# Fever rule to adjust rapid and basal dosage

As many have experienced an infection with episodes of fever will lead to higher blood glucose. For me the adjustment of the basal dosage is the key to compensate these effects. Usually I increase my basal by 2 to 4 units per day. Now I came across a rule of thumb by Dr. Helmut Pallin and I would like to share it with you:

Rule for temperatures in Celcius:

For every degree in Celcius of fever (t) increase the dosage of rapid and basal insulin by 10 to 20 percent. Example: 39°C => 2°C of fever (37 is normal) => t = 2

10 percent:
DosageFever = [(t * 0,1) + 1] * DosageOriginal

20 percent:
DosageFever = [(t * 0,2) + 1] * DosageOriginal

Rule for temperatures in Fahrenheit

Obiously the above rule needs some adjustments to work with Fahrenheit. By simplification I came to these figures:

For every degree in Fahrenheit of fever (t) increase the dosage of rapid and basal insulin by 5 to 11 percent. Example: 102°F => 4°F of fever (98 is normal) => t = 4

5 percent:
DosageFever = [(t * 0,05) + 1] * DosageOriginal

11 percent:
DosageFever = [(t * 0,11) + 1] * DosageOriginal

Whether you need 5 or more percent depends on your reaction to fever of course. It is just a rule of thumb and food for thought. Most importantly this rule recognized the need for more rapid and basal insulin with feverish infections. With a pump you can easily create a second profile of basal rates and insulin factors according to this rule.

Let me know what you think about it.

Very Cool!!! Awesome!!

Thanks for sharing this! I’ve never kept track of how much more insulin I need when ill, other than knowing it’s a boatload. What I usually do, & far from scientific, is take 1 unit of rapid acting every hour or so. I’ve found that larger doses at once won’t bring down highs as effectively as a steady stream. I don’t have a pump, but it would be very helpful in this situation

That’s really organized! I just crank my basal rate to 150% of normal and that usually makes my BG run low. I figure low BG is not good for me but it’s probably worse for germs?

I guess I raise the question about whether it would be advantageous to let your blood sugar run a little high during these times. I mean normal bodies raise their glucose output in response to infection and resulting fever, maybe a slightly elevated blood sugar is actually beneficial.

Just some food for thought.

This is a good question. I have no information if healthy people experience raised blood glucose with fever. But I would doubt it. I know of a study with patients in intensive care. Most patients with life threatening conditions have elevated blood glucose. The question was raised if this could be benefitial or not. Like you they assumed some unknown strategy behind that. To find out they had two groups - one was treated with insulin and the other was left untreated. The result was that normalizing the blood glucose of patients in intensive care significantly increased the likelyhood of survival. The insulin treatment is still not part of the standard routine due to liability concerns.

I have never tried to increase my rapid insulin as well. I just tested more and did some corrections. But my cold in the last week showed me again that increasing the basal is not enough. It seems logical that the degree of fever should be part of the equation. We will see - hopefully the next infection is far far away.

I think of it more along the lines of “if low bg kills brain cells and germs/ viruses only have a few cells to begin with, which are essentially eating machines, if your BG is low, it will have some sort of antiseptic effect”. Of course, I have no evidence of this since, like Holger said, doctors are gunshy about “pushing the envelope” like we astronauts do, just a wierd feeling that a few times I was sick, ran my BG down into the 40s and felt sort of cleansed by it? It may just be that I am a nutso insulin addict too…

I think the study you are referring to involves stroke. I am just talking about infection and inflammation. Here is what wiki says about a Physiological stress cause of hyperglycemia in normal people :

Hyperglycemia occurs naturally during times of infection and inflammation. When the body is stressed, endogenous catecholamines are released that - amongst other things - serve to raise the blood glucose levels.

Presumably a natural reaction would help the process, but I don’t know how. It may well be that high blood sugars don’t help with a stroke.

Well, I think this is true over the long-term. Clearly, elevated blood sugars feeds infections, that is the argument about why foot wounds are so dangerous and why many of us have problems with gum disease. While you might have felt “cleansed,” I think you may have also just enjoyed punishing yourself for getting sick.

I enjoy punishing the germs!!