Sick day vicious circle

manicarrie

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Hi all, just really want to have a bit of a moan, and see if anyone else has had the same as me and how they got out of it.
For a start, I know I have let my diabetes get out of control, but I have made steps to get things back, by re establishing contact with GP and clinic, and now reporting to my DSN on a weekly basis.
However, since getting back to clinic, I seem to be in a vicious circle of illness and high BG. I get a bug, as my BG was higher to start with, which chucks my BG through the roof which leaves me open to the next bug. I am currently on day four of a bad cold with tonsillitis, I have only had two readings within or below range snce Weds (it's now Sat). My highest was 27.4, but ketones 0.5, my lowest was a 2.9 on Thursday. Otherwise, my lowest has been11.4 and I am stuck around the 15 mark today. I have been adjusting my insulin with the guidance of my DSN and today with my meter (Accucheck Insulinx), but I am at the point where I am so fed up with the high bg making me feel so rotten on top of the cold, I am severely tempted to go out and have a sugar binge, if it's going to be high it might as well be worth it. I won't do that, but that's the mindset it's got me in. I am not ill enough to see GP, not even off my food, in fact, hungrier than ever, so sick day rules I was given by hospital don't really apply other than extra fluids (I would anyway, a cold always dehydrates me even before diabetes) and testing more regularly, especially for ketones.
I guess I am just feeling sorry for myself, especially as cannot access my DSN today so can't talk about worries.
Anyway, thanks for reading x
 

manicarrie

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I thought that I had better also add that at the moment I am a complete hypochondriac about infections, due to personal circumstances I have seen the effect of a couple of simple infections have had on a type 2, completely avoidable complications with the right treatments, so now the slightest bug scares me
 

manicarrie

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Thanks noblehead, I suppose I just want a whinge, sat here with no one but a 6 year old, 2 cats and a dog, none of whom care lol, and it's just the constantness (is that a word), if it's not a stomach bug it's a gum infection, or an ear infection, or migraine or chronic tiredness, well you get the picture that I am a right little ray of sunshine! x
 
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jack412

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I'm T2 , so it's more for me to understand than to give you advice,

is this right?
from what I have read, one can bump up ones basal for anything that's going more than a day.
after one work out ones correction, they have a choice of 1/2 or full bolus depending if the appetite is ok, at the least sip sugar water for a half basal


Sick day rules
http://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf
Sick day rules flowchart
http://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf
 
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noblehead

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Thanks noblehead, I suppose I just want a whinge, sat here with no one but a 6 year old, 2 cats and a dog, none of whom care lol, and it's just the constantness (is that a word), if it's not a stomach bug it's a gum infection, or an ear infection, or migraine or chronic tiredness, well you get the picture that I am a right little ray of sunshine! x


:)......don't worry about having a moan, the forum is here to share the good times and the bad.

The simplest of things can make type 1 diabetes difficult to manage, hopefully over the next few days things will improve, just keep to the Sick Day Rules and monitor your bg and ketone levels carefully.
 
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manicarrie

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On the plus side, still getting used to my shiny new meter adjusting dose, and didn't realise I could ask it for a no meal dose. My pre breakfast was 19.8, asked it for an adjustment, it suggested 13 units of novorapid (6 for the meal and 7 to correct), post breakfast was 15.9. Had a play, saw a no meal option, it suggested 3 units (5 units to correct, but I still had 2 units of my breakfast insulin active), and my pre lunch was 7.9! Yay! Maybe I should have nosed at that no meal option before :). Still feel rubbish, but a lot more hopeful of regaining control now which helps. Thanks guys!
 
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noblehead

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I use the Accu-Chek Aviva Expert, much like your meter it has the option to include things like illness and exercise when calculating insulin doses.
 
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manicarrie

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Yes, it's awesome, only got it Tuesday so still figuring things out, I remember her going through the mealtime adjustments, but don't remember if she said about the non meal, I did have my son with me which was a bit distracting, but my hubby and everyone else was working, so no one to have him. I was chuffed to find on the computer that I could add a category to the notes though, it had medication, exercise etc, but not illness, so I added that. In fact, I emailed the report to my DSN on Friday, explaining I had been ill and she herself said the infection was doing the BG thing, so keep doses as is. As I have been so high for so long, my target BG on the meter is 5.5-7.5 for now, with doses of 6 units for breakfast, 6 for lunch and 10 for tea as that is when I am peaking. I do love this new toy, the more I play with it :)
 
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donnellysdogs

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Good to get down to 7.9.. It will take a while for infections to go, but higher levels as you know hinders the healing processes...
 
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manicarrie

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Thanks, it's shot back up again now, but at least if I have got it down once I can do it again and then hopefully get better quicker x
 

donnellysdogs

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Did the rise occur 2-3 hours after eating?
 

manicarrie

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It was 15.8 two hours after food, which was kind of expected, and then my old meter (trying to conserve strips until prescription ready Monday) said 24.9 but 0.5 ketones. Went onto new meter to get an insulin calculation and it said 16.3, which 'feels' more like it if you know what I mean. Apart from the sweats, I have no other hyper symptoms, the thirst, toilet and blurry eyes, am putting tiredness down to the virus
 

donnellysdogs

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Rises 2-3 hours after food generally means 1 of 2 things:

1) you have guestimated carbs wrong or
2) your bolus ratio for that meal needs to give you more insulin.

Why were you expecting it, is your DSN advising you on your bolus ratio?

Did you give a correction when it has risen?
 

manicarrie

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Hi, was guessing it as still working with DSN to get my adjustments right, only been back under their care a week yesterday, and given my new meter and dosing Tuesday. She worked out a dosage for each meal going off my current figures, 6 units brekkie and lunch, and 10 units for tea as that is when I tend to spike, she was going off my figures Friday lunch to Tuesday morning. I had adjusted my dose via the meter, still trying to get it right at the best of times, but now is hard. For example, Friday to Tuesday my highest was18.3 when I had a temperature but felt fine, otherwise I was keeping around the 9-10 mark post dinner and 6-7 post brekkie and lunch, that's what the dosages and corrections were being worked from. Obviously it's a trial and error process, just this bug has thrown me so much off course. My HbA1C was 101 which will tell you what my prior levels were before I went back, the last contact I had with the unit was May last year, I had so much other stuff going on I just couldn't make it to clinic and had to be re referred x
 

donnellysdogs

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Have you been on a dafne course to learn how to dose adjust for what foods you eat?

Prior to giving up... Did you just have a standard set amount of insulin each mealtime then?
 

manicarrie

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Hi, I have been put forward for a DAFNE course this time, couldn't make it before because of other commitments. There was one starting at the other hospital next month, but didn't want to go to that place as my mum only recently died there and the unit is in view of the ward she was in, stupid I know, but if I can avoid that place I will for the time being. Its also 5 miles further out, especially if my sons school rings. She hasn't got the dates for her hospital as yet. Before I was guessing doses of between 4-8 units for meals depending what I was eating going off what was said when I was diagnosed (July 2012) and when I lost contact, I had actually lost contact before in the September 2012, but was admitted with DKA after a stomach bug in April 2013 but again lost contact due to all the other stuff. Basically my mum was feeling poorly around the time of my diagnosis and admitted into hospital End October 2012, and diagnosed with cancer in the November, so I put myself on the back burner so to speak. I have been looking after her since then, and was also working part time, and my son is special needs, so the diabetes became a hindrance and I really didn't have the time to maintain contact, between school drop off, working the morning, taking mum to and from chemo and doing her shopping, fitting in my sons routine appointments (he is under about 6 different consultants), school pick up etc. I left work at the end of last year as my mum became bed bound, and I was on call 24/7, when she died in July it was a shock as it wasn't the cancer, it was a urine infection with diabetes and cancer being secondary causes. That's why I am so hypochondriac now, just a simple UTI in the end. But anyway, it was a kick up the butt for me, and I have more time now as I haven't started thinking about work yet, and my sons appointments have gone from 6 monthly to annually. It took me a few weeks, as obviously, there is a lot to do after a death, but I decided enough was enough I was going to turn things around, saw the GP week before last and had a call to go in on the Friday and the rest I have said already.
 

CarbsRok

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Hi Carrie, I'm so sorry for the loss of your Mum (((((((((((hugs)))))))))))) It's no wonder you put yourself on the backburner for a while.
Hopefully now you can start to sort yourself out and begin to live again.
This link http://www.bertieonline.org.uk/ will take you to an online course so you can learn to carb count yourself :)
 
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donnellysdogs

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Hi Carrie, I'm so sorry for the loss of your Mum (((((((((((hugs)))))))))))) It's no wonder you put yourself on the backburner for a while.
Hopefully now you can start to sort yourself out and begin to live again.
This link http://www.bertieonline.org.uk/ will take you to an online course so you can learn to carb count yourself :)
Loads of hugs too!! Bertieonline is a great way to start learning to carb count.
Would you consider for the meal time that shot you high today to raise the bolus you give by 1 unit. Only asking if you would consider it, as that is what I would do... I'm not advocating for you to do it....
Are you having different food for that meal time tomorrow?
 
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donnellysdogs

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If you had the same meal again and gave 1 unit extra you would have a gauge for future meals when you had it again.. Just until you can have a look at bertieonline.. Thats what I would do.

Incidentally, do you have any snacks in between meals?