Wouldn’t it be dandy if none of us ever got sick? No need to bother with ketone checks, trips to the hospital, sick day diets, yummy liquid medicine and all those other little things that make diabetes and illness such a fun combination.
Despite our best efforts to take care of ourselves, illness does happen. And having diabetes makes us more vulnerable to a variety of infections and other acute ailments. We all know how hard it can be to manage diabetes during an illness. Now here’s the kicker: the worse your diabetes control is, the harder it is to recover from an illness. Bacteria and viruses just love to grow and multiply in a high-sugar environment. Elevated glucose levels also make it harder for the body’s immune system and healing processes to work properly. So managing diabetes during illness isn’t just a nuisance, it’s a necessary part of recovery.
When it comes to dealing with illness, using an insulin pump gives us some special “powers” that non-pumpers just don’t have. Mainly, these powers come from the ability to make special adjustments to our basal insulin. For instance, many people find that their blood sugar goes very high and is sluggish to come down when they are sick or have an infection. Raising the pump’s basal rate (using a temporary basal increase or an alternate basal pattern) can work wonders for getting the blood sugars back to normal. I recommend a 50% increase in the basal rate if the blood sugars are high during an illness without the presence of ketones, and a 100% increase if ketones are present. Talk to your doctor to determine an adjustment that will work best for you.
Regardless of the adjustment, do not suspend your basal rate when you are sick, even if you are not eating as much as usual. Your body still needs some insulin to offset the sugar being secreted by your liver and to function properly. Discontinuing the basal insulin can lead to rapid onset of DKA (diabetic ketoacidosis).
At the other end of the illness spectrum, maladies that involve gastrointestinal distress, such as stomach flu, often make it very hard to keep blood sugars from dropping low. When you can’t eat and your blood sugar is dropping, what’s there to do? Lower your basal rate! A significant (50-80%) reduction in basal insulin for a couple of hours will usually keep a downward-trending blood sugar from dropping too low. If that does not work, try administering a small dose (10-20 units) of glucagon with an insulin syringe. Also, whenever nausea is present, it is a good idea to wait at least five or ten minutes after eating (to make sure the food stays down) before giving your mealtime bolus.
Otherwise, most general principles of sick day management hold true. Take in a steady supply of caffeine-free fluids to prevent dehydration. Even modest dehydration can keep your insulin from absorbing properly and may elevate your blood sugar levels. About one cup (8 ounces) per hour while you’re awake is a good rule of thumb. And do your best to take in some calories even if you don’t have much of an appetite. Your body needs energy to help fight the illness, so carbohydrates are in order. Easily-digested carbs such as breads, cereals, crackers, soft fruits, juices, rice and potato products are excellent choices.
If your illness is severe enough to require hospitalization, or if you need to undergo surgery, talk to your physician about letting you keep your pump on and allowing you to manage your own blood sugars. Sad to say, most hospitals are ill-equipped to provide intensive insulin management the way you do at home. The more you can keep within your own control, the better. Just don’t forget to bring ample supplies for changing reservoirs and infusion sets while you’re hospitalized, as well as insulin and blood sugar testing equipment.
Speaking of which, being sick is no excuse for failing to change your infusion sets according to your usual schedule. Frequent blood sugar checks are also necessary during an illness. It is usually a good idea to check every 2-3 hours and bolus accordingly if the blood sugar is elevated. Don’t forget to take the “active insulin” or “insulin on board” into account when checking and bolusing frequently. Ketone checks every 4-8 hours will also provide useful insight into the extent of your illness and the supplemental insulin that you may require.
If you are having a great deal of difficulty controlling your blood sugars
during an illness, have vomited more than once, or have persistent diarrhea
or moderate/large ketones, be sure to give your physician a call. Sometimes,
a quick visit to the emergency room for i.v. fluids, antibiotics, electrolytes
(and possibly insulin) can help you turn the corner towards a speedy recovery.
Gary Scheiner MS, CDE is a diabetes educator with a private practice (Integrated Diabetes Services) near Philadelphia, and author of Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin. He has had Type-1 diabetes for 20 years, and offers diabetes education and management consultations via phone, fax, and Internet to patients throughout the world. Submit inquiries to firstname.lastname@example.org, or call (877) SELF-MGT.