Diabetes management is not easy for me to learn: it takes me a while to figure things out. Here are a few things that I have learned in the past year about sickness BG management that I did not know a year ago:
The core problem is basal need
basal needs vary incredibly fast and by a huge range when sick. I now control sickness much better by radically changing basal as opposed to dealing with instant BG level
Sick peaks may not be sick peaks
same idea from another angle: these sudden rises we see when sick are in general NOT momentary sick peaks (there are exceptions) but sudden increases in basal needs. To deal with them, you need to both (a) increase basal radically and (b) administer a bolus to deal with the rise itself. Otherwise, we keep on injecting many units of bolus insulin every 1.5 hours.
Decreased insulin needs are as much of a problem
When sickness ramps down, dealing with decreased insulin demand is as hard if not harder, and requires as much anticipation as possible. On the pump, I find half-hour suspends a powerful help when caught (more than that sometimes creates unwanted peaks for us).
Pump is easier
it is a lot easier to deal with sickness with a pump than on MDI, because changing basal is so much easier. With MDI, you need to compromise in your basal increases/ decreases or you are badly caught later.
Short basal changes on MDI
Last year, thanks to many of you, I discovered the use of NPH as a “short basal”, which worked well with us, particularly at night. For some people, levemir may also work when their levemir DIA is short.
Sleep
sleep makes a huge difference to recovery.
Timing of insulin need changes
Insulin need changes can precede sickness symptoms, for us by one to two days. For us, they also persist after sickness symptoms are gone, often for several days, up to 1.5 weeks.
Daily rhythms
there are daily rhythms to insulin needs in sick time. For instance, when my child is past the worse but still quite sick, his insulin needs may be radically lower between 2-3am and 1-2pm than the rest of the day (for instance, yesterday he needs +20% basal in that period, but +80% the rest of the time).
Technique: extended boluses
Because of these radical changes in insulin needs, I find that it can be very useful to use extended boluses when unsure of what is coming up, because it is easy to cancel them before they are fully administered and you don’t have to fully deal with the consequences of a large insulin overdose due to a wrong guess. For instance, if I see a peak that I suspect may be high (but I am not sure), I may increase temp basal by another 30 or 40%, administer a 2U immediate bolus and an extended bolus of 3U over 1.5 Hours. If, 20 minutes later, I discover the peak steadied out, I just cancel the extended bolus and reestablish the original temp basal. The same technique applies when it looks like a big bolus seems to have activated while doing nothing, and I feel I need to stack.
What have you learned about sick day management with experience that you did not suspect?
What have you learned about sick day management with experience that you did not suspect?
That the same physical symptoms (runny nose, fever, sneezes, etc.) don’t necessarily correspond to the same sick-day physiological response, and that my son can have stomach-bug-like sick days (i.e. delayed or tamped down glucose processing) without any symptoms of disease showing up. But I do suspect those still reflect some kind of disruption in digestion.
i agree 100% (no TB puns intended ). it is much easier to raise a TB by 50% than to bring my basal back down with a smooth landing. its really a matter of how sick i still feel and continued and frequent testing (if you don’t use a CGM, which i do not).
i was sick for 2 weeks just recently and was on a 50% increase on my pump for the first week. very very slowly i was able to come down. when i got to 20% elevation, it became trickier. i had to monitor myself every half hour. a real PITA.
also, i noticed that when i was feeling better, i still needed more basal for the following couple of days (like a 10% increase) .it wasn’t until i started going low that i knew for certain that i didn’t need any more TB.
Thank you @Michel so much for writing this post. We are up in the middle of the night repeatedly tinkering with EH’s basal/bolus stuff over the last three days because he came down with a cold apparently on the way to the airport. Now we are in Austria and he’s very sick. Knowing how to start with the tinkering has been very helpful.
Prior to FUD no one had discussed sick days with us. Seriously. Didn’t know there was a protocol.
Thank you! I realized this might be useful for someone else…
Eric got up this morning at 9am, ate an impressive and leisurely breakfast made by our hosts, and went back to bed around 12pm. He’s just gotten back out of bed at 9:30pm. He made a new sick day program that was +100% more basal which we ran from 12:30pm until 5pm and that worked pretty well. Then at 5pm he started trending low, switched to +75% until 7pm, but still drifting low, so I switched him back to normal. He basically slept through all of it! We did some finger sticks but he just went right back to sleep. Which is amazing!!! Now it’s time for dinner, and he’s drifting back up, we are back on the 75% one. Having a few sick day programs made this much much easier.
Love this post, @Michel. My experience w my recent stomach bug matches what you’ve written about. And it somewhat parallels dealing w hormone induced resistance. Bonus!
I have been diabetic for 15 years, and I have never even used a “sick day” basal pattern. I’ve just march stubbornly through all of those days, sticking bandaids on highs and lows as they arose. That’s the bad news. The GOOD news is I now use every one of those strategies you mentioned up there for sick management as part of my daily routine. I spent the first 14 years and 9 months of my diabetic life without those strategies either. I have learned them here, and I’m a much better equipped diabetic as a result. Now I look FORWARD to my next sick day… I’ve got new skills to play with.
Yeah, and I really thought I was escaping this one. My husband got it two weeks ago Wednesday. My oldest got it one week ago Wednesday. And I got it this Wednesday.
I’m employing the “fake it 'til you make it” strategy of getting better right now. I have got to be up and moving to get this insulin going in my system. I just can’t wrap my head around going higher than +50% extra basal when I’m still a bit nauseous and can’t guarantee my ability to eat/drink my way out of a basal low.
At the same time, after sleeping for a day and a half straight, I do feel about 80% recovered. So that’s good.
I have to laugh. We are again on a trip and again EH’s basal needs seemed higher due to impending illness, I think. But I can’t remember the protocol amid everything else going on. So I search FUD, and find…my own post from the last traveling illness! I’ll keep myself and everyone else posted.
@Sunny, since you guys are new to the game, there might be some good info in here for your consideration. There are plenty of parents in here talking about sick day management of their young ones. I’m sure they’d be happy to answer questions you may have!
I have completely misunderstood insulin needs in relation to sickness. This past week I must have eaten something bad or caught this from someone else, but I ended up having diarrhea, nausea, vomiting, and a slight fever I think. I was under the impression that having no food in my body would make me really sensitive to insulin, but this was completely backward to what actually ended up happening!
My insulin needs changed as soon as symptoms began. I ran around 300 the first night, and the next day after reading this I ramped up my insulin. I used +60% basal and was frequently correcting for mild highs (around 150) even though I hadn’t eaten anything all day. I ended up using 2 times the amount of total daily insulin with only having a piece of toast. The 2nd night I ran a +30% basal and still ended up in the 200s. Day 3 my symptoms persisted (just diarrhea and nausea, no vomiting or fever) but my insulin needs started to come back to normal. Night 3 I used no temp basal and had stable numbers at 100, and it seems like my insulin needs are back to normal now. Symptoms are currently persisting, but I’m hoping they’ll stop today fingers crossed
Also just want to express annoyance that a few days of running high brought my average blood sugar up by 7 and to get it to come down by even 1 takes it feels like weeks of great control
I must say, it sucks to have to work twice as hard with BG mgt on top if being sick.
and to get it to come down by even 1 takes it feels like weeks of great control
Double or triple TDD and still high AVG!