Insulin Requirements When Sick

I posted yesterday about severe pain I experienced when my blood sugar went high. Long story short, I was in ketoacidosis. After getting sufficient insulin I was able to recover mostly. Thanks to everyone who responded.

But, I now have another question.

This all started the night before last. I am still not sure what was the cause. I woke up and my BG was 200 and increasing. I took more than enough insulin to bring down the BG, but it went to 350 before long and that is when I had the pain and trouble breathing. After taking an enormous bolus of 50 units, I can down to about 200 and stayed there most of the day. By the end of the day I had injected over 150 units of Humalog.

I have A1Cs that are always stable around low to mid 6’s. My CGM average is 120 with a standard deviation of 40. I am on a tandem pump and Dexcom G6. I am slim, swim everyday for at least 2 miles (fast), and in pretty good shape despite being in my 60’s and being a type 1 since childhood.

Here is the weird thing.

My daily insulin is between 25 and 30 units. Yesterday I took over 150 units! Today I am on a schedule that looks like I will also have delivered 150 units.

I do not feel sick (other than the effects of the DKA from yesterday).

I know that we need more insulin when our bodies are fighting infections, but my experience has been a 50% increase in dosage - not a 5X increase.

Has anyone had an experience like this?

BTW, I have changed vials thinking that maybe one had gone bad, but that was not the explanation.


So glad you found a cause and it wasn’t a big ugly one. On the DKA front, we don’t have any experience other than diagnosis, hopefully someone here has and will post.


I am glad you are feeling better and hope another member can provide some insight.


I’m glad you are feeling better and determined the cause of the pain. But 5x your normal TDD is a huge amount. I will need to do up to 3x TDD when I’m ill as in a flu or some other illness but I don’t think I’ve ever gone as high as 5x, unless there was an issue w/ my pump (Omnipod) or site. Have you ruled that out?


Yes, I have taken boluses using both pump and syringe. I have changed out the infusion sets and reservoirs a few times. I do not think it is the pump or infusion site.


Have you been tested for COVID-19? I mean perhaps this is unlikely but that’s the first thing I would wonder about – some new illness that can present in a variety of ways…


I one of the FIRST indications I have that I’m fighting something is increased sugars and insulin usage. I have a “sick” and “semi-sick” setting that I created on my pump. I easily use 3x as much insulin when sick.


I have had many DKA’s. Although not for a number of years now. Stress was the main catalyst for mine. One thing that is taught where I am, is more about the ketones. Do you have a meter that can test ketones? In the past, I feel like I’ve had more than enough insulin on board to bring those high numbers down (I use mmol/l so haven’t calculated what your 200 was yet) but because of the presence of ketones, I’ve required so much more. Even more than the recommended amounts. I’ve attributed that to the fact that guidelines are so generalised. We all have our own versions of the disease and that is why what works for others, won’t work for me.
You haven’t said whether this has happened to you previously @mike1, but for me, it was only after it occurring multiple times, that I was able to see the pattern emerging.
I’ve included the images of the guidelines that I have used in the past, they are in mmol/l. I hope you can see them as they have faded slightly.


Many thanks for the info.

Yesterday and today (Thursday) I am doing much better. I took over 150 units on Monday and Tuesday, but Wednesday I was down to near normal levels of about 35 units. Today looks like it will also be normal.

I am concluding that I am not sick with a bug, but this whole thing was induced by stress. I have seem my BG spike when under stress, but nothing like this before.


Glad to hear that you’re feeling better @mike1!

Stress really is detrimental to those of us with T1D. I used to thrive on high pressure situations in my work. However physically, my body had other ideas. Stress can trigger that fight or flight response and releases cortisol, which raises our glucose levels. For me, that’s when sh*t gets real.
I am unable to work because of my body’s reaction to stress. It’s now been 10 years. I was hospitalised 7 times in 2 years and the final one was the most serious. I am extremely lucky to still be here!

So, I would suggest watching your stress levels very closely and monitor your levels more often when stressed. If you can, get a meter that tests for ketones, then that may help to avoid having a similar response to me.


Dehydration is a contributing factor along with lack of insulin. Hydrating A LOT along with checking for ketones is important. As we get older, we tend not to feel thirst as much. And that often leads to dehydration. Glad you are feeling better.