Sick days

[Hydie]

Hi all, I am looking for advice as my diabetes specialists advice is not working.

I am type 1, been so for 8 years and never been particularly ill, when I have, I have muddled through with minimal impact on my diabetes.

Long story short, following a course of steroids which saw an increase in basal levels by around 350% (I never did get to grips with it so can't be sure) I am in hospital with neutropenia which is a severe lack of white blood cells, ie no immune system. And my diabetes is totally and completely off the charts. And they don't have any doctors/nurses/consultants on duty with specialist knowledge of diabetes until Tuesday.

I normally take 18 units of Lantus but took 26 last night and sugars were in single figures all night. Hurrah. Then I had breakfast and took 10 units of novorapid where I would normally take 7.5. An hour later I could feel I was high so measured. 15mmol. I whacked in another 5 units and waited another hour... 16mmol! ***?!! Another 5 units and another hour and I am down to 10mmol. I suspect I will need a snack before all that I rapid insulin is out my system but what should I do next mealtime? Has anyone experienced such crazy increases? Is this what is known as brittle diabetes?

And how quickly will my basal requirements get back to normal? I am panicking that there is so much insulin in my system, particularly long acting. I have not slept properly now for 10 days, am I going to be too tired to wake if I go hypo overnight??

I could have another 6 months of this. Loads of people have recommended an insulin pump and I have come across continuous glucose monitoring which looks like a fine tool. But my diabetes nurse says it would take me at least 3 months to get to grips with a pump and thinks that I am better off with what I have got. I am an analyst by profession so I am reasonably confident that she underestimates me, and as I am on sick leave for 6 months it is hardly like I have a busy life that is going to get in the way. Am I being overly optimistic of my cerebral capacity?

Your thought and advice would be greatly appreciated

 

[Danaemac]

The increases unfortunately I cannot help with however with regards a pump there are things that you are expected to do/ be competent in before they will give you a pump you would be expected to. Be proficient in carb counting attend DAFNE or equivalent learn sick day rules among other things and this would take 3 months to complete before you would even get a pump authorised then it would be getting Basals/ bolus ratios all correct and this can take time, if you are ill and then get better and reduce your levels this would then need adjusted again I am in the process of having things tweaked on my pump and have to attend the DSN appointment once per week dietician appt and consultant appt every 3 months for the first year it is a lot of work and when you are feeling as poorly as you are your DSN may be right wait until you feel better and discuss it again then I would not be without my pump now and the work will be worth it but focus on getting yourself better first would be my advice

Hope things work out

Danae

 

[noblehead]

Testing one hour after injecting 5 units wouldn't tell you much as the insulin doesn't peak until around 90 - 120 mins after injecting, insulins like Novorapid can be active up to 4 - 5 hours after injecting.

Stacking insulin doses does lead to hypo's so I would be careful on the dose that you give yourself for lunch, perhaps do a reduced dose just to be sure. As for the pump, I do think that's a great idea considering your health issues, not sure how long it takes to get to grips with a pump but would imagine it takes a while, why don't you ask to see your diabetes consultant and ask them if a insulin pump is the best option for you.

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