Insulin reduction doses and illness

[Gary S]

Hello
Can anybody help please? I'm T1 and find it impossible to work out correction insulin doses when ill. I use Novorapid to bring my sugar levels down by 2 points normally, but when ill I find I'm injecting crazy amounts sometimes to no avail.
Any help in this would be gratefully achieved.
Thank you to all in advance.
I'm very new to this site so if the answers are already in the database somewhere, I apologise in advance.

 

[Ljc]

Hi Gary, you might find this guide helpful
http://www.mydiabetesmyway.scot.nhs.uk/resources/leaflets/SickDayRulesForType1.asp.

 

[Ljc]

Please don't be concerned about asking questions that may have been asked by others before, we all know it is much easier to ask rather than trawl around a site for answers , especially when you're worried or not feeling too good yourself. We're a friendly supportive community and we can't give cyber support if you don't let us know when your under par.

 

[grovesy]

Welcome.

 

[novorapidboi26]

When your ill, in the first instance, you should be looking to increase your basal insulin in response to an increased resistance.....

this means you are minimising your need to make changes to either your insulin/carb ratio and/or any correction factors.....

of course you may still need to adjust the insulin/carb and correction factor but with an increased basal doing some of the work the changes should be small and more manageable...

are you referring to a recent or current illness? were.are you able to eat....? are you aware of ketones?

 

[trophywench]

Well I disagree - you don't immediately recognise you ARE ill at the same time as jabbing your basal, plus once you've increased your basal dose, you are flippin stuck with it for the duration - anything from 12 - 36 hours - so just doing the fast acting is both far more expedient and far safer.

I mean fair dos NRB - if you happen to fall off a cliff or get squished by a steamroller well you do know it's gonna last - but unless I knew it would, I'd rather just firefight on MDI. Plus of course depending what's wrong you might need anything from 5% extra to 305% extra - so you can't just wing it - and altering boluses is simply more cautious when you really don't know what you're doing - if it's not enough - have some more - if it's too much well you're only banjaxed for a few hours.

 

[Gary S]

When your ill, in the first instance, you should be looking to increase your basal insulin in response to an increased resistance.....

this means you are minimising your need to make changes to either your insulin/carb ratio and/or any correction factors.....

of course you may still need to adjust the insulin/carb and correction factor but with an increased basal doing some of the work the changes should be small and more manageable...

are you referring to a recent or current illness? were.are you able to eat....? are you aware of ketones?

Thanks, that makes sense to me.
It was a week long stomach illness I've previously had, with little/no food. My ketones readings were just about acceptable, but the Insulartard doses were around 200+% 3-4 times a day, and still nowhere near normal levels.
I'm on 16u Lantus normally, and an average of 14u NRapid total a day. Any idea how much I should increase the basal units by?

 

[Gary S]

Well I disagree - you don't immediately recognise you ARE ill at the same time as jabbing your basal, plus once you've increased your basal dose, you are flippin stuck with it for the duration - anything from 12 - 36 hours - so just doing the fast acting is both far more expedient and far safer.

I mean fair dos NRB - if you happen to fall off a cliff or get squished by a steamroller well you do know it's gonna last - but unless I knew it would, I'd rather just firefight on MDI. Plus of course depending what's wrong you might need anything from 5% extra to 305% extra - so you can't just wing it - and altering boluses is simply more cautious when you really don't know what you're doing - if it's not enough - have some more - if it's too much well you're only banjaxed for a few hours.

Hello Jenny
Thank you for your answer. Between yourself and Novorapidboi I have the answer to the two types of illness you can have - short and long term. Of the 20 years being type 1, I've only been on Bolus and Basal insulin for three years, having been on a twice daily long term insulin until then, so I'm relatively new to this regime and still learning (daily almost, it seems)
Thanks again for the answer, and like yourself, I will go on and impart any wisdom that I have gained on anyone who requires some help.
Merry Christmas
Gary

 

[trophywench]

God you've only had D 5 minutes and you seem surprised you are still learning - I learn summat new almost every day Gary.

Trouble is at my age, my brain doesn't absorb stuff as readily as it used to when I was 16 - but for the last 44 years I've been grateful to Dave Willetts for teaching me the absolute basics about diabetes during my Biology O level lessons!

 

[novorapidboi26]

Well I disagree - you don't immediately recognise you ARE ill at the same time as jabbing your basal, plus once you've increased your basal dose, you are flippin stuck with it for the duration - anything from 12 - 36 hours - so just doing the fast acting is both far more expedient and far safer.

Did you read my full post.....?

if you can, increase basal to minimise messing with the several other variables in the equation....

then move on to the bolus adjustments....

bolus for me is a quick fix, its in and out in a short time, 4 hours personally.....

if there is a full day increase in resistance a basal increase is common sense...initially and if possible.....

having a split dose of basal is the basis of the opinion I suppose, so if your on a single dose...its much less flexible when your ill......😉

 

[SB2015]

Good to have you on the forum Gary. When you are ill your body will not process the insulin at the same rate so you will need more to do the job for you. Whilst it depends how ill I am I increase both background (basal) and bolus as necessary, sometimes getting up to 200% of both.

For colds etc, I tend to get the increased BG the day before I know that I have a cold. Once I know it is a cold and therefore so it is going to be more long term I start to increase my basal insulin. That will be needed whether I am eating or not. Then I use the settings on my handset of stress (+20%) and illness (+50%) to up any corrections and bolus as necessary. If these are not enough then I start to increase more.

Whether ill or not, I find that if I am doing a correction and my BG is above 10 I will need more than my correction ratio tells me, so I apply the stress increase, and above 14 I use my illness increase.

I have found these figures work for me but everyone is different. So you will need to work out what you need for what levels.

 

[trophywench]

Did you read my full post.....?

if you can, increase basal to minimise messing with the several other variables in the equation....

then move on to the bolus adjustments....

bolus for me is a quick fix, its in and out in a short time, 4 hours personally.....

if there is a full day increase in resistance a basal increase is common sense...initially and if possible.....

having a split dose of basal is the basis of the opinion I suppose, so if your on a single dose...its much less flexible when your ill......😉

So you'd advocate someone who hasn't a clue yet what extra insulin his body might need or when it actually needs it - to launch happily into extra basal instead of being tentative at first, and just deal with the hypos in the middle of the might or whatever - instead of trying just a teeny increase first of all?

When would YOU immediately increase your basal (on MDI remember, no TBRs available) for a cold then? at the first sneeze or when your BG starts increasing for the very first time in your whole life with a cold 3 weeks later? - and actually I landed up throwing the whole of the rest of that box of insulin cartridges away cos it turned out the next one was no better either - but when I started the new box (dispensed on exactly the same day and both kept properly on the same shelf of the same fridge in my kitchen) - my BG immediately decreased again to what it should have been.

I mean - being as every single one of us is different as to how our bodies behave - although yes there are sick day rules we all need to be aware of - in fact I've never had an illness - or an operation or procedure either major or minor - when I've actually needed them! What if the OP is like ME?

 

[SB2015]

in fact I've never had an illness - or an operation or procedure either major or minor - when I've actually needed them! What if the OP is like ME

Lucky you!! I have been glad of a logical set of rules to follow when I have felt very ill
and following various operations.

Gary. Do you have access to the sick day rules? It would be worth asking the DSN if not. Also you mention that you have only recently switched to MDI. Did you get to do a Dose Adjustment For Normal Eating (DAFNE) course? There was a lot of in formation that I gathered from that course, and life suddenly became a lot more flexible and my insulin doses more reliable.

 

[Gary S]

Thank you to you all for all your excellent posts. I have learnt a lot from all the inputs I've received in this and still have a course to do (as from the last post). I've written the snipets down (in case I forget) and put them in my medical drawer to pull out whenever the next inevitable bout of illness comes!
I'll go into the next time armed to the teeth with great info and won't feel so overwhelmed.
You've all been a great comfort to me, thank you.
Gary