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Evergreen

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Relationship to Diabetes
Type 1.5 LADA
Hello everyone,

I’m after some advice if possible.

I seem to have come down with gastroenteritis and ended up in A&E with it on Sunday, not quite reached DKA luckily but had to stay in hospital for a couple days.

I was discharged on Tuesday and thought I was doing ok, but last night after eating I felt very sick again, ketones went up to 0.8 and my blood sugars went up to 13 overnight. I managed to get them down (BG and ketones), but its left me quite scared.

I’m feeling nauseous this morning, managing to drink but unsure if I can keep any food down. Can I skip a meal (or several) or would this be dangerous? Im worried about ketones going up again.

Im waiting for a call back from the diabetes team, but any advice in the meantime would be great!
 
Sorry you’re feeling so unwell. If you went up to 13, and manage to bring it down again, it’s not really anything to worry about. Yes, it’s higher than you’d like, but we all get stupid spikes if we are unwell, and in the long term it won’t cause any harm. Ketones at that level aren’t worrying either, and are probably caused by not being able to eat, your body may be burning. a bit of fat to keep you going.
If you can’t eat, as long as you don’t take your mealtime insulin, you should be fine, as your Basal should hold you steady. If you find your blood glucose levels dropping, trying a few sips of a sugary drink every few minutes if it’ll stay down, might help keep them up.
Hopefully your team will get back to you with more detailed advice specific to you, meanwhile, if you run into more problems, give them a nag.
 
Thank you, that’s really reassuring. I’ve spoken to the team who said something along the same lines 🙂

They also advised me to take my insulin after eating for now to see I can keep it down, which makes sense.

Any advice on what to do when I do vomit after taking my rapid acting insulin? As in what to try and eat or drink that works fast enough to combat a hypo?

Thank you again!
 
@Evergreen Sorry to hear you’ve been ill. Stomach bugs are horrible with Type 1. I recommend full sugar Coke for upset stomachs. Sip it slowly. Toast made from white bread is good too when you can stomach it. If you do go a bit low, putting a Dextro tablet in your cheek and letting it dissolve can work better than eating it (the glucose is absorbed through the cheek) and not induce nausea so much.

I also advise you inject after eating. I give it a while to make sure I’m not going to be sick, then I often inject half and half a little later just to be sure. You might also find you need less insulin because your digestion will be messed up. I need as little as a third of what I’d normally take for bolus for the same meals. I also eat small amounts more frequently.

Try to keep hydrated. Dioralyte can make you feel better too. Although you don’t want to push the eating, even eating small amounts can help you recover quicker.
 
Flat lemonade is another option
 
Thank you! That’s all really helpful!

I’m noticing my digestion is completely messed up. Food doesn’t seem to make my blood sugar go up as much (which is good I suppose), but insulin doesn’t make it come down in the same way either. It’s just so strange.

I really thought I’d beaten this bug, but clearly not! Hopefully very soon. Thanks everyone for the advice, I cannot tell you how much I appreciate this forum!
 
I was going to post this on another thread where a lady’s poor son has had a bad stomach too, but I’ll post it here first. These probiotics were a godsend when I had a stomach upset that went on longer than normal but left me with ongoing digestion problems. They help ‘take out’ the dodgy virus/bacteria and really did help me. I took them for a couple of months (yes, it was that bad). I started on one a day, then built up to two a day (I took them before meals):

Special probiotic formula

For your son too @Jani
 
Interesting! I’ve used probiotics for my son when he was a baby and struggling with dodgy tummy due to allergies, so that makes total sense! Thanks for sharing!
 
Hi everyone, just a quick update! I seem to be feeling a little better although I can still only really eat ‘simple’ things. Hoping it’ll be better soon!

Now, something I did notice is that I seem to be super sensitive to insulin now. I need less than half I think. Another weird thing I noticed is that the insulin seems to balance the food out quite well for 3 hours and then blood sugar starts dropping. I’ve not really noticed that before.

I’ve already dropped my basal a little and obviously taking less bolus. I’m wondering if this is something that anyone recognises?
 
Maybe you need to reduce your bolus a little more? I found my boluses only needed to be 1/3 of what I’d normally have. It’s to do with reduced food absorption from the recovering digestive system. Just be cautious and only take the insulin you need not what you think you should have.
 
Yes that’s what I’ve been doing, it just seems so dramatic! I think my ratio is currently about 1 unit for 30-35 grams of carbs, just bizar.

I cannot wait for this bug to be gone, it’s never taking me this long to get back to normal and I keep worrying the diabetes is causing this somehow…I have ordered those probiotics you recommended so fingers crossed!
 
Sorry just another question, do you need to reduce your basal too? I’ve reduced it last night and still think it’s too high potentially.
 
Evergreen said:
Sorry just another question, do you need to reduce your basal too? I’ve reduced it last night and still think it’s too high potentially.
Click to expand...

Yes, I reduced my basal too. I’m on a pump so I fiddled around with the hourly rates and also used temp basal rates as needed. I don’t remember by how much I reduced it (I’m only on small amounts of basal).

Sorry - not very helpful, but do reduce it a bit more if you think it’s needed. Always err on the side of caution.
 
No that is helpful! Thank you. I might go down another unit tonight to 7u.

I’ve been wondering if a pump is more useful to manage ‘erratic’ diabetes. How are you finding your pump and would you recommend it for people who have trouble managing their diabetes?
 
I’ve had various pumps for almost 20 years @Evergreen I got mine because of nighttime hypos. My insulin needs vary a lot through the night.

So, a pump is good if you can’t find a basal insulin that suits your body’s needs. It’s also good if you’re very sensitive to insulin and need tiny/precise doses. On a pump you can bolus 1.75 units, for example or do a correction of 0.35 units. So, the answer depends on why a person has trouble managing their diabetes. Pumps need quite a lot of user input and adjustments, so they’re not an easy answer. They’re only as good as the user. Injections are easier IMO. But if you have issues that you’ve tried to solve and can’t with the tools available, then a pump might be an option. You have to fulfil certain criteria in order to get one.
 
That makes a lot of sense. And food for thought.

I’m struggling to manage my levels quite a bit and it seems so incredibly unpredictable. I have weeks where I feel in control but it never last long. It’s giving me a huge amount of anxiety and im realising whatever is happening now is unsustainable. However I think I’ve had a secret hope that a pump would be a miracle cure, which it obviously won’t be.
 
Not sure if it helps but I find my diabetes ebbs and flows. I can have a couple of weeks or more where I feel like I am really on top of it and things work as I expect (mostly anyway) and I can easily get 90% TIR or more but then then things seem to go off kilter for a few days or a couple of weeks or sometimes longer and I am adjusting basal doses and doing a lot of corrections to try to keep on top of it and it is really frustrating. Then just when I am really starting to get exasperated with it, it just seems to come right again and I am back into calm waters and smooth sailing, until the next bit of instability. I have learned to just keep plodding on during those challenging periods, doing whatever I feel I need to, to keep my levels in range. A few days ago I needed 14 injections of fast acting insulin in one day to keep my levels mostly in range and many of those were 2 and 3unit stacked corrections because my levels just kept going up despite the insulin I had previously injected. Other days I might just have 2 meals and 2 small boluses and not need anything else other than my basal injections and sometimes I can whittle that down to just one a day instead of 2. My focus is to keep my levels in range as much as possible by closely monitoring my Libre and if that means I need to inject more insulin, I do, if I need to reduce basal and bolus another day, I do.
To some extent it depends which basal insulin you are using as to how much you can adjust it and it is one of the reasons that I love split dose Levemir because my basal needs change A LOT particularly my night time doses and if I have been particularly active for a few days on the trot, my night time dose goes down to zero, but my morning dose is usually still fairly stable. Some days I can get away with just 10 units of bolus insulin and sometimes I might need 30, even on a low carb way of eating. I try not to feel confined by any rules about injecting now and just accept that I need what I need and if my levels are heading up when they shouldn't be I jab some insulin to bring them down and if I need repeated corrections I up my Levemir dose the next day and if I am having to frequently eat JBs to head off hypos, then I reduce my Levemir the next day. Other basal insulins are less responsive, so you need 2-3 days for any changes to be fully effective, but Levemir I can change day to day or night to night and regularly do, depending upon what I have been up to and what my levels have been doing activity wise.

Other people find that really long acting basal insulins like Tresiba work well for them. A lot of it depends on body chemistry and metabolism and circadian rhythm. Finding a basal insulin that suits your lifestyle and body and getting the doses right or getting confident of adjusting it both up and down, makes a huge difference to diabetes management, but acceptance of the variability of diabetes is also really important, so that you learn to roll with it when it goes wonky and just do the best you can to weather the storm until you hit smooth waters again.
 
I think that does help yes, thank you. Although possibly not what I wanted to hear. I think I’m stuck in a place where I want predictability and maybe I need to accept that that’s just not going to happen. I’m struggling to accept this has happened to me anyway and that is probably where the biggest problem lies.
 
Sorry to hear how poorly you have been @Evergreen

So stresful when you can‘t really be sure what food will or won’t stay down, and your BGs are simultaneously rampaging :(

And then to be left with a whole new system of food and insulin absorption to get used to is a real faff :(

For future periods of illness you might find this ‘sick day’ rules flowchart from Leicester Diabetes Centre helpful?

Sickday rules pdf

Sick day rules flowchart from Leicester diabetes centre. Particularly useful for people with Type 1 Diabetes during the Coronavirus outbreak.
www.t1resources.uk www.t1resources.uk
 
I can remember when I was really resistant to changing my insulin doses (particularly basal) and it was an incredibly frustrating time. I think acceptance that things don't stay the same is an important part of the process and was a turning point in my diabetes management.

For me getting Libre really helped with that, because it became more of a game of keeping levels in range and less of a health management issue. I am now happy that I need whatever insulin I need to keep in range most of the time. Sometimes it might be that I don't eat until levels come down or I just eat something low carb so it involves quite a bit of discipline and other times it will mean me being quite Gung Ho with the insulin and just keep jabbing a bit more as and when I need it, in the knowledge that I can have a JB or 2 if it turns out I have over egged it. Then other times I might find that I need to ease right back on the basal and bolus as a result of exercise/activity.

I have only ever needed more insulin when ill, so your current situation would be strange for me, but I love the idea of reducing my insulin doses, so I would take it as a temporary bonus.
 
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