ILLNESS AND MDI'S

When my daughter is unwell and isn't eating, we would only be giving a bolus to correct a high as childrens bg can increase dramatically when they are unwell. I would be testing every two hours and giving a correction dose if needed. Whilst also ensuring they drink plenty of fluids to flush out any ketones if the blood does run high.

When pumping it is easier to alter the basal, but on MDI this is not advisable as you sometimes need to wait a few days to get the full effect of any change.

Hope this helps.

Illness is a whole other set of things and DAFNE teaches you a whole set of rules on how to deal with it.

The first on, as you said, NEVER stop taking the insulin even if you are not eating.

What you do next with regards to Bolus doses depends on your blood glucose levels and also ketone levels.
If there are no ketones and just high sugars then administer correction doses.
If there are low / moderate ketones then there is a little maths involved but essentially you end up giving a fraction of your total daily insulin every couple of hours.
If you have high levels of ketones then the fraction goes up.

What surprised me when I learned this one is just how much insulin you end up having to take, even if you are not eating.

Until you have done a DAFNE course the best advice would be:
If you are ill and your sugars are high, test for ketones. If you detect large amounts then it is time to call a DSN or simply get down to A&E.

It's seems a little extreme but the thing I learned from talking to other people on DAFNE is how quickly a seemingly minor illness can escalate for Type 1's.

Best of luck for your daughter and hope she feels well soon.

Andy

DAFNE sickday rules works out your correction by using a percentage of your previous days TDD (total daily dose) and calculates from their either 10% or 20% depending how high the ketones are..

Assumption of rule of thumb being, that if your ketones are quite high then its likely that your blood glucose will also be, and the higher the blood glucose the more resistent it because to insulin..

Some other choose to go a slightly simpler route of using their corrections dose, and worked out an increase in dose to compensate insulin readings at a higher BG level..

But basically what you do is every time the BG is 14mmol/l or above check to see any presence of ketones.. If none then normal correction dose taken..

If you are unwell or you find ketones then you start the sick days rules..

Correct blood glucose, ensure that you drink plenty of fluids to prevent dehydration (also helps to flush out BG's)

Check BG and ketones level in 2 hours, repeat correction if necessary and recheck in two hours, if you find that your BG is back within normal ranges but still showing ketones, then keep drinking plenty of fluid a check in an hour..

If at any time you start to get stomach pains, feeling/being sick, breathing becomes shallow or they become unressponsive call for medical help.

But it can be difficult to keep up with the intensive treating to prevent DKA getting a hold, so there is no shame of calling for medcial assistence to help out..

all of this is excellent advice

the one thing I'd add is to be wary when it comes to illnesses like food poisoning. If for example you are unable to digest food, and your bgs are not rising, then obviously putting in bolus insulin will send you dangerously hypo. I speak from experience.
The key thing is to keep, keep, keep checking bg - and even if you do need to hold back on the bolus insulin, keep taking the basal.

Knew someone would remember the DAFNE sick day rules.
Luckily I seem to get ill so seldom that I always have to check back with the book to see exactly what I should be doing

The book is the DAFNE course material though Jopar pretty much nailed it.

It is a little scary since the doses sound insanely high but they do work though by DAFNE educator did say that in practice you will find that you probably only go for a day or so if you are ill before you will go asking for help since you will be completely exhausted simply from having to wake up every couple of hours to test, drink and inject.

I would really recommend that you ask around about a DAFNE course because for MDI is makes life a lot better.

Andy

stoney said:

I have not been on a DAFNE course and I don't think there is anywhere in South Wales where they do it

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http://www.dafne.uk.com/wales-courses-3.html
There's a DAFNE centre in Merthyr Tydfil. Don't be put off if people say 'we don't do it here' - if you are prepared to travel to it, your GP can (should) refer you to any DAFNE centre.

I've done DANFE several years ago..

To say a GP can refer you to any DAFNE centre isn't strickly correct..

There's not as such a DAFNE centre, just a hospital that does DAFNE training/courses, hospitals that provide DAFNE are totally dependant of PCT/hospital funding for any one year and this funding will determin if and how many courses will be run in one year!

I know that the year I went on DAFNE Jan 2008, the diabetic clinic were still pushing for funding for the next finacal year, They had managed to arrange for 4 courses after the April by 3 courses were funded from the hospital budget and the managed to arrange a fourth course by the training (consultant, nurses and dietitians) staff giving up their spare time and/or taking holiday leave and this isn't the first time that the team had used their free time/ anual holidays to provide course for diabetics..

Hospitals that provide DAFNE will have a waiting list, I waited a year to attend mine for many hospitals the waiting list is 2-3 years long..

There is an online course that may help you in the interim.
http://www.bdec-e-learning.com/
The site map only becomes active when you log in.

Sadly DAFNE isn't available to under 18's or parents/carers only to the actual over 18 diabetic..

Not sure why this is, as information taught is relavent whether you are the diabetic or the carer, but the b-dec on line course is pretty good, and with the back of a dietitan teaching carb counting, and getting either Pumping Insulin or Think Like a Pancreas will help a lot with undestanding not only the carb counting but the verious other aspects that we got to consider when managing our diabetes..

Hello

I am newish to posting here
My daughter changed from the 2 injections of premix to the basal/bolus regime yesterday
It did not go great as i was so tired i forgot to prime the Levemir and she didn't get any

This morning she was high when she got up, gave the Levemir at 7:30am, worked out how much Novorapid she would need later on before breakfast to bring her down to normal but at 8am she burst into tears and said she had really bad tummy ache and felt really sick so i sent her to bed!
Re-tested at 8:30am and she had gone up a bit, she also had +4 ketones so i rang her nurse in a panic and left a message on her mobile, luckily she rang me back 5mins later - pheeew

What she told me to do today was test blood every 2 hours, urine every 4 hours and inject Novorapid every 2 hours. She gave me a sliding scale on how many units to give her as she had a series of meetings today so would not be available at each test time but she did phone me a few times to see how she was getting on. I was also told to keep her carb free if i can until she comes back down to normal levels which she hasn't yet. Luckily she hasn't been sick.
She has had huge amounts of Novorapid today when yesterday she had hardly any and it seems to have taken a long time to have any effect.

Hi, When I am really ill and cant eat, I dont take any bolus insulin, just the basal. This prevents serious hypos and going into a coma and ending up on a trolley in A & E.
I think it all depends on the individual person and how their diabetes reacts during illness.
My advice is to test regularly and dose accordingly using the scale measurenent that the nurse has given you.
Best wishes. x

this is an interesting read to a relatively newly (13 months) diagnosed T1 and as always i find peoples' experiences invaluable.

one question though - how do you measure your ketones? i've not had anything from GP or diabetes clinic to do this, is it something i should be asking for? my last hba1c was 5.7 so happy i've got it under control but if i ought to be doing other tests as well i'd like to be doing them!

any advice gratefully received as always

Wig

You can get ketostix on precription (they are also available over the counter) and it's a case of dipping them in a sample of urine then comparing it to colour code on the side of the tub.

You can also if you've got the right meter get test strips to read ketone in the blood, I think it's the optium meter that reads ketones but the ketone strip is different to the BG strip..

jopar said:

You can also if you've got the right meter get test strips to read ketone in the blood, I think it's the optium meter that reads ketones but the ketone strip is different to the BG strip..

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It is the Optium Xceed meter and the Ketone strips come in boxes of 10. Be aware you may need to argue the point with some Dcotors as the strips are expensive.
I argued that I was actually throwing away a lot more Ketostix than I was using because they were going out of date after opening and only using a few.

I have only been through 1 box of these strips since they come individually wrapped and so you don't end up binning a load because they are out of date after opening.

My DAFNE educator / DSN also prefers the blood ketone tester since they are more accurate and they give you the figures as they are right now. With the urine test what you see is actually a minimum of 20 minutes old.

Thats the one..

My team don't express a preferance for any meters as such,

When I did DAFNE our discussion concering meters, the all opted for the one I was using the Ultrasmart as this has an elecrtronic log book, where you can enter your insulin dose and carb amounts etc in..

Most felt this was a bigger advantage than the ketone testing bit...

Me I just used to the ketostix way of doing things, its a tad irrating to chuck out a tube when you've only used one strip out of it, but saying that I very rarely in the position to have to use one, rarely ill etc.. Think I've had on repeat prescription for them in 2 years or so