Took insulin for breakfast, enough for 24-32 carbs at this time of day. Then vomited as soon as I had part of my stevia sweetened cocoa. Didn’t even taste the eggs I had cooked.
BG was at 112 at 6:25, took 8u Humalog at 7:00, BG at 7:50 was 136. This is the time of day BG rises without food or insulin, so I don’t expect a really fast drop. The eggs will be far too hard to digest, so I’ll have to pass on them, but what do you think I have the best chance of keeping down, so I don’t have to call the medics? Saltine crackers? 7-up? Something else?
I don’t think I have anything appropriate in the house to eat now, but could send my partner to the store. I probably have at least an hour before my BG is likely to drop into the hypo territory. At least I would under normal circumstances. Who knows what BG will do when I’m sick. I haven’t really been sick since I became diabetic.
I would get some sugar-sweetened ginger ale to sip. Ginger can ease the stomach queasiness and the liquid sugar can help neutralize the insulin. Drink the ginger-ale in small quantities informed by your current BG and trend – resist over-treating! Test a lot so that you’re well aware of any drop into hypo-territory. Good luck and please keep us updated if you can!
Sorry you’re sick! I’d try something liquid like (regular) gingerale, and sip it slowly, one sip at a time, over a while. The good news is, it’s not too hard to get 24-32 carbs that way, and if you’re sick, you prob will need the fluids. Also recommend getting some saltines etc in case you need them later (I’d start with the sipping the liquid though). Another option is something that can dissolve in your mouth, like icing or glucose gels—not a bad idea to have those around in case you can’t eat. Hopefully just a one-time vomiting this time though!
Humalog has been really slow getting started dropping my BG lately. It used to be I could expect a drop of 100 points in one hour if I was trying to correct a high so took no food in the interim. But lately it has only dropped 18-24 points in an hour. And that was later in the day. But with DP at this time of day, it might be slower yet. Will test in another few minutes and see where I’m at.
Just sent my partner to the store for ginger ale and crackers.
LOL! BG at 8:34, more than an hour and a half after bolus - 146! That’s 34 points higher than it was before I took the insulin! I guess I don’t have to worry about all the tourists likely to be in line at the store on a sunny summer weekend at the seashore. My partner should be able to make it home with my soda and crackers long before I risk hypoglycemia.
This is probably the first time I’ve been thankful for DP at work. Usually I cuss it.
It may be that you will need none of the ginger-ale or crackers. Better to have it and not need it than the other way around. DP can be very potent. I’ve actually taken a breakfast dose of insulin and then chose not to eat due to BGs not falling. Your meter is your friend!
Based on what’s happened so far, I would also posit that because you’re sick, you might run higher, so the 8U might not have near the effect. I would be careful around 5 - 6 hours in though. In my diabetes life, I have frequently found the biggest effect is about the same time I’m expecting to have nearly zero IOB.
Not helpful for you this time, but in the future it is good to have some Phenergan available as an emergency to prevent vomiting until your insulin has completely flushed out. A Phenergan suppository is what you would want.
The other thing would be intravenous D50, if you were so handy.
These are good tools to consider for future emergency.
Good point, @YogaO. I’ve been surprised more than once when an unexpected insulin tail rises up and rudely slaps me upside the head! Insulin action profiles are for books and package inserts; real world action can vary.
Initially your suggestion to have a prescription of Phenergan on hand sounded like it might be a good idea. But after reading the warnings online, I’m not so sure.
It says to use extreme caution in the elderly, as they may be more sensitive to its effects. (I’m 75.) It says side effects such as low blood pressure and seizures can be increased on ACE inhibitors, which I’m on. I’ve already had one seizure of unknown origin.
And my blood pressure can be erratic. I had to have my doctor lower my BP meds a couple of months ago because, while my fasting and preprandial readings were in a high normal range, I’d occasionally have postprandial lows down as low as systolic 77 and 78 and one diastolic down to 39. But now I have to increase my meds back up to that same level again, because I’ve been getting fasting systolics in the 150s and 160s. Picked up the new BP med yesterday, but haven’t taken this new dose yet, as my fasting BP this morning was about 40 points lower than normal. Will have to wait until I’m over whatever bug is affecting me.
Well, I took a few sips of soda. And my BG at 9:37 was 171. Guess I’ll have to just sip water or weak tea for a while. Although Humalog has been taking a long time to initiate action for me lately, it has also had a long tail. (Pain in the derriere on occasions I want to go to bed five hours after dinner bolus, and still can’t really tell where my BG will end up for the night.)
I had planned to go back to bed this morning, since I had inadequate sleep last night. But now I need to stay up, because who knows at what hour the insulin could start crashing my BG.
Weird thing is, I now feel perfectly fine. Not nauseated at all. Like I could eat a normal meal. Of course, I don’t dare. As soon as I eat “normal food,” I suspect that I’d get nauseated again.
So sorry you are not feeling well! Vomiting is the worst. And I agree that since you are not seeing the big drop you should win insulin on board and no food, you probably have some kind of bug. Sorry about that because now the fun with high blood sugars may start.
I, like you, don’t get sick often but I have a few bottles of sweeten Gatorade or Pedialyte always in the pantry with directions for hands off for everyone else in the house. There are just a few things that are off limit to the family and these are one of them. Dehydration is a huge problem when vomiting which is why keeping these drinks in the house is a good idea. Good luck and hope you are feeling better soon!
Phenergan is a prescription drug. If you really have trouble with vomiting and diarrhea that is very serious when you are insulin dependent. you should not resort to extreme measures at home. Your situation hardly seems like an emergency. and I would never recommend that somebody sit around there table and insert a catheter in their arm and given themselves a D50 IV. That is just dangerous. If you really believe your life is in danger go to the ER or an urgent clinic.
For more modest situations like this I would remind everyone that you can absorb glucose without swallowing it and absorbing it through your stomach. You can take candy, sugar or dextrose tabs, chew them up in your mouth and just “swish” them around. The glucose is directly absorbed through the tissues in your mouth, it is quick and effective and evades concerns that you might vomit again.
ps. Thanks to Scott Strumello who taught me if you sit with your head facing down to the floor you can keep the glucose solution in your mouth for a really long time without swallowing it while you do this maneuver.
Well, my six hours from bolus are up. Theoretically, insulin action should be over. My BG is now 162. And all I had was 2 crackers (4 grams carb) plus 11 grams carb worth of soda. So total of 15 grams carb. My ISF is normally 34 and my I:C ratio in the morning is normally 1:3. So if I weren’t sick, only five units should have handled that and put my BG back down to around 112. So that’s a lot of extra insulin used up just for being sick.
Well, next time if I feel the least bit queasy before a meal, I’ll wait until after I eat to bolus, even if that does cause my BG to climb before the insulin action gets started. I did feel a little bit off this morning, but often I just feel “sick” to my stomach when I’m overly hungry, so didn’t think too much of it. I will after this episode, though.
Oh, I have plenty of fast acting carbs in the house. Glucose tabs, hard candy, beer. I use any of those plus others that aren’t quite as fast acting for normal lows. I don’t experience the severe symptoms with a low that many others do, so unless I’m really low like 30s or low 40s, things like milk and whole fruit work fine for normal lows and are fast enough. The problem in this case was - what would I be able to keep down long enough to absorb as many carbs as I needed? So I needed something that would, in addition, tame the nausea.
As it turned out, the lowest I went was 127, so I was never actually treating a low, just trying to prevent one.
Brian’s suggestion that one can just hold appropriate foods in the mouth and be able to absorb enough carbs to prevent (or treat) a low was brilliant. That could be a real life saver when the stomach and intestines just won’t tolerate food.
Thanks for the updates, @Uff_Da. Glad your hypo never happened! You were right in assessing the risk and raising the alarm. Diabetes never stops teaching. I hope your appetite returns soon.
