Type 1 High BG: should one go to the hospital?

[DanisV]

Hi people, I have one stupid question: if the blood sugar is more than 15 for like 3-4 Hrs should one go to the hospital or try to "correct" it at home? Sometimes correction takes time, it does not work immediately and/or sometimes the cannula has to be changed. When is the turning point when one should go to the hospital?

Thanks in advance !

 

[Circuspony]

I don't. But I can also check ketones on one of my meters so if for any reason it didn't come down all day then that's what I would do - plus drink plenty of water to encourage it.

 

[Ledzeptt]

@DannisV Assuming you’re fit and well, I would try and do some exercise (anything from a brisk walk to going for a run/cycling) as a quick way to bring your BG down.

For me, 20 mins brisk walking will bring my BG down by 3 or 4 mmol straight away.

Sorry, I don’t know rules when to go to hospital- if you were in UK could telephone NHS 111 for advice - do you have an equivalent 24hour help line?

 

[Celsus]

@DanisV

For me, 20 mins brisk walking will bring my BG down by 3 or 4 mmol straight away.

Sorry, I don’t know rules when to go to hospital- if you were in UK could telephone NHS 111 for advice - do you have an equivalent 24hour help line?

Sorry @Ledzeptt , for a Type1 then you should not exercise if your blood sugar is over 15!
Especially not so if you also have ketones!
It is a situation where you clearly do not have enough insulin available and your bg level will typically even increase further due to the exercise you do. Stimulated by the demand from your exercising muscles your body will pour glucose into your bloodstream (from liver and muscles). But your advice to drink water is always a good thing, to help your body to flush out the surplus sugar/ketones and support your kidneys as much as possible in the filtering job.

But now back to @DanisV's question regarding going to the hospital for correcting a high or not? Well its definitely always depending on your own individual situation, how well you feel and how assured you are to make self-corrections at home, etc.
But first off, 15mmol/L is no emergency life threatening situation. Far from it actually! (except if its been like that for a very long time and you have ketones raising up, but your description does not indicate that to be the case, as severe nausea, vomiting etc should then also be there). Most Type1s have tried from time to time to have an off-day, where for whatever various reasons we get our insulin therapy wrong and the bg goes up like a spacerocket and we take a few hours or a day or two before we get it down again within the 'allowed range' of max 10mmol/L. Most types1s will typically take the necessary corrective fast acting insulin at home. Especially so, when having the routine and knowledge about determinating the required dose of fast acting based on the knowledge how much 1 unit of fast acting will drop their bg down. Personally mine drops around 3 mmol/L per units of fast acting. So if I measured I was up at e.g. 20mmol/L, then I would take 4 units of fast acting. And then set an alarm or be cautious to measure your bg 1 hour later to check the status and trend. You may at that time observe if you should take a little bit more or you should wait another 1 hour before doing so, if the bg has already dropped down considerably to be near your 10mmol/L mark. Always keep in mind that the injected bolus may take 2-4 hours before its full effect has incurred. It should also be observed that typically you will need more insulin units to drop your bg by a fixed mmol/L when your bg level is higher than 12 mmol/L. Aka, so you are more insulin sensitive when your bg is in the sweet spot zone of 4-8mmol/L and less insulin sensitive when your bg is too high.

 

[Seacrow]

I've found that while doctors don't like the high bg, they are happy for you to fix it yourself UNLESS you are also producing ketones. High bg + ketones they like you to get medical help.

I had clinic today, and because of unusual circumstances my bg was 33. The nurses whisked me away, checked my ketones, and on finding only 0.2 immediately relaxed. They made sure I had taken a correction dose, but it wasn't a big problem.

 

[DanisV]

Sorry @Ledzeptt , for a Type1 then you should not exercise if your blood sugar is over 15!
Especially not so if you also have ketones!

@Ledzeptt actually what @Celsus says is really true. I could not believe that; I have always hoped that extra activity would lower BG but it just does not (( Actually it made my sons condition even worse.

My son has a pump but sometimes if we do a correction then it just really does not work and this what you say about "Aka, so you are more insulin sensitive when your bg is in the sweet spot zone of 4-8mmol/L and less insulin sensitive when your bg is too high." seems pretty much correct. And it happens that after 3-4 Hrs it starts to drop like crazy (with 3 arrows down on the pump display, even the active insulin seems to be gone i.e. almost 0.0).

Btw the ketones are always there , at least 0.2 - 0.3. Even when the BG is not more than 12.. (Does this mean we can do exercise only when they are negative ??)

 

[catapillar]

Btw the ketones are always there , at least 0.2 - 0.3. Even when the BG is not more than 12.. (Does this mean we can do exercise only when they are negative ??)

How old is your son? What is his diet like?

Ketones are produced when you don't have enough insulin. These are bad ketones that need correcting following the sick day rules.

Ketones are also produced when your body is burning fat for fuel, either due to starvation or a low carb diet. These ketones are nutritional ketosis and nothing to worry about.

You tell the difference between ketones that are fine and ketones to worry about by your blood sugar levels. If ketones were 0.3 and blood sugar 15 then the ketones would need correcting following the sick day rules. If ketones were 0.3 and blood sugar was 7 then ketones wouldn't need any action, especially if you knew they were there because of low carbing.

 

[DanisV]

How old is your son? What is his diet like?

He is almost 7 months. Eats everything, as suggested by the pediatricians/nutritionist. The problem occurs after wheat-based porridges, some fruits (apple, peach) and potatoes !

When we talk about reducing ketones , it is actually reducing the BG level?

 

[Freema]

Having such a little child having diabetes you need to be in a close comunication with a diabetes team. You need to have easy access to help and advice . Never hesitate to call diabetes helpline and talk things through , you need to be sure of what to do always

 

[Bic]

@DannisV Assuming you’re fit and well, I would try and do some exercise (anything from a brisk walk to going for a run/cycling) as a quick way to bring your BG down.

For me, 20 mins brisk walking will bring my BG down by 3 or 4 mmol straight away.

Sorry, I don’t know rules when to go to hospital- if you were in UK could telephone NHS 111 for advice - do you have an equivalent 24hour help line?

Sorry but that's not good advice fot type ones! T1s are strongly advised NOT to take exercise if BG is above 250 mg/l, as exercise would only bring levels UP instead of down.
To correct a hyper, I usually take a correction dose, drink some 1/2 liter (or more) of water, rest, drink some more water and check again after a couple of hours. Anyway, better not overcorrect hypers, either. If things aren't back in range in a couple of days, I would phone my doctor.
Hope you are better soon!