@lspielberg, would appreciate if you could share your sick day protocol. I’m knew to T1D (3 months) and have gone through a flu or anything like it as yet. As I got Moderna also, I’d like to be prepared for the potential. Thanks.
Tom
2 Likes
@TomH, I am going to split your request because it is a great topic and while it has a relation to Post-Covid, it is also much broader.
1 Like
Our son’s varies. Basically, he can go from needing no extra insulin when sick to needing double or more. I usually look at what he used the day prior and just run a temp basal to that effect. So if his TDD is 12 units and he’s using 15 when you factor in all the extra corrections and autoboluses, I’ll set a temp basal of 125%.
1 Like
A good place we always start is double and go from there
1 Like
For me, it’s super variable whether and how much being sick affects my blood sugars. Sometimes minimally, sometimes a lot. My basic plan is to much more aggressively correct and adjust basal insulin aggressively if it seems like I am having higher blood sugars, but to make sure I have things on hand that are easily to treat with lows with (like regular gatorade and ginger ale). The biggest thing is to check ketones regularly. If ketones are elevated, you need more insulin, period, even if you have to take in extra sugar in order to take more insulin. You also need fluids and electrolytes. If ketones are elevated, and you cannot keep anything down in order to take more insulin and fluids, that’s when you need to go to the ER for IV fluids, glucose, and insulin. Do NOT mess around when sick and running ketones.
5 Likes
This cannot be emphasized enough, because it is the biggest issue for new diabetics. i.e. knowing when is it time to hit the go to ER button.
5 Likes
Unless of course you’re @Eric, in which case you probably just DIY the IV insulin/fluids/glucose. 
(Note: don’t do that!)
3 Likes
Way back when, I was wondering what’s the “or else” if I ignore high ketones when I’m dehydrating because I can’t keep anything down. One article said clearly, “acute kidney failure within 24 hours.” I’m sure that’s not the end of it…
3 Likes
When I was hospitalized a couple of decades ago with severe DKA and dehydration secondary to salmonella, my mom (who was there and interacting with the ER staff) was told I was maybe 24 hours away from potentially permanent organ damage. I had lost 10 liters of fluids by then. It was bad. Spent I think 5 days in the ICU and took probably a month to fully recover.
5 Likes
I have IV’ed dextrose solution myself. And it is significantly awesome. 
3 Likes
Did you prepare the dextrose solution yourself too?
2 Likes
Actually there is an even better story to that!
You know you can’t buy dextrose solution for injection in the U.S. without a prescription.
But you know who else uses it? Farmers. Dextrose is often injected in cows and horses after they give birth because of the onset of lactation and their lack of interest in food after birth. And it is also given when the dairy demand becomes too high.
You don’t need a prescription to be a farmer.
And while it does say that it is only for use in animals, it also says it is sterile. 
6 Likes
Let’s be a little careful about this. Injecting 50% dextrose sub-Q or IM is a bad idea. The word in the sheep world is that dextrose pretty much needs to be given IV to avoid tissue damage. In a hypothermic new-born lamb it’s possible to heavily dilute 50% dextrose and give it sub-Q with small amounts in multiple places. For an adult it isn’t practical to give a large enough dose because you would need lots and lots of dilute solution but it isn’t safe to give many cc’s per injection site.
Background on ketosis in ruminants: In the last weeks before birth the fetus is so large that there isn’t space for the rumen to fill to a normal volume. So the animal may not be able to eat enough forage to stay out of ketosis (called “pregnancy toxemia”). To avoid this we try to give enough concentrated grain that the shortage of rumen capacity for forage doesn’t drive the mom into heavy fat metabolism. But too much grain can trigger a life-threatening clostridial infection in the gut, so it’s a delicate balancing act. The usual treatment for emerging ketosis (spotted by noticing a certain kind of lethargy and reluctance to eat) is to give oral food-grade propylene glycol, which is naturally produced by the body as an intermediate stage in carbohydrate digestion. The propylene glycol provides the energy of carbohydrates without stimulating bacterial overgrowth in the gut. (Note this is propylene glycol, not ethylene glycol, the antifreeze that is lethal.) IV dextrose is used for an attempted rescue from advanced ketosis. At least in ewes, ketosis generally is a before-birth issue. After birth the metabolic issue is more likely a calcium insufficiency (“milk fever”).
Bet you didn’t expect to read that in a thread about sick-day protocols.
3 Likes
Yeah, I would never do dextrose by IM or sub-cu injection. That just damages the tissue. I was only talking about IV use. That’s the only way I have ever used it.
The background information you gave was cool. 
I have never given it to an animal. 
1 Like