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Do you inject if you don't eat? Getting conflicting advice!

T

TheSparkyPony

Well-Known Member
Messages
136
Location
Cheshire UK
Was ill last week and as a result didn't eat. I'm on novorapid and levemir, and was puzzled over what to do.

Doctor 1 says if I'm not eating, don't inject my novorapid, as I only inject that to cover what I eat, but to still take the levemir so I still have background insulin in my body.

Doctor 2 says to always inject something, regardless of whether I eat or not. And obv to still take the levemir.

Opinions?? Am sick of confilcting opinions from the doctors! Ended up having DKA last week due to being ill and not having enough insulin, consulted both doctors but they still remain the same!

Thanks :mrgreen:
 
Re: Do you inject if you don't eat? Getting conflicting advi

Always inject your levemir. Always.

The thing about injecting the novorapid, it IS meant to only cover what you eat, so if you don't eat anything, you shouldn't have to inject.
But personally, when I'm ill, i always need to injecyt a little, as illness puts my blood sugar up.

Test, test lots, and sip on that low sugar lucozade to stop yourself getting dehydrated.
Inject yourself if you need correction doses, but don't worry aboutslightly high blood sugar, as 'normal' people's sugar rises during illness too, up to 11 is the high bar, so I don't usually worry about anything up to 10.

Do what YOUR body says. If your sugar is high, then you need some more insulin.
 
Re: Do you inject if you don't eat? Getting conflicting advi

When my daugher is ill we always continue with the Levemir (basal). If she's not eating we only inject Novorapid for correcting high readings which are usual when she's ill. If her reading is good and she isn't eating then I wouldn't inject the Novorapid. But keep testing often to keep an eye on your bloods and if they start rising then do a correction dose. Be careful not to give a second correction dose before the first one has worn off otherwise you may over do it.
 
Re: Do you inject if you don't eat? Getting conflicting advi

I agree with the others and would add, you need to have some ketone strips and test for ketones if your glucose levels are about 14mmol or above. You then need to know how much insulin you need to correct both the high glucose and ketones. You should ask for advice before you need it.
 
Re: Do you inject if you don't eat? Getting conflicting advi

When ill, you may find bg's creeping up even though you have not eaten, so it may be possible to add correction doses of Novorapid to stop your bg increasing. The only way you will know is to monitor your blood glucose every hour in the initial stages, and should you find your bg is rising, correct this with 1-2 units of Novo. These are called 'sick day rules' in DAFNE terms (carb counting course) and when bg's are high, do as Pheonix says and check your urine for ketones. Also, before I forget, you must always take your levemir as normal.

Next time you are ill and have any concerns, try ringing the NHS helpline for advice.

Nigel
 
Re: Do you inject if you don't eat? Getting conflicting advi

ok so pretty much going to repeat here but ... test, test, test. test your bloods and test for ketones. I ended up with DKA a few months ago due to an ear infection of all things and was in the high dependency unit for quite a few days. This could have possibly been avoided if I had tested for ketones and checked my blood levels regularly. I was also told I should always give myself a couple of units of my novorapid every now and then because even with my base glargine my body thought I was starving it of the insulin it needed.
So my advice would be to give your self a few units but nothing to drastic and test like there is no tomorrow.

Shell
xoxox
 
Re: Do you inject if you don't eat? Getting conflicting advi

TheSparkyPony,

I meant to say in my earlier post, ask your dsn about the DAFNE course and put your name forward. On the course there is a whole afternoon devoted to 'sick day rules', which as I said covers how to treat rising bg's and ketones, plus there is a opportunity for family members to come in to the session and take part, so if you are too ill, they have the knowledge to assist with your situation.

Regards

Nigel
 
Re: Do you inject if you don't eat? Getting conflicting advi

My nurse has allways told me when doing the 4 jabs a day and the 24hour jab to allways do the 24 hour jab (Lantus / Levimr) but if you don't eat theres no need to do the other jabs.
 
Re: Do you inject if you don't eat? Getting conflicting advi

Hi, being ill sucks most of the time but when you'r blood glcucose goes up too it's just plain worse!! I'd do what everyone else says and test and treat. I always find that if i don't eat my BG's go up anyway so I've got to take a little something!!
feel better
 
Re: Do you inject if you don't eat? Getting conflicting advi

mindii said:
I always find that if i don't eat my BG's go up anyway so I've got to take a little something!!
feel better
Click to expand...

Same here, my sugar levels go high if I don't eat for a long period of time so small meals often are also good for this 8)
 
Re: Do you inject if you don't eat? Getting conflicting advi

Sometimes you cannot eat. This is problematical to type 1 diabetics because you don’t just need insulin for reducing your blood glucose concentration you also need it for the normal function of your body including a catalytic amount for uptake of glucose into the muscles.

Therefore you should always continue to take your long acting basal dose. Without at least this dosage you will (say three days or a little longer depending), become ketotic with all the hassle that involves – probably a hospital (self), admission to stabilise your excessive blood glucose and electrolyte levels which will suffer under DKA.

WRT to the quicker acting insulin, I agree with what’s said above: test and correct taking small doses if you’re not eating anything. Agreed, illness and infections certainly seem to cause a rise in blood sugar levels.

Keep an eye on it – if it gets out of hand and you become ketotic, present at your local casualty. Caught early, they’ll sort you out in, say 24Hrs :) .
 
Re: Do you inject if you don't eat? Getting conflicting advi

Hi

I've been on lantus and novorapid for years, and if I am ill I monitor my sugars very closely, however- for me I know that 1 unit of novorapid will bring my levels down by 2 full units on blood tests. If my levels are 8 and rising I will give myself 2 units (without eating) if I am laid up and and not doing anything (but moaning!). If I am able to poodle around the house I will give myself just 1 unit of novorapid when it is rising to about 8. There on depending how long the illness lasts I just keep an eye on myself every 1-2 hours. If after 4 hours my sugars are still rising, I will give myself another 1-2 units. I have never stopped the lantus ever. I find that this works, but I would never risk doing this if I was going out thehouse or driving etc.

You have to find something that works for you, the insulins we use are a generalised medicine and everyone reacts individually. I also found that doing my lantus injection 2 times a day was the best thing ever for me, as it stopped my night hypo's and stopped my sugars rising so enormously in the mornings. No GP or nurse ever advised me to do this, I had to work out what was best for me.....largely depends on how ill you are, and I just use the guideline that 1 unit of actrapid will bring my sugars down by 2, and I would never try to get them below 5 when i am ill.

Good luck....Sha
 
Re: Do you inject if you don't eat? Getting conflicting advi

noblehead said:
I meant to say in my earlier post, ask your dsn about the DAFNE course and put your name forward
Click to expand...

Thanks Nigel, I'll ask today as I have a follow up appointment this afternoon to check how I'm doing.

Thanks everyone for your advice, will take it on board. I suppose it was my own doing really being DKA as BMs and rational thinking went straight out the window and was instead focusing on purely keeping fluids down!

Got some interesting news the other day as a result of my DKA put will post it in another topic as unrelated to this but could do with some views there too!

xxx
 
Re: Do you inject if you don't eat? Getting conflicting advi

Good luck today Sparky, take the opportunity to ask your nurse any other questions you may have.

Nigel
 
Re: Do you inject if you don't eat? Getting conflicting advi

I got dka because I had food poisoning and assumed the constant puking meant I didn't need any insulin. Didn't realise that after probably the 2nd day the puking was down to dka rather than food poisoning! Was in hospital for a week. Oops.

That's why I wish I'd been able to do the dafne course 10 years earlier, as nobody had ever told me about what to do when you're sick.

Yep, always continue to do your background insulin. As for corrective doses of quick acting, only you can decide that, not your doctor. And you can only know if you test. Obviously if you're in range you don't need to correct. But illness can make your blood glucose go really high so it's worth trying to correct before you end up spending 5 days in the 20s like I did!
Also if you can't keep fluids down at all you need to go to hospital so they can rehydrate you intravenously. And if you do get hospitalised, bring all your own kit and some hypo treatments. You'd think a hospital could treat a hypo, but I waited half an hour and ended up with hot chocolate - I would have been better off staggering to the little shop and buying lucozade :-)
 
I am type 2 on humulin background insulin and Novorapid before meals. I have been wondering about this issue for a long time. I have developed a nasty stomach ache today and really don't want to eat, but no one has advised me what to do about the Novorapid shots in that instance. Why is there so little info on this?
 
onnecar said:
I am type 2 on humulin background insulin and Novorapid before meals. I have been wondering about this issue for a long time. I have developed a nasty stomach ache today and really don't want to eat, but no one has advised me what to do about the Novorapid shots in that instance. Why is there so little info on this?
Click to expand...
Fast acting insulin like NovoRapid is used to “mop up” the glucose from the food you eat AND make corrections. This is why those of us with Type 1 count carbs and calculate the bolus dose for each meal. We also have a correction factor which we used to adjust for high BG.
Therefore, if I did not eat and my BG was in range, I would take no insulin. If my BG was too high, I would take insulin to bring down my BG.
If you are on fixed doses, i guess you will not have a correction factor. Therefore, your injected insulin is only for the food you eat. If you eat no food, your BG should not rise at that time so you need no bolus.
 
But as mentioned above, if you're ill you'll likely have high blood sugar even without eating - theoretically one could increase basal/long acting to cover this, but I don't think anyone actually does this (or certainly I don't unless I'm running high for multiple days) and instead take novorapid to try to force BG back into range even if I'm not hungry, and if I am hungry I correct and take cover for food and generally find it's not enough!

Humulin (I?) is not as flat as most modern basal insulins, so you may find you need to adjust dose if you start running low and are not hungry, though it's more likely that you'll run high if you're poorly.

Hope your stomach ache gets better soon
 
Hi, I've been type 1 for 50 hrs (now 55 ) and as others have already said, illness often raises your BG levels with zero carbs, so you must try to adjust accordingly but there is no hard and fast rule. I've been on a pump for 25 years, but the principle is exactly the same on a pump - if I have a temperature/virus I generally have to increase my basal level sometimes by 50% for a day or 3 (the equivalent to your Lantus or other long acting insulin)......HOWEVER..... because a pump delivers tiny doses of short acting insulin, its OK for me to do that as I can stop it as soon as I'm a bit better and BG returns to normal. If you mess with your long acting insulin and get it wrong, you are stuck with it in your system for say 24 hours.

Everyone iis slightly different and both your doctors are kind of right, but my advice would be to 1. Test regularly 2. Do your long acting as normal and 3. Make adjustments with your short acting even though you are not eating. At least then you can control it over short periods, but regardless its very hard to get right even with a pump (!) so don't worry, it's just one of the trickier bits to manage that settles down after a few days. Good luck.
 
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