Please help if you can - low sodium and chloride, but pedialyte ramped up BG

Type 1 & LADA
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Hi, all. I am just looking into this, but feel too sick to really comprehend the complexities with us T1Ds between sodium levels and blood sugars and such. Long story made short(er) I was put on an eyedrop called cosopt (combo of dorzolimide and Timelol, a beta blocker) by new eye doc when mine retired. I was first put on just the Dorzolimide portion for 4 weeks then he put me on Cosopt. I never felt good the whole time with such low energy that my 40 plus years exercise schedule kept being compromised and I felt depressed. Nonetheless I tried to abide until I got tired of waking each day with what I call jittery blood and just yucky feeling and tiredness. So, after 7 weeks on Cosopt, I decided to take some time off of it. I felt much better and did one if my fastest 4.2 mikes walks in a ling time, but then worried about not getting his permission. So after missing just 3 doses (was taking one drop per eye, twice a day), I restarted, then all hell broke loose with me feeling horrible and pooping 5 times a day after re-starting and just worse and worse feelings. My Bgs went high and I had just been to NP at Endo office with a 5.8 A1C the week before. Then found G6 was reading 51 points lower than fingersticks on both hands, so was probably even higher than I thought. Calibrated and got it right, but was on rollercoaster. So, having quit that Saturday PM and the restarted that Monday at 3:30 pm, with 5 poops, all solid by Tuesday, I continued struggles and by Friday, called eye doc and asked to quit. They approved and assured me cold turkey was fine way to quit. My symptoms got worse. Side note: when first diagnosed with LADA, ended up in hospital around that time with very low sodium, ER doc said a point away from death. But now I see there may be a link between high BG and Naturemia (low sodium). I thought I was dying that night and finally went to ER (very squeamish and did not want to go) by 3am. This is how I have felt lately, and really in a mild way, I believe, the while time on Cosopt. Over these 3 years since, I occasionally have some few ounces of pedialyte if I feel punky and all resolves and my sodium is usually low but not flagged on bloodwork with endo each year. Also, it has been hot and humid all summer in SC. So, this time with pancreas not working at all anymore, I have had a hard time with pedialyte’s carbs acting like many, many more and my insulin needs for the past 2 weeks have increased from 14 or 15 Tresiba to now 19 or 20 and needing 20 % more for boluses. I have never been sick as a t1d, so these are hard lessons. I only eat 3 meals a day of 111 to 130 carbs. But making so many corrections. So, I did make an appt. With a doctor who did bloodwork but has offered nothing in the way of curing symptoms (whether related to cosopt or not, I do not know). I told him and showed my journal of having had 16 ounces of pedialyte with my lunch one hour before bloodwork. Well, 2 days later after first msg. from nurse assured me tests were all fine and pedialyte doesn’t cause pooping, (which I asked about). Then more tests came in and chloride is actually flagged at 97 as low, but sodium 135, lowest of range is not, and alkaline phosphatase is 48 (don;t know what that is). But all this is with a ton of pedialyte help the hour before. So now trying the Nuun tablets, but really feel all this may be too much back and forth. I felt good yesterday using nuun tablets, just 4 carbs, yesterday with one at lunch, then 1/2 at 2:15, 1 at supoer with the last one at bedtime 9:00 as bgs were rebounding low post supper and I was feeling punky. But woke to bad somach ache and had to poop at 1am and lately have been very thirsty after any sort of Pedialyte, and for the first time last night after the last Nuun tablet. Was fine on the rest. Anyway, sorry to mention poop, but I ahve always been a one poop a day after coffee and water and before exercise, so my system is out of whack. Whew - sorry, but want to give you every crumb of evidence if you have any knowledge to share or experience and especially if you can help. I have not slept in days - awakening with 160 type bgs! Scared to do much with Tresiba since this is most ever and daytimes have been getting better. I think I need to trust I won;t die and not reach for electrolytes when feeling bad. Yesterday was my best day yet and I was so happy I had learned if the Nuun tablets on this forum. I think I overdid it. I wanted to try to increase salt intake with food (at Breakfast I had eggs and bacon and toast and no electolyte added, but lunch is 1/2 grapefruit, half apple and peanutbutter with two chocolates, so ate jut]st on 5 carb piece and gad Nuun in16oz water. I have always well-hydrated due to exercise. Then afternoon wanted sort if pick me up and had the 1/2 r]tab in 8 oz water and full with supper. So questions galore implied here. I feel that one of ingredients of cosopt may have affected my sodium over time and then stopping threw everything out of whack. That is just my theory.

But now I need to get balanced out and find a way to do this without continuing bg issues. Yesterday was the best day in 2 weeks of more stable bgs until I blew it with too much correction in supper bolus leading to choice of Nuun with water for first 4g feeding, but then had to eat an glucose tab and a reese dark min 6g hoping to sleep through the night. If you can advise/help with any suggestions or understandings I will be so grateful. The medical system is not seeming to be able to help ir understand the other major stress if such high insulin needs right now. This is my worst time yet and I keep trying and making myself notes about timelines and trying to connect dots. I have no more ideas except to get bg under control while trying not to use so much or frequent electrolyte replacements. Yesterday showed hope, but overnight bg abd waking today to alarm at 171 was not good. Also tried to walk, but HR was way too high (BTW cosopt lowered my bp to at times being 80/60 and lowered exercise pulse so much I had to run to for a bit to see if it would go to 122! So I still believe some sort if rebound retribution is happening after eye drops.) But, bottom line is first to get well and get sodium better. Any and all help appreciated. I am 61 and fit, but sick now. Thanks and truly sorry for all the details. I hope some of you that may not like that were able to skim. Have a great day.
Laura

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Sorry you’re having such difficulties! I have normally low sodium and have learned to take it more than I used to do, for sure.

The first electroyte powder on the following list has 500mg of sodium. It is also stevia-sweetened, so there shouldn’t be much effect on BG (or the GI system). Hope this helps!

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Sorry you’re having trouble, but you’ll get it worked out for sure. It sounds like you have already made some steps in a good direction, even though it’s not all right just yet.

If my BG is too high, I need more insulin. My body gets to decide how much insulin I need, and it doesn’t matter what I used to need or how much I would have preferred to need.

If my BG is rising overnight, that means I need more insulin (basal) overnight. If it keeps happening, I’ll increase the basal little by little until the BG is under control. (Except if the high BG was caused by a really low hypo that made my body dump hormones and glucose into my bloodstream to rescue me.)

If a sufficient basal for overnight is causing lows during the day, the best solution I’ve found is to use a pump because that way I can have different basal rates for different times of the day. If a pump isn’t in the picture, a more difficult but possible way is to take a small amount of the really old long-acting insulin at bedtime (Regulin-N or Novalin-N or NPH,) which acts like a really slow Novolog (like peaking in 6 hours rather than in 2.). I say more difficult because NPH doesn’t give a steady dose over a long period like Tresiba or Lantus. It gets stronger and stronger over several hours, then tapers off for several more hours. So it’s a matter of gradually increasing the dose day after day until reaching the maximum that doesn’t cause a hypo in the middle of the night.

As far as the hyponatremia, high BG and diarrhea can each cause a loss of sodium, and you’ve been dealing with both. Maybe a little less water and a little more salt could be enough to solve it. I say that because I’m on a diuretic for high potassium, which solves the potassium issue but it also flushes out too much sodium. To solve it, I put a little salt in the palm of my hand and lick it. If my reaction is “yum, this tastes really good” it means to me that my body wanted the salt, and I’ll take a little more. If my reaction is “ugg, too salty” that means I don’t need any more. Primative compared to the special high-performance electrolye formulations, but it has been enough for me to get my sodium levels back into range.

Keep up your courage, I’m sure you’ll get this all under control.

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Thanks for your help @CatLady and @bkh . I appreciate it. My insulin needs just keep rising and did pedialyte in 3 oz or so “doses” but still up every 2 hours at night and am waiting to hear back from my NP at endo office. Have not been able to exercise in w weeks and after trying a short easy walk yesterday ended up with trace ketones. Never had before, so really scared - I am scared of hospital and don’t want to go, so drank fluids, stayed inside and felt okay for good bit of day and by mid-day, no trace of ketones. But up all night peeing and drinking 2 oz of pedialyte when bgs allowed and awoke at 2:30 to very high bg, so gave 1 full unit Lyumjev. Looked at data and used 20 tresiba yest and 8 units Humalog and/or Lyumjev for boluses but 4.5 units were also used for corrections. Waiting to hear if I should go higher on tresiba. Managing blood sugar that is crazy like this is so taxing and would love to sleep. But learning and can hopefully get figured out. I appreciate the idea of listening to my body and giving it what it needs insulin-wise. And I appreciate the electrolyte powder suggestion. It looks perfect! Thank you both! Take care.

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But trace ketones is a good thing, not a bad thing. It just means that your body is burning fat as fuel. High ketones are a problem for people with diabetes, but low ketones are a normal part of the body’s metabolism. Here are a couple simple articles for reassurance.

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@bkh Geez! Thanks so much for that. I have exercised regularly for 40 years and have been sick for two weeks and every time I tried to walk, had to come back for feeling sick and BGs going up so much. I thank you for this! What a relief. Question: if I get my bg to my normal pre-exercise level, shouldn’t it be okay to do my walks and wts? The reason I have skipped wts for 2 weeks is that it usually raises my bg and stays higher even when well, but walks will have it go up, but then drop and often need feeding before the walk is over and then I bolus for half of those carbs with breakfast. Maybe if I can get these stubborn morning highs to go away by increasing tresiba I can get back to normal. 171 upon waking is horrendous. The week before I started this sick stuff, I had a 5.8 A1C and 5.6 the time before. Now I am in range less than 50% of the day. Crazy. Hope it passes soon. Thanks for the Ketones info! Good news indeed.

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Being sick is a stress on the body, it can raise BG. Really intense exercise can also raise BG from the stress. Moderate exercise will tend to lower the BG as your muscles consume glucose for energy. Competitive athletes will have a strategy to control BG, maybe starting with no basal if they are pump users. It sounds like you need some modest insulin to prevent or limit a BG spike, followed by carbs to prevent a low. As long as you have plenty of fast carbs and insulin with you, it should be fine to experiment with the dosing to find out what works for you. And yes, it should help a great deal if you can solve your morning high BG.

Too passive for my taste. Instead, I hope you actively solve it by learning to adjust your insulin dosing to compel the BG to go where you want it to go. Your friends here at FU will help.

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Thanks for that. I am upping Tresiba and making sure to adjust every bolus and hope to get to exercise tomorrow. Thanks for the encouragement!

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