Insulin doses when ill...

[Vix]

Sods law that the one week my dietician and DSN are away I get the lurgy, nothing serious just a cold, headache and fever but I haven't been told what to do about my insulin when ill (and not vomitting.) My sugars have not been below 11.8 all day, and mostly at 15+ despite extra insulin with meals... I don't know whether to increase my basal tomorrow? I even did more correction than usual with dinner as I know they've not been going down but I'm still 15.4 before bed and I don't want to do extra now as I don't want them to drop in the night - what do you do about your basal/bolus doses when BGs are high due to illness?

Xx

 

[pgcity]

I put up both my basal and bolus but its a lot easier to do this on a pump. Have you checked for keytones? Those levels are pretty high and I would take some insulin and set my alarm to make sure I don't go low.
Hope you feel better soon.

 

[everydayupsanddowns]

Sorry to hear you are feeling ill

I used to just firefight with corrections on MDI, but now these days I would gradually 'ramp up' basal 10% every day or so as the cold progresses, then take it back down again at the other end.

Only slight complication with Lantus might be the 'lag' where it takes 2-3 days to settle, but it might still be worth adding a bit extra to help your boluses/corrections to work properly.

 

[Vix]

Thanks, I do my lantus now so I'm going to put it up a couple of units and see what happens... Ironically no ketones but when I have 'random spikes' that my DSN can't even figure out I have med-high ketones!

Hope it isn't a long lasting cold as feel bad enough without my BGs being constantly high! My increased bolus yesterday didn't seem to make much difference but am scared to increase too much Incase it goes low... Trial and error for now I guess

Xx

 

[trophywench]

Well I've just mentioned alsewhere that my standard setting for illness bolus increase for my pump, is +20%. I think I'd be inclined to try +10% first though on MDI, as you never know exactly what your basal is doing.

 

[Vix]

Thanks Trophywench... Excuse my ignorance but I've never been told about adjusting doses when ill - does +10% mean add 10% of my total daily dose at meal times??? That's what I tried and it doesn't seem to have done much... I've increased my basal by 2 units from 18 to 20 but would rather adjust my bolus if possible (like I said my take on 10% doesn't seem to be working but no idea if I'm working it out correctly) I have ketones of 1.5 (urine)

Xx

 

[everydayupsanddowns]

Thanks Trophywench... Excuse my ignorance but I've never been told about adjusting doses when ill - does +10% mean add 10% of my total daily dose at meal times??? That's what I tried and it doesn't seem to have done much... I've increased my basal by 2 units from 18 to 20 but would rather adjust my bolus if possible (like I said my take on 10% doesn't seem to be working but no idea if I'm working it out correctly) I have ketones of 1.5 (urine)

Xx

+10% on basal sounds like a good idea.

Additionally, for meal boluses I'd add the % to the calculated bolus. So if your meal/correction totals 5.0u, and you are adding 10% you would actually bolus 5.5u (easy if you use a phone calculator and x each bolus by 1.1).

If that ends up not being enough, you could try 20% (eg your 5u x 1.2 = 6u) but best to ge gently to start with.

Keep your fluid intake up to try to flush those ketones. And if they get worse/you start to feel sick consider a trip to A&E

 

[Vix]

Thanks Mike,

In that case I've been completely over calculating!! I've been doing my usual dose eg 5 +10% of my total daily dose (approx 34 for basal/bolus combined) so for breakfast I did 6 (including correction dose for lowering BM from 11.9) +3 extra = total of 9 units and my BG was 12.9 when I checked 2 hrs after breakfast (have the same breakfast every day) ??? I did 3 extra units at bedtime last night when I was 16.3 and still 11.9 when woke up

If I calculate 10% of that bolus dose then it ends up being 0. something as I tend to have between 5-10 bolus units with meals - is that right? I can only inject in 1 unit increments so it seems like I'll never really add much more to my dose? Something strange is going on as if I'm adding +3 units (which for breakfast is +50% of my usual dose) and it's not bringing it down that doesn't seem normal does it??? I've increased my basal from 18 to 20 in a morning, which i guess is about a 10% increase...

Xx

 

[pgcity]

Thanks Mike,

In that case I've been completely over calculating!! I've been doing my usual dose eg 5 +10% of my total daily dose (approx 34 for basal/bolus combined) so for breakfast I did 6 (including correction dose for lowering BM from 11.9) +3 extra = total of 9 units and my BG was 12.9 when I checked 2 hrs after breakfast (have the same breakfast every day) ??? I did 3 extra units at bedtime last night when I was 16.3 and still 11.9 when woke up

If I calculate 10% of that bolus dose then it ends up being 0. something as I tend to have between 5-10 bolus units with meals - is that right? I can only inject in 1 unit increments so it seems like I'll never really add much more to my dose? Something strange is going on as if I'm adding +3 units (which for breakfast is +50% of my usual dose) and it's not bringing it down that doesn't seem normal does it??? I've increased my basal from 18 to 20 in a morning, which i guess is about a 10% increase...

Xx

It's very tricky when you are Ill especially with keytones. On Sunday I was on +40% basal and adding corrections totalling 12u. Which is loads for me as my TDD is only 20u. I injected 3u on a bg of 8.3 with keytones of 1.7. This got rid of the keytones and I was worried about going hypo to find my bg after 2 hours 8.2 and after 4 hours 6.8. Wtf

 

[everydayupsanddowns]

Thanks Mike,

In that case I've been completely over calculating!!

Not over calculating if it hasn't been working! The idea behind going gradually is not to add hypos into the chaos, but if your corrections aren't correcting then it seems to me you might try adding a bit more basal and bolus % from now on.

Looks like you assume 1u drops you by 2mmol/L or thereabouts?

In your shoes I would add up correction/food bolus then x by maybe 1.2, then if that doesn't work try 1.3 (130%) the next day, then 1.4 (140%) and so on. Each time putting basal up by 1u or 2u a day until doses/corrections start behaving.

By which time your illness will prob be subsiding and you'll need to back off all those increases again quick smart to avoid crashing hypos 🙄

 

[Vix]

Thanks pgcity - I've managed to get my ketones down but cannot get my sugars into single figures! Looks like it's the diabetes random numbers game again 😉

Mike, looks like i just need to keep going with the trial and error then and like you say by the time I get it right I will hopefully be feeling better again! With the calculations I did with my dietician 1u drops me by 3mmol/L... I could really do without my sugars being high at any time but I have to see a psychologist tomorrow about my fear of blood tests and I know I'm going to be in tears before I even get in there if my BG is high, especially as I will be stressing about it anyway but must resist the urge to increase my doses too much and then I'll end up going in hypo 😉 The battle continues!

xx

 

[trophywench]

Are you scared of the testing or just the results? And did you mean finger-pricks or the armful of blood type?

I only ask because if it's the former, Alan Shanley has some tips about pain-free testing on his Blog - see

http://loraldiabetes.blogspot.co.uk/2006/10/painless-pricks.html

Worth a read.

 

[Vix]

It's the full on arm hba1c type test... absolutely hate it - I had a really bad experience when diagnosed and no idea what the nurse did but my arm was so swollen and bruised I couldn't bend it for 3 days - kind of put me off a bit 😉 so I just don't trust anyone to do it... I found a great phlebotomist in London but now we've moved back to Yorkshire she's too far away 😉 Her mannerisms were great and once I knew she could get the blood out without 7 attempts (that's the average) and didn't tell me I have small veins (yes I know that!!) I was fine when she did it. I'm the same with getting a canular in for drips... literally took the registra 9 attempts for my last operation and I find it's usually the registras that do it and don't seem to have the best bedside manner for someone with a fear for it... anyway I won't go on as I'm sure I'll have to go through it all tomorrow but if we are wanting to start a family I'm going to have to find some coping strategies for it 😉

xx

 

[trophywench]

I see your point.

I'm lucky as our GP surgery has F/T phlebotomists (as opposed to someone doing it rarely) and they are good. If it's any consolation they did used to have a bit of trouble with getting blood off me when I was in my teens and twenties - but I sort of seemed to grow out of it.

Do they ever ask you to 'pump' - put the velcro tourniquet round your arm above the elbow, then make a fist and move your hand/lower arm up and down? - that helps bring your veins up BUT - you absolutely MUST unclench and relax the hand and arm before they jab you - otherwise you WILL bleed like stink and have a humungous bruise.

Also helps to have the arm straight - if they don't have proper chairs with proper armrests to keep your arm 'flat' just have it by your side and support the elbow - push it up - with the other hand to support your arm.