Being sick and lows

Type 1 and LADA
1

Having difficulty controlling BG when sick, particularly high numbers, is something that gets discussed a lot around here.

There's another, potentially more dangerous side-effect of illness that is often overlooked -- hypos. Hypos that can get dangerous, and hard to recover from.

How? When you're sick with something that affects your digestive tract, food absorption can be compromised. This can make it hard to "fix" a hypo, when your stomach isn't interested in passing anything along to your intestines. Or worse, simply tosses it back out.

I went through this nightmare early Thursday morning. I was fine, healthy, happy, PWD until 1:30am, when I had cramps and got up to use the bathroom

Blowout, if you know what I mean :-)

What followed was 12 hours of lower GI nightmare. And odd, CO2-like belching. Tasting the sandwich I'd had for lunch 12-18 hours before that.

I'd bolused properly for dinner. But the usual rise an fall of BG didn't happen that evening. Rather, it just started heading down. And down. And down.

By the time I was dealing with the back-end problems, I was in the 50's. I'd already been huffing glucose tablets for an hour. I dipped all the way to 42 before things finally started coming back up.

So, I spent the day yesterday (in bed) deliberately keeping my BG over 120. I was scared of insulin all day. Good thing I couldn't eat anyway, due to the illness.

SO! Don't forget that part of the BG control strategy is a functioning digestive system. If it ain't working, be careful about your insulin dosing, and err on the side of high BGs for a few days while you're sick, until you are sure what you eat is going to be digested and absorbed in a expected manner.

I don't have gastroparesis, but I have a glimpse into what it must be like now.

2

I have had this happen once or twice over the past few years, not with prolonged illness but with an afternoon or evening of having my stomach upset. Not fun at all!

You might be interested in looking up mini-dose glucagon. I have heard of parents of kids with Type 1 using it for this exact situation, to avoid trips to the hospital.

3

Interesting Jen, I haven't heard of mini dose glucagon, I will ask my endo about that.

4

Sorry you went through that Dave. I was very ill about 2-3 weeks ago, vomiting all night and I was going low too, fortunately I got enough sugar into me with little pieces of candy when possible to keep me from bottoming out. I think 50 was my lowest. But I woke up super high so the virus or whatever it was pushed me to the other end of the spectrum eventually.

5

One remedy that works for me is sipping non-diet gingerale carbonated soft drink. The ginger soothes the stomach and GI tract while the sugar helps balance the insulin on board.

I've also experimented with mini-doses of glucagon. I used a glucagon emergency kit. You need to inject the fluid into the small vial containing the powder then just draw up small doses. I used an insulin syringe and used about 10 units per dose. It did effectively counteract a low without having to add quick-acting carbs.

Unfortunately, once the fluid is mixed with the glucagon powder, it has a limited shelf life. It's been effective for me for several days afterward. I usually ended up wasting quite a bit of the batch since I did not have to treat lows every day. The kits are expensive and I don't know if the doctor would write enough quantity for this purpose. I'm also uncertain if an insurance company would pay for this on an ongoing basis. Once they figure out how to make glucagon that can be stored long term as a liquid, then this would be a viable tactic. Here's a JDRF press release from earlier this year that talks about the development of glucagon by two companies that the JDRF sponsors.

Non-diet gingerale seems easier to use.

6

Depending on what I'm sick with, I usually get low (apparently bronchitis is my worst low-provoking illness--go figure).

As for GI problems, I'd recommend a sugar drink (soda or OJ or apple juice or something) and "holding" it against the roof of your mouth with your tongue for about 30 seconds at a time, then swallowing it. (Of course, if you're vomiting, you could just spit it out.)

The basic idea behind it is simple enough--the mouth absorbs sugar faster than the GI tract, and more efficiently, too. Also, what's already been absorbed that way can't leave.

It's similar in principle to rubbing cake gel or honey on the gums of a PWD too low to treat their own low.

7

I have never actually used it. I think I read about it on the Children with Diabetes site a few years ago.