Taking care of someone with diabetes when they’re sick is tough; taking care of yourself when you’re sick and have diabetes is tougher (and not to mention super freaking scary). For those of us living with type 1 diabetes something as small as a stomach virus can quickly become serious if you make the wrong move. Knowing what to do and when to do it is more complicated than you might think. Why is that? Because everyone’s body reacts to a cold or virus differently (heck my own body acts differently every time!) so you need to be prepared for the unpredictability that is stomach virus blood sugar…and since you’re already a T1D you should be a pro at unpredictability.
How Illness Affects Blood Sugar
The body perceives illness as stress, and when your body is stressed it releases hormones such as cortisol and epinephrine (adrenaline), which raises your blood sugar levels. However, sometimes the illness can lower your blood sugar because you aren’t eating (and have background insulin running) or can’t keep food down (and have just bolused for a meal).
So My Blood Sugar Goes A Little Crazy For A Day Or Two, Big Flippin’ Deal
Most of the time it really is no big deal, however, being stuck up shits creek (literally) and not having a plan in place is a big flippin’ deal. There are two ways an illness can go really wrong really fast when you’re a type 1 diabetic
- DKA – Diabetic Ketoacidosis (which is much different than nutritional ketosis – but that’s a post for another time) is when there is a toxic amount of ketones in your blood. So much so that your blood becomes acidic to the point of being fatal. The acidity becomes even more potent when you’re dehydrated, which will happen if you are losing it from both ends and can’t keep anything down (or in).
- Low Blood Sugar – If you’ve just bolused for a grilled cheese sandwich & chicken noodle soup (which seems to be the gold standard for sick day food) and your body decides it wants none of it…well you’re in quite the pickle, because in 1.5 hours you’ll most likely be on the floor, passed out. Which is no bueno for you or your family (especially if you’re home alone).
That’s Why You Need A Sick Day Toolkit
This is how you survive. You know the saying, it’s always better to have a T1D sick day toolkit and not need it, than to need it and not have it. Okay, so maybe that’s not a real saying, but it’s still true! The last thing you want to do when you’re battling the stomach virus and about to die (literally) is to be googling what to do. Which is precisely why you need a Sick Day Toolkit. There are three major parts of the sick day toolkit
- #1 Preventing DKA. When the body is sick it will produce ketones, whether your a diabetic or not. But here is where T1D’s jump off the train…In response to ketones in the blood, the body will produce insulin to remove it, then, if needed, the body will counteract that insulin by producing glucose to keep blood sugar stable without you having to lift so much as a finger (or a muffin). As diabetics, we are in charge of doing this manually. And how scary is it to give insulin when your sugar is already low and you can’t keep anything down. Yet the only way to get the ketones out of your blood and prevent DKA is to inject insulin. Do you see the dilemma? So what’s a diabetic to do?
- Stay hydrated. If you’re having a hard time keeping liquids down try these tips:
- Take small sips of water, constantly through out the day
- Suck on ice cubes, constantly
- Eat Popsicles (sugar free or full sugar – depending on your BG needs)
- Activated charcoal works wonders on stopping vomiting and diarrhea
- Keep your electrolytes up. Another important thing to remember with DKA is that you not only need to stay hydrated, but you need to keep your electrolytes up. Gatorade and Powerade will work in a pinch, but there are much better ways to get electrolytes:
- Check your ketone levels every 2-3 hours. Even if your meter or CGM is reading stable numbers. You can still go into DKA despite having normal BG numbers.
- Try to keep your basal insulin in the game. Your body needs insulin to carry ketones out of the blood, however, if you need to suspend your insulin because of a major low then take care of that first.
- #2 Bring a loved one into the Loop. Ask a family member or friend to check in on you every 1-2 hours. A simple phone call or text will suffice if a drop-in is too much. Feeling weird about it? Don’t. That’s what friends do. I dedicate an entire page on my phone to emergency contacts. Some live close by, others live a distance away, but I would feel comfortable having them on the phone with me in an emergency situation. God-forbid I dropped off mid conversation and needed them to call 911 for me.
- #3 Keep Blood Sugars Stable While Fighting The Stomach Virus
- Battling Lows: If eating isn’t working, and you can’t keep anything down try rubbing honey or maple syrup on the inside of your cheeks (or under your tongue). You may need to suspend your insulin (basal included) if the drops are too severe. You can also try small sips of juice (or my favorite… maple syrup), constantly throughout the day. Or allowing a glucose tablet to dissolve in your mouth. I have also heard of people using suppositories to stabilize a low blood sugar and giving mini-does of glucagon, but I have not tried either of these methods so I can’t speak to them. I would definitely ask your doctor before trying either of those methods.
- Battling Highs: If your blood sugar is stubborn and not responding to insulin, you may need to increase your basal. If that still doesn’t do the trick my favorite thing is to jump into a hot shower or tub after giving myself insulin to open up my blood vessels and allow for better insulin absorption. Remember, if you have high blood sugar you probably have ketones, so stay hydrated to keep ketones at bay.
The Tipping Point
Most cases can be handled at home, but when should you seek medical help? Personally, as long as someone is physically with me, I always push it because going to the ER scares the crap out of me. I have found that although ER doctors try their best, they don’t always know that much about type 1 diabetes.
But you do have to ask yourself, How much longer am I able to handle this on my own? And at what point am I putting myself in danger? If you feel like you can’t control the situation then definitely get help. My reasons for getting medical help are:
- A fever for 2-3 days
- Vomiting or diarrhea for over six hours
- Blood glucose levels above 250mg for more than 24hrs (despite giving insulin)
- Moderate or large ketones
- If I have symptoms of DKA
- If I feel like I can’t take care of myself
There’s no shame in asking for help. You haven’t failed at anything. Stomach viruses and diabetes are just a case of shit happens. So go make your sick day toolkit right now! Seriously! You’ll be glad you did.
Download PDF of Sick Day Took Kit
And for the legal mubo jumbo: I am not a medical doctor and can’t warrant medical advice. I am simply sharing advice on what has worked for me. Always consult with your doctor before taking any kind of action.