I have been on Tandem CIQ since November 2020. Like many others that use this pump, I had my ‘adjustment’ period. What I need help with now is: I recently had a UTI which made it necessary to take Bactrim for a week. This was followed by a toenail procedure in which my ingrown toenail was removed.
The Podiatrist felt it was necessary because of my Type 1 diabetes for me to take 10 days worth of Keflex. I have found that my ‘decent control’ prior to both the above problems has disappeared. I run the ‘sleeping’ mode 24x7 and I have decent numbers for most of the night.
I made a separate profile that raised my rates to 150% to try and offset this hyperglycemia I am facing while on the antibiotic and trying to heal the toe. Actually the toe really hurts, although it doesn’t look too bad considering.
Is there anything else I can do, or should I raise basal rates up from 150%?
While I don’t have any CIQ or Tandem experience, I have dealt with several significant infections in my 37 years of T1D. These infections include a few stubborn sinus infections, a serious case of an infected poison oak rash, and a dental infection following a root canal procedure that led to a 60-day case of c-difficile that needed two courses of antibiotics to clear.
What I learned regarding blood sugar control during these infections was that I needed a lot more insulin (up to 2x or 3x the typical doses) and my glucose control was better but still not acceptable. This meant a lot of time spent in the 150-200 mg/dL range. I had to console myself that had I not taken aggressive action my BGs would have likely been in the 300-400 mg/dL range and expose myself to a real risk of dangerous diabetic ketoacidosis.
When I was taking 2-3x more daily insulin, I was worried that the need for that elevated insulin amount might recede quickly and drive me toward dangerous hypoglycemia. That never happened to me.
Here’s what I would counsel:
Don’t be afraid to ramp up insulin delivery to levels that would scare you absent an infection.
Aggressively monitor your glucose levels. A CGM shines in this situation but without a CGM, I wouldn’t be afraid to fingerstick 20x/day.
I would cut back on the size of meals you consume and definitely avoid meals with a high glycemic index.
Daily light exercise like walking is way better than exacerbating things with becoming sedentary.
Increase your hydration. This helps to minimize damage that high BGs can cause.
Harbor a high index of suspicion if you think a bad infusion site develops and leads to poor absorption. When in doubt, swap it out particularly applies to infusion sites and an ongoing infection.
With regard to your doctor’s order for antibiotics, follow it carefully and don’t stop taking the antibiotics before the course runs out.
Diabetes is harder when you’ve developed an infection but the stakes are high during this time and you mustn’t relax your attention to all the minutia. Change your infusion sets on time or early, BG test a lot, and add insulin if your hyper-BGs indicate such action.
This is a time when you just have to be tougher than your diabetes. It’s not easy and mediocre glucose levels will tend to discourage you. Don’t give up! You can defeat this infection and this is when tenacity counts. Good luck.
