Fungal infection effect or wound effect on BG?

[Spiker]

Hi again everyone. I've been in and out of hospital for the last few weeks. I'm currently out. I had an infected foot wound, that apparently resolved with antibiotics. But since then I've also developed very severe fungal infection wounds on my feet. I'm finishing the course of antibiotics today. My BG is persistently up around 20 and won't come down, resistant to correction doses. I've done full pump replacement and also used pen insulin from a different source, without effect. No ketones. No infection symptoms other than resistant high BG. I'm guessing it's several weeks of strong antibiotics that opened the door for the severe fungal infection - never had anything like that before.

My question basically is, does the persistent and resistant high BG prove that an "occult" (hidden) bacterial infection is still active? Or is it possible for a fungal infection to drive up BG? Or could it just be the wound trauma alone that is driving up BG? Apparently I have the most severe fungal wounds the diabetic wound clinic have ever seen. Lucky me eh?

The clinic want me to discontinue the antibiotics today as they believe the bacterial infection is gone. I'm not convinced. And if I am barely holding BG down to 20 with the strong antibiotics and using real time CGMS, I'm worried what will happen if I come off them. It could get very bad, very fast.



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[noblehead]

Hi spiker sorry about your recent troubles. Any illness, trauma or infection has the tendency to push up bg so it could well be that the infection is still active, I would mention this to your Dr as you may need to stay on antibiotics longer.

As for your bg, I would maybe ask for advice from your consultant or dsn, you seem to be doing everything right but your bg is still high, with high bg the wound healing will take longer so it's in your best interests to get your levels down.

 

[Heathenlass]

Great to see you back, Spiker, and I'm sorry to hear you are going through the mill, it sounds horrendous You must be stressed as 'ell.
I'm about to run out the door but will have a stab at replying properly later.

Take care

Signy

 

[jack412]

Can they reintroduce skin bacteria to balance the yeast. The same as probiotics for your gut after antibiotics ?

 

[iHs]

Hi Spike

wondered why you hadnt posted for while on the forum and presumed you were ok but obviously not..

... Thrre have been a few times when using the Combo pump, Ive used my pen to deliver the bolus and not thr pu
mp esp when bg levels have risen fairly high and Ive wanted to get them lower as quickly as possible. On the
Vibe there isnt the option of telling the pump that the bolus has been delivered by pen and this should be addressed by Animas just in case a pen or syringe needs go be used.

if I was in yr shoes, I would use my pen for the bolus and yike up the basal probably to 150 to 200% for a few hours just to see how my bg levels went.... as long ss youve got plenty of strips, you can test evrry hour to monitor. What sets are you now using as they might not be delivrring insulin that well and you might need to use another type or another body area like yr arm. Have you considered reverting to Lantus or Levrmir to get you through this bad spell?

 

[sanguine]

Good to see you back Spiker, although the circumstances could be better! I hope you find a solution to this soon.

 

[Bluetit1802]

Yes, good to see you back Spiker, and sorry the circumstances aren't great.

I can't help at all, but could the antibiotics be something to do with the high BS?

 

[AndBreathe]

Hi again everyone. I've been in and out of hospital for the last few weeks. I'm currently out. I had an infected foot wound, that apparently resolved with antibiotics. But since then I've also developed very severe fungal infection wounds on my feet. I'm finishing the course of antibiotics today. My BG is persistently up around 20 and won't come down, resistant to correction doses. I've done full pump replacement and also used pen insulin from a different source, without effect. No ketones. No infection symptoms other than resistant high BG. I'm guessing it's several weeks of strong antibiotics that opened the door for the severe fungal infection - never had anything like that before.

My question basically is, does the persistent and resistant high BG prove that an "occult" (hidden) bacterial infection is still active? Or is it possible for a fungal infection to drive up BG? Or could it just be the wound trauma alone that is driving up BG? Apparently I have the most severe fungal wounds the diabetic wound clinic have ever seen. Lucky me eh?

The clinic want me to discontinue the antibiotics today as they believe the bacterial infection is gone. I'm not convinced. And if I am barely holding BG down to 20 with the strong antibiotics and using real time CGMS, I'm worried what will happen if I come off them. It could get very bad, very fast.



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We were just mentioning you the other day, commenting you were missing in action.

I hope things improve for you soon. What antibiotics have you been on? Something like Metronidazole ?

 

[Spiker]

Hi Spike

wondered why you hadnt posted for while on the forum and presumed you were ok but obviously not..

... Thrre have been a few times when using the Combo pump, Ive used my pen to deliver the bolus and not thr pu
mp esp when bg levels have risen fairly high and Ive wanted to get them lower as quickly as possible. On the
Vibe there isnt the option of telling the pump that the bolus has been delivered by pen and this should be addressed by Animas just in case a pen or syringe needs go be used.

if I was in yr shoes, I would use my pen for the bolus and yike up the basal probably to 150 to 200% for a few hours just to see how my bg levels went.... as long ss youve got plenty of strips, you can test evrry hour to monitor. What sets are you now using as they might not be delivrring insulin that well and you might need to use another type or another body area like yr arm. Have you considered reverting to Lantus or Levrmir to get you through this bad spell?

Hi Sally

Good ideas there. With the Vibe when I do a pen dose I also dial and deliver the same dose on the pump but unclip the canula during delivery. That way the pump IOB tracker is correct. I agree Animas should add a function to record a non-pump injection.

I was pushing +150% - +200% basal (TBR) when admitted to A&E (twice) but the hospital diabetic docs were strongly opposed and said never go above +50%. I don't know what they expect us to do exactly. It's true that it would have been more use to me to add a fixed amount of basal per hour rather than add a %, but the pump does not have that option. Yes I could have frigged my profile or added a profile but I did not fancy my chances of doing that while semi delirious. It would be good if the Vibe let you copy an existing profile, then edit the copy. The problem with +200% basal was that it kept me level during the day but sent me hypo during the DP surge in my profile. The other thing that was happening was I raising and reraising my TBR too fast, without waiting a good 4 hours to measure the effect of the raised TBR.

Funny you should say "in your shoes" - it was a new pair of shoes that started 3-4 weeks of hassle. :-(


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[Spiker]

Actually an additional dose of Lantus, on top of my pump basal, would be the ideal way to get "+1.5u / hour", which is what I was trying unsuccessfully to achieve with my high TBR. Good idea Sally.


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[Spiker]

We were just mentioning you the other day, commenting you were missing in action.

I hope things improve for you soon. What antibiotics have you been on? Something like Metronidazole ?

Thanks for that.
Clarithromycin and its relative erythromycin. They tried co-amoxiclav first but I got a penicillin reaction to that (first time ever).


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[ElyDave]

what are you doing to treat the fungal infection?

I once got a very nasty case of athletes foot from a winter ride that went cold and nasty on me. Was absolutely excruciating, all over my feet. Rubbing twice a day with tea tree and lavendar oil cleared it up in no time.

Hope you get to the root of it quickly.

 

[Spiker]

Cheers ElyDave. At the moment, nothing, though a few days ago I blasted it with a one off fluconazole tablet. Seemed to stop it in its tracks at the time but now it seems to be coming back. It's a bind because with strong antibiotics killing off the competition, the little fungi guys have free reign.

 

[Spiker]

I will pop to Boots for tea tree and lavender oil and use it when I change the dressing to contain any spreading elsewhere. But as I have open wounds in the worst affected areas I will have to keep the oils away from there.

 

[Pipp]

I will pop to Boots for tea tree and lavender oil and use it when I change the dressing to contain any spreading elsewhere. But as I have open wounds in the worst affected areas I will have to keep the oils away from there.

So sorry @Spiker . When I hadn't seen posts from you I had thought you were on holiday.

I am afraid I don't have any real answers to your dilemma, but just a thought, fungal infections thrive when there is high sugar. Maybe some change to diabetes meds needed to control?

Hope you are well again soon.

 

[Brunneria]

Glad your back - we've missed you.

Maybe the one good thing about your foot problem is that you will be so bored by immobility, you will have to post here for entertainment!

I've head good things about ElyDave's tea tree oil treatment (although keeping it away from the open wound is a must), and I've also heard good reports of Shea butter as a preventative foot moisturiser, but you need the good stuff, un heat treated, 'unsanitised' Shea butter. If you use the highly processed stuff, all the good anti fungal effects have been removed. You will end up with fantastically good skin on your tootsies too.

Unfortunately, one of the things feeding the fungus is your high BG. So you may find it keeps recurring until that is sorted.

Keep us informed?

 

[craig81]

Sorry to hear you've had a difficult time of it Spiker. Just to add my two cents - are you taking any probiotics or eating any probiotic foods like sauerkraut, kefir, or fermented yogurt (along with prebiotic fibrous veggies) when you've been on the antibiotics? I only ask because the antibiotics will be indiscriminate in who they kill and your gut bacteria could be adversely affected for a long time as you recover. This may lead to longer term health issues if there are no good guys left in the gut and they don't get the nutrients they need to stave off the antibiotic onslaught.

Fingers crossed you get better soon.

 

[Adele99]

Have the Diabetic foot clinic done a skin scraping of the fungus to check it is a fungus in origin and also what would be the best treatment to put on it.

Asking because the podiatrist who does my my feet told me. I had athletes foot, and I've very restricted circulation in legs so told important I dealt with it. Skin was peeling etc, and Really itchy , was driving me mad. I spent a small fortune on every fungal treatment available , from lotions to herbal and natural remedies over the next 4months trying to get rid of it , and it just got worse.

Eventually directed to Dermatology clinic when skin on foot sole started breaking out in blisters and skin was broken. He did a scraping of the skin and it Wasn't athletes foot at all but some sort of skin condition . Never had any skin problem previously. I was prescribed a steroid cream Lotriderm and given Doublebase emollient cream to use twice per day. The. Lotriderm as well as steroid also has an anti fungal and antibiotic in it and worked a small miracle. But not for application to broken skin.

Hope your blood sugars return to normal soon and your foot mends ASAP.

 

[Jaylee]

Hi Spiker,

Sorry to hear about stuff..!
Far.be it for me to say this to you but these things can be overlooked..?! I appreciate infection raises BG.

You mentioned being delirious? Is that a fever & high temp too? I'm wondering if body heat transfernce has affected the integrity of your insulin stored in the pump reservoir...?

Hope you mend soon.!

 

[Spiker]

Thanks all. Good point about pro biotics, I'll see if I can get live yogurt. The clinic did a skin scrape but it won't be ready until Monday. BG is under control, kind of, with +60% temp basal rate and aggressive corrections every 2-4 hours (and remember kids, never correct more than every 4 hours, but the pump IOB wizard protects me from the worst of stacking).
So I'm hanging in there even as the antibiotics are pretty much worn off now, nearly 20 hours since the last 12-hr dose.