at BG 26.3) was the point at which I decided I really wasn't sure if i should be seeking help immediately or waiting till tomorrow. I completed the NHS 111 form which said to see a GP. Getting in with them would take a few days too, so I filled in the part requesting a callback. They got me an appointment at urgent care that evening. When I saw the nurse my BG said HI on my meter and i had no urine ketones on her test. She spoke to various people and i was taken to the ward to check for blood ketones. BG from my arm was 28 with only 0.2 ketones. I was admitted to run tests to check for infections etc, iv fluids to help rehydrate, and to speak to the DSN the next day.

I felt really bad about taking up a bed (and a side room because of the stomach upset) when I was pretty confident I didn't have DKA (hadn't thrown up, no ketones in urine, T2 so it's rare to get DKA, had been doing loads of corrections). Felt like i should probably have just been more confident about doing more corrections at home, and waiting for the DSN callback in the next couple of days.

What would you have done? At what point would you have asked for help and who/how would you have asked?

Happy to talk more about what happened in hospital but this is way too long so stopping now!

 

[ColinUK]

You did the right thing by seeking help and there’s no way they’d have given you a bed if you didn’t need it.

In some respects I’m a typical man so it takes me ages to seek help for some things whereas other things I’ll fire off a message to the doctor almost immediately and panic myself by typing symptoms into Google.

If my bloods were out of the normal range for me for an extended period though I’d absolutely speak with the GP and if that was going to take too long for my liking I’d head ten minutes down the road and to A&E.

 

[Inka]

You did the right thing @Lucyr Better to get checked and find it’s nothing than not to be checked and get worse.

I’ve phoned for advice with a blood sugar of 15/16 and nausea. I had ketones and felt crap and scared. So, for me it’s not just the blood sugar number alone. Having said that if I was 19/20+ I’d be considering seeking medical help and if the highs persisted as yours have, I’d phone for advice too.

I find an upset tummy and vomiting the worst for putting my blood sugar up. I can feel things going bad very quickly, and if I couldn’t get control, I’d phone sooner rather than later.

 

[Bloden]

You did everything spot-on @Lucyr. I would have sought help after a couple of days of highs and corrections. It’s so hard sometimes to make a judgement, but if we’ve done everything in our power and are still seeing highs, it’s time to get help.

How are you feeling now?

 

[rebrascora]

I hope you are over the stomach upset and feeling better now.
I can only agree with the others. I certainly think once you see "Hi" on the meter despite doing corrections, you are on very dodgy ground and need assistance. You had a prolonged period of several days of very elevated levels despite insulin use, so it suggests that things were getting beyond your control and you needed support. I think if you had posted here and asked us at the time, we would have said "Get yourself to hospital pronto!"

 

[Lucyr]

I'm still feeling totally wiped out. When in hospital on Monday night there were various tests carried out through the night, plus general hospital noise, so i didn't get any sleep that night. My stomach was better on Tuesday, i was very thirsty though and between the IV fluids and drinking lots i easily had more than 6 litres of water.

I was able to continue managing my insulin doses myself but obviously, that hadn't been working for the last few days. None of the tests showed anything of concern so it was decided to be a combination of being ill recently and running high, with either a stomach bug or reaction to something i ate (the meal on Saturday lunchtime was covered in sesame which a few immediate family members are allergic to and i've not really eaten before), the dehydration that that caused, insulin resistance caused by high bgs making corrections less effective, and the stress of it all / stress of having to go to hospital.

I asked about doing extra / larger corrections but the staff on the ward said to stick to just doing normal carb ratio and correction ratio with meals until i'd spoken to the DSN. I was 23.x when it was agreed i could be discharged once i'd spoken to DSN and 19.7 before leaving.

DSN said to eat normally or eat what i felt i could manage, continue to drink plenty to keep hydrated, and to correct with meals, and correct 2 hrs after every meal if needed, regularly over the rest of the week. They'd expect my blood sugars to improve now i'm rehydrated and stomach has improved, but if not ring DSN and say i've been recently discharged and am struggling.

BGs today: 13.4, 12.6, 16.4, 15.1, 18.6, 13.1, 15.0

 

[Lucyr]

I think if you had posted here and asked us at the time, we would have said "Get yourself to hospital pronto!"

Me too... and i didn't really want to because of worry of their reaction so i didn't post! I had decided if i saw 3+ or 4+ urine ketones i would have gone to a&e at the weekend but they didn't get that high.

 

[Leadinglights]

I wonder if your stomach was just protesting about all the different medications you are taking.
Interestingly New Scientist had a snippet that travel sickness tablets had been shown to alleviate migraines and the associated nausea.
I hope you soon start to feel better.

 

[Lucyr]

I wonder if your stomach was just protesting about all the different medications you are taking.
Interestingly New Scientist had a snippet that travel sickness tablets had been shown to alleviate migraines and the associated nausea.
I hope you soon start to feel better.

Maybe, though last week was actually the first week i really cut them back. Last week i took:

Lantus, Apidra, Metformin SR every day with dinner, propanalol 3x a day. Those are my standard meds.
Multivitamin with iron every morning
Amitryptaline every evening which is my newest med (2 weeks ish)
Sumatriptan i probably took 1-2x in a week
Metacloperamide i probably took 1x in a week
Paracetamol and ibuprofen or naproxen i probably took 2-3x in a week

 

[trophywench]

It would have to be a combination of constant too high BG and constant ketones for a few days, for me to seek help.

 

[leonS]

Permit me to observe:
Type 2s do not usually get DKA
21 is very young for type 2 diagnosis.
Type 2s seldom need MDI, and then not so soon after diagnosis.

My money would be on slow onset type 1.

Medication given by mouth would then be as much use as snake oil.

An infection could trigger s fresh attack on your beta cells causing an increased need for insulin.

 

[Lucyr]

Permit me to observe:
Type 2s do not usually get DKA
21 is very young for type 2 diagnosis.
Type 2s seldom need MDI, and then not so soon after diagnosis.

My money would be on slow onset type 1.

Medication given by mouth would then be as much use as snake oil.

An infection could trigger s fresh attack on your beta cells causing an increased need for insulin.

I’ve never had cpeptide or antibodies tests, though I’ve asked previously have been declined due to time between diagnosis and starting insulin. However I would have started insulin sooner if I hadn’t had to go through the pathway of trying all the tablets first. For 14 years I’ve tried every T2 medication available and none of them work. That suspicion of whether I am actually T1 or T2 is why I test ketones regularly when high or feeling unwell.

My full blood count has been remaining high whilst feeling ill with the post viral syndrome, and having the high bgs. But no one has found any infections that should be treated and I’ve had all sorts of tests looking for one.

 

[Lucyr]

It would have to be a combination of constant too high BG and constant ketones for a few days, for me to seek help.

What level of BG/ketones would you seek help at? I was thinking if it increased to and stayed at 3/4+ urine ketones for a couple of tests, with bg in 20s, or if bg stayed at HI without ketones then I’d go to a&e. But that was gut feel I hadn’t been previously given any rules.

 

[everydayupsanddowns]

It would have to be a combination of constant too high BG and constant ketones for a few days, for me to seek help.

That’s pretty much my gut feeling too.

What level of BG/ketones would you seek help at? I was thinking if it increased to and stayed at 3/4+ urine ketones for a couple of tests, with bg in 20s, or if bg stayed at HI without ketones then I’d go to a&e. But that was gut feel I hadn’t been previously given any rules.

I’m not sure. I have had occasional visits to the high teens or 20s since being on a pump (levels I never saw on MDI) - especially in the first year when I was using unsuitable cannulas. But they’ve always come down within a few hours, and I don’t seem to produce ketones very readily.

Whenever I check for them they always seem to come out clear.

I think you handled the situation well Lucy. Hope you are on the mend now 🙂

 

[trophywench]

Having seen the lady's fibroids - and her womb! - last night on TV, and having just seen an article on MSN about endometriosis - I conclude that women just do not moan enough about their health problems - and diabetes is certainly 'just another' one of them.

 

[DaveB]

I occasionally go over 20 when my insulin control is particularly bad. I keep an eye on it. My ketones are always 'zero' even at that BS level so I don't panic but just try to get the BS back down.

 

[Lucyr]

I occasionally go over 20 when my insulin control is particularly bad. I keep an eye on it. My ketones are always 'zero' even at that BS level so I don't panic but just try to get the BS back down.

I was trying to get it down, with extra corrections etc… but it wasn’t working.

@Pattidevans wrote it here, they didn’t find anything particular but said it was probably a combination of upset stomach, dehydration, everything going on lately with already dealing with a virus, stress of high bgs and hospital… etc

 

[helli]

I have never really thought about when I would seek help with high blood sugars. I think it would depend on what I had done to bring them down, how long it had been going on and what else was going on (health wise) at the time.
Thankfully, when they go high, I have alway been able to bring them down with insulin. Some times, I have changed my pump and/or insulin pens and often I end up "Rage Bolusing".

I have once had to call for an ambulance when I was in severe unexplained pain. I told them I had high blood sugars and ketones as well. Without the pain, I would have persevered with the insulin.
(The pain was un related to diabetes and the high blood sugars were due to my body's stress reaction to the pain so came down when the pain eased ... and the insulin started working.)

 

[rebrascora]

I think living alone puts a slightly different slant on these sort of situations too. I think you have to give it extra thought and perhaps just be a little more cautious when you don't have anyone there at home for back up.

 

[DaveB]

I was trying to get it down, with extra corrections etc… but it wasn’t working.

@Pattidevans wrote it here, they didn’t find anything particular but said it was probably a combination of upset stomach, dehydration, everything going on lately with already dealing with a virus, stress of high bgs and hospital… etc

When my BS goes very high I find corrections are very slow to work and need to be large. It's well-known that high BS can be difficult to get back down. I sometimes add an extra Basal as well as Bolus for correction.