First time to the ER, & what to do if I have to go back

Hi all this might be long but wanted some insight,

I spent Saturday in the ER. My first time since diagnosis 6 years ago. I would only go if I knew something might be wrong and I couldn’t gain control of my numbers, etc. so here’s what happened

This past week I was feeling pretty crummy, mainly just really worn down and my blood sugars started getting more resistant. I thought it was normal at first, as it’s the week before my menstrual cycle so that’s not out of the usual. Until Thursday when I developed a low grade fever, and slight achy-ness. Thought I could bare through it, that it would pass, so I just took tylenol & advil back and forth because my husband and I had a pre-planned trip out of town this weekend, tickets already purchased.

Friday is when my blood sugar really started to be resistant. I was in the 200’s all day, but was able to get down to 150. I check an hour later or so, and it would be right back up to 200 something. I corrected, drank a ton of water and went to bed. Woke up Saturday morning 2:30 am really nauseous. I checked; 350. I stayed up all night long. I couldn’t lay back down because I was so nauseous. I took anti-nausea meds but it didn’t help. I drank and drank water, corrected, and tested my ketones since I felt so bad. They came back moderate amounts, tested later, trace amounts, tested again, negative. I thought I was in the clear and had hydrated enough.

I was still in the 200’s all through the night, didn’t sleep, just kept drinking water. I tested my ketones again, trace amounts came back. I drank more and more, tested, still high blood sugar and large amount of ketones this time. I also had a bout of diarrhea which definitely caused alarm; I know how quickly that can dehydrate. So we decided to pack up and travel back home (2 hours) and I went to the ER.

They ran blood work, did a bunch of heart tests, and I got 2 bags of straight saline. My ketones came back negative, my fever was gone when I was at the hospital (it’s back now at 100) and they said it looks like a viral infection and to just drink plenty and rest until it runs its course. If I can’t keep anything down, to get back in there.

So I’m home but still with a fever, feeling so sore and achy all over, but I’ve been able to keep my blood sugar at around 180 which seems so low compared to everything I’ve seen the past couple of days. I wonder how often I should check for ketones? The doc told me there’s not much I can do about high 200-ish blood sugars as it’s common with viral infections. She said as long as I keep fluids down I shouldn’t worry too much about ketones. Should I test for them? To be honest it was driving me mad doing it. I feel like unless I can hydrate myself 24/7 they might show up until I can flush them again. Are ketones something to worry about if you aren’t vomiting? How often should I test and when? The ketostix paper says to test when your blood sugar is above 300 but I know they can happen before that, and when I asked the nurse she had no idea at all.

I definitely don’t want to end up back there and have them do my blood sugar management. Luckily since everything came back fine other than a virus, they didn’t give me insulin, but prior to results they were planning to monitor me with fluids and give me insulin “as needed” even though they only tested my blood sugar once. I tested every hour I was in there. lol The doc was okay with my last result 209, which went to 199 later, so she didn’t seem concerned. I have no clue.

Is there anything in particular I should do or lookout for, or ask, if I end up needing care again in terms of blood sugar management? I didn’t want to chance DKA so I went, but as for ketones and all of this, I’m really lost. As for now I’m okay. I haven’t tested them again since I’ve been home because I’ve been under 200, and they came back negative when I was in there.

Sorry this is all over the place, just trying to get a feel for better preparation in case this virus gives me any issues such as stomach problems. Crossing my fingers no vomiting or other comes out of it because I don’t want to go back there. Thanks for the listening ear!

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Hospitals are infamously stupid with respect to managing blood sugar, so it is best to stay away from them if at all possible and re-establish control on your own. You have years of experience managing your own case 24/7, while doctors can get a certificate proudly to display on their office wall stating that they are a qualified ‘diabetes expert’ for having just two hundred bedside hours managing patients in the highly unrepresentative circumstances of a hospital. The worst thing is that not only don’t they know much about blood sugar management but the social power structure which supports them teaches them to believe that they know everything about it. Fortunately they now and then listen to patients and learn something.

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I’ve read so much about so many doctors and nurses not listening, and doing what they want. I found that the people I dealt with today especially the doctor listened to me. I made sure that the saline they gave me wasn’t glucose (have read horror stories about that while BS was high) and I asked plenty of questions about insulin in case they were to administer.

All I know is that when I was diagnosed, while they did save my life, they couldn’t get my BG under 350 the whole 3 days I was there. As soon as I stepped out of the hospital, I had it down to 200 and to normal numbers the next day. I’m a very research heavy person and took my care head on, and forums were where I learned everything. I have never learned aside from one endo, about how to properly manage my diabetes. All came from reading on my own. Go figure. Thank goodness for other T1D’s! :slight_smile:

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The last time we had a sickness which came with high and resistant BG, after trying a number of hours at getting the BG down with relatively smaller amounts of insulin, I bumped the basal rate to 50% higher basal rates than typical as well as put an extended bolus in place for 18 units over 12 hours at 0% up front, 100% extended (ie - extra 1.5 units per hour “bolus” delivered continuously)

We monitored the BG with our Dex CGM as well as periodic fingersticks to confirm the numbers just to avoid a possible mistake given the unusual circumstances and treatment very much different than normal. The CGM low alarm was raised to the highest possible value (100 on our version of the app) such that if we were not watching, this would (as a backup) alert us to BG going down.

Our intention was to start backing off the increased insulin once the BG went below 180.

In terms of food, we tried to find stomach friendly foods with low to no carbs. As we were battling high BG already, adding carbs on top did not seem to be a good idea although we typically do not eat a low-carb diet (moderate carb probably).

To avoid dehydration, which as mentioned can put somebody in the ER pretty quick, we use the low carb sport drinks which have some carbs (maybe 12 or 13 per 20 oz bottle or so?) as well as water.

Ketone check while sick each trip to the bathroom while BG is over 250. Medium or Large warrants a call to our Endo.

It appears to be a crazy amount of insulin but it seems to work for us.

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these Sick day rules may help
https://c.ymcdn.com/sites/www.ispad.org/resource/resmgr/Docs/CPCG_2014_CHAP_13.pdf

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Thanks so much for the info! I’m having a better day today, still not feeling well and fighting a fever, but have to let the virus run its course. I have been drinking powerade zero that doesn’t have any carbs, and Gatorade G2 which has 13g per bottle. I’ve also mixed both with water (having a hard time stomaching water alone) and I’ve managed to stay well hydrated that way. I have been eating pretty bland food, some fries and toast since my BG’s have gone down below 180. I’m responding better to insulin as well. I appreciate your tips on what you all do! It helped affirm what to do! :slight_smile:

This has been so helpful, thanks so much!!

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Sorry you are not feeling well but sounds like you are doing a good job of taking care of yourself.

Hopefully this passes soon.

:slight_smile:

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thanks so much! Feeling back to normal now! Long stretch getting there but finally better :slight_smile:

You did the right thing. Never take a chance with high Bg, high ketones and dehydration- you could end up in dka easily. Last spring I woke up with 100 Bg and then 2 hours later 350
going up with very high ketones. I was violently nauseous. I took zofran and we drove to the er. I was admitted for 24hrs on fluids etc. Close to dka but not dka fortunately. I don’t know what happened. I had been having stomach issues and crashing Bg with every meal digestion troubles pain and nausea and had lost weight before this episode. And then some runs that week. They said severe gastroenteritis and dehydration etc but no one knew exactly what happened. I did all my Bg management there and they tested my Bg at meals etc. they did try the 60 g per meal thing but I explained that situation and that I never eat that much even in normal circumstance. Unfortunately I got glutened while I was there which made my stomach worse. I’m now totally gluten and grain free which has helped me. I remember my tests showed very high eosinophils and other irregularities like low calcium and phosphorous.

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Thanks! I really didn’t want to go but I’m glad I did. And I’m actually starting to feel like I’m coming down with something again which is wonderful. Fingers crossed I stay out of there! But yikes! I def dont want to go through it again; it was my fear that I would have to be admitted as well. They didn’t know exactly what was wrong with me either, the doc just said “some type of viral infection possibly” lovely. I’m glad you were ok! T1D freaking sucks on its own but is a whole other story when we get ill. Sigh.

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I don’t think there’s anything wrong with going to the ER like that. It may not be particularly useful (as you found out they like to run heart tests on almost everyone coming in) but it’s not wrong either. Don’t feel bad that it wasn’t useful, it’s not really your fault that it wasn’t useful.

I’ve been sick and vomiting and shown up at the ER for them to run blood tests and then the ER doc chides me for running my bg as high as 160. Even though I had been working hard has heck for several days chasing a long string of high bg’s with insulin and that was actually one of my lowest numbers.

I think the attitude that bg’s will often be in the 200’s or even 300’s when you’re (or I am) sick like that, is much more realistic. Trace or low levels of ketones are actually to be expected when not eating or holding down food, even for non-diabetics, so it’s hard to get excited about an occasional low-level ketone result.

The “sick day rules” chart seems a bit under-aggressive. If I knew I was sick like with a virus, and was getting a couple bg’s in the 400’s, I’d be upping my TDD by 50% at the very least. That’s just me and my experience though. I know upping my TDD by 10% in such a situation is nowhere near enough.

I’m not sure how much your husband knows to help you out by testing your bg or ketones for you, or following your entire management when you’re sick to make sure you’re taking and adjusting your insulin. I’ve been married for 20 years now and even though I’ve trained my wife on checking my bg she’s only ever done it once. The thing I’d be worried about (because I’ve been to that edge at least once as a teenager) is being so sick that I can’t even check my bg or take my own insulin and that not taking insulin for 12 to 24 hours, would be what would push me over the edge into full-blown DKA.

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Reading all of these posts and was getting confused with mmols/l and mg/d. My daughter has been sick all week. Blood sugars have been out of wack big time. Especially at night. she has been going to bed with bg’s of 7mmol/l and 2 hours later she is 14 and rising fast. Thank god for the dexcom g5. Her correction factor is 1 unit for 8 mmol/l. At night I will give her 1 unit and it will take her forever to go down. When her BG goes down, it will only go down 4 mmol/l instead of the 8. Not sure what the hell goes on at night. Thank goodness she doesn’t wake up with many keytones.

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The relationship of mmol/L to mg/dL is 1:18. But you don’t need to learn the mg/dL system except when you want to interact with those of us who live under the mg/dL system. I try to write my comments using both systems but I’m not 100% with that intent.

3 mmol/L = 54 mg/dL (this and lower is serious and clinically significant hypoglycemia)
4 mmol/L = 72 mg/dL (low end of normal range)
8 mmol/L = 144 mg/dl (high end of normal range)
10 mmol/L = 180 mg/dL (hyperglycemia)

A one unit of correction insulin to 8 mmol/L indicates a person very sensitive to insulin. Have you verified this number in your daughter? Perhaps 1:4 mmol/L (1:72 mg/dL) more accurately represents her insulin sensitivity.

Insulin sensitivity does not remain static across a whole day. Many people are more reisitant to insulin in the early morning hours.

You would likely benefit from using a continuous glucose meter (CGM) at least on an intermittent basis. It’s a great teacher to discover how your daughter’s glucose metabolism works.

Read through all the posts here addressing your distressful situation. It is very common to have high BG’s during illness, and we have to do our best with that. What also occurred to me was that you went out of town. Not knowing what you are using for insulin intake, it crossed my mind to ask if you are using any technology? If you don’t adjust that technology (e.g., pump) for time zone changes, it will wreak havoc as well. Experienced that this fall (forgot to change the time) and ended with one reading at 376 and several others in the 300’s. Just a thought.

My daughter has the dexcom g5. Amazing piece of technology. We are relatively new to it. Emma was diagnosed Nov 2016 so we are now going through the pump process now. We have been administering needle injections. Looking forward to the pump. Time zones never crossed my mind. I’m sure that is something we would plan for when the time came.

Hi! I wasn’t using any technology, and we only went out of town 4 hours from where we live, so no time differences. It must have just been the virus causing highs, and not being able to get hydrated. It was an awful time!