How to tell what's an emergency during Sick Days?

My husband has the stomach bug. I know it's coming for me. I just stocked up on supplies and I'm now trying to make myself an easy to follow flow-chart so that my sick-idled brain can follow it.

All the "Sick Day Rules" online say that when certain things happen, you need to "Call your doctor." I don't know about you, but I never have some sort of worrying medical issue during office hours. How do I know if something is an actual emergency or if I can wait until the Endo's office opens to talk to them about it?

I'm specifically talking of things like...
- BG over 250 for 24 hours
- BG over 300 for two tests within 8 hours
- Ketones in urine (what if it's just "light"? Still ER?)
- You feel sleepier than usual (but... I'll be sick...)
- You can't think clearly (again... sickness)
- You throw up more than once (is there a time limit? does a spit up count?)
- You have diarrhea (it's a stomach bug, of course I'll have diarrhea)
- You have an infection

Help me out a bit. I want to be proactive about my health, really, but I'm not going to go to the ER at 2am just because the sickness has made me a bit sleepier than usual.

**** I know no one is going to tell me "yes" or "no," I just want some thoughts and guidelines so that I can use my own common sense.

Hi -

I haven't been sick too often over the past 7 years but I did get a light case of the stomach flu about a month ago. I threw up twice and didn't call my doctor because I was able to keep pumping insulin at the problem and was able to stay under 250.

Make sure that you have plenty of zero-carb liquids on hand and keep taking insulin even if you aren't eating. Your body will need a ton of insulin. The "call your doctor" list basically is covering sustained high blood sugars, dehydration and the effects of going into DKA. If your blood sugar is over 250 and you can't keep liquid down/inside then you do have a potential serious problem. If you're feeling so poorly that you can't self-treat you have to ask for help.

By the way, I was taught that if I tested above 250 with ketones, the correction should be the greater of the correction based on your normal ratio or 20% of your total daily dose. In my case, the ketones would double my correction from about 2.6 units to 5.2.


Well, the answer you probably don't want to hear is that its unique for everyone so you have to learn your limits, and your level of comfort to be able to discern when it is, or isn't time to go to the hospital.

The key is to check much more frequently, and to watch for ketones. Anything up to 1.5 mmol you will want to drink lots of low carb fluids and then test later - your CDE can probably give you a set of guidelines you should follow when sick. Above 1.5 mmol you'll want to seek assistance as you're at high risk for DKA.

Another thing to watch out for is if you can't keep anything down. You may find you're having a lot of lows, and if you're not able to get anything into you to bring your sugars up your options are to microdose with Glucagon or visit the ER. I've had to set a temp basal rate to lower my insulin input while sick before to avoid dropping low, and that helped to prevent a trip to the ER.

I agree with previous commenters. I haven't had a flu since high school (I had diabetes in high school, but my mom managed it), but I would seek help if my BG was high (thinking over 300 mg/dl) for a day or more, I couldn't keep anything down, or I had large ketons (> 1.5 mmol/L) for a sustained period of time, or any combination of these. I would probably call my endocrinologist first to see what he thought, but if I was feeling really bad I'd head for the hospital.

In over 22 years of Type 1 I have never had to go to the hospital because of my diabetes, though.

Your list looks like it is provided by a physician in order to keep them from a lawsuit if anything goes wrong! There is nothing wrong with the list, but it is very very safe.

If your BG goes up over 200, then you need to attack it. A temporary increased bolus is a great start as illness often causes BGs to rise. Remember to bolus and consider bolusing for well over what your pump or logs suggest. Also, remember to check your infusion set. It may be best to take an injection instead of bolusing to make sure you are receiving the dose.

Ketones are my major concern when ill. If you get slight ketones then you need to drink lots, bolus lots and consider seeking medical attention. Things can go downhill quickly when you have ketones. If you are quite ill and you ketones increase you may be too ill to ask for or get help.

Throwing up is a sign of ketones and I would take not of this and test for ketones if applicable. Another concern is not being able to keep food down when your BG is dropping. I have kept drinking juice and kept it down long enough to raise my BG. A dropping BG when you cannot keep food down is when you need to consider your glucagon as well.

The other items are just being ill and I would not be concerned and suffer through it. Good luck and I hop you feel better.