How to adjust insulin dose when you're sick?

I'm coming down with a cold and my BG has been high for the last few days. Yesterday I slightly raised my Levemir and ended up taking a ton of Novolog (twice my usual daily dose!) because the highs barely budged. Today I added a few extra units to my morning Levemir dose AND I'm taking twice my mealtime Novolog. My BGs are better, but still higher than I'd like.

I want to rein in my BG, but taking this much insulin makes me nervous about going low at some point. How do you calculate your basal/bolus doses when you're sick? How do you know when to cut back to your normal doses?

I appear to be in the same situation right now, having taken more than double my usual dose of humalog, I also am having continued highs. I don't really think there are any rules or calculations, you just have to adjust. If you are concerned about lows, then you can just use your standard basal and meal bolus and then add corrections with each meal bolus to help restore a normal blood sugar. As long as you don't stack your insulin, you should avoid most problems with lows.

And most of all, don't beat yourself up for less than model blood sugar control when you are sick. Your body may well force your blood sugar higher no matter what you do, that is just part of your natural response.

Thanks for your advice and encouragement, Brian! At first, I was stacking my boluses, and my BG was not responding. The combination of raising both my basal and my I:C ratio did the trick and now I'm getting better numbers. Also starting to get over my cold, so I'm going to scale back a bit today and see what happens. I hope you're feeling better, too!

I am feeling better thank you. My fast numbers are better and today had a number below 100 mg/dl, something I hadn't seen for a couple days.

this is something i do regularly with my endo. i am on the pump, so if anything happens (malfunctions, etc) I NEED A BACK UP PLAN.the pump has different settings and its wonderful to program in a basal "pattern" for when you are under the weather, etc.

when were sick, we tend to become insulin resistant, and we may need to so much as double our basal/bolus. i would definately talk to your doctor about this so that you wont end up sick and stuck.

I have a cold and I have been having higher highs and rapid fluctuations. I have also been very stressed so I'm not sure if that is contributing. What I have done is to take corrections of fast acting and sometimes higher bolus as well as an extra unit of basal when I felt I needed it.

I am still having lows though so I have to be careful. Yesterday I corrected a mid meal low and ended up at 186,( I was 96 before the meal). I ate 9gm of carbs and took two units- I waited too long to eat and then drank a 1/4 glass orange juice for the low. At about 3am the next day, after some mild activity, I went from 106 to 47 in 1/2 an hour.

I was taking diabetic tussin(guafenesin) for the cold, I'm not sure if this affected my higher readings or not. Actually I don't know if I was sick enough for it to affect my bg- my endo said you don't usually need to adjust the basal dose unless you aren't eating and you have a high fever and fluid loss. But I add more when I feel I need it and it seems to work for me.

That’s a good idea, Daisy Mae- I will ask my endo what adjustments she recommends for insulin resistant sick days. I wish she were more experienced, though. Sometimes I wonder if she has any other T1 patients! Sounds like you have a really thorough endo.

Meee- sorry you’re sick, too! The fluctuations sound really stressful. Hope you’re feeling better. Your endo’s advice to leave basal dose alone unless you’re not eating makes sense logically, but sometimes when I’m having an insulin resistant day, I take correction after correction and the numbers barely budge. Maybe there’s something else going on with my hormones that’s causing periodic insulin resistance.

thanks Rennie, I agree, it could be hormonal things etc. as well as being sick... I'm feeling better and my bg have been more stable the last 2 days again except for a hypo where I waited too long to eat( I have been doing that a lot lately) and then went up after eating more, but not too high fortunately. I am going to ask for a more specific plan too. When I seem to be insulin resistant, exercise almost always brings me down anyway though, so if I'm not too sick and just get out the vacumn cleaner or go for a walk etc. Maybe you can try that too after a correction. Hope you're feeling better too.