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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

  1. 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).
  2. 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. 

sick day tool kit

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. 




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Leave A Comment

  1. Jody McClaine February 3, 2017 at 1:21 pm - Reply

    Thank you thank you, this saved us last weekend <3

    • T1D Living February 3, 2017 at 2:10 pm - Reply

      🙂 glad this could help! I use it everytime I get sick – it’s my rock!

    • Dan Morgan April 16, 2021 at 4:06 pm - Reply

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  2. Lisa Dave July 19, 2017 at 4:31 am - Reply

    Hello everyone i am Lisa Dave, i live in USA here in this forum i am so glad that i have this great opportunity to come out here and share my testimony on how Doctor EREDIAWA OKOH, was able to cure me totally from Diabetes, i have been suffering from this Disease for approximately Six Years now, i have tried various ways to get rid of this Virus out of my body, i have also purchase for Medical treatment from my doctor but they all failed, sometime back now while i was browsing the Internet i found some good quote concerning Doctor EREDIAWA OKOH Herbal Medicine, and how he has been using it to save souls from Different Disease including Herpes, Cancer, someone also said she was been cured Hepatitis of true his Roots and Herbs, they gave out his contact details in case anyone needs his help, i decided to contact Doctor EREDIAWA OKOH and i told him about my Diabetic illness he told me not to worry that he was going to send me his herbal medicine all he need is my personal details and i did all that was required by Him, i took the medicine just as prescribe by him, an i took the ROOTS AN HERBS for two months after which he told me to go for check up in the hospital which i did and to my great surprise my Doctor told me the Virus is gone) was no longer there, i even went to other hospital for better confirmation its was still the same thing, Today i am so happy that i am Negative again, Doctor EREDIAWA OKOH, has given me reasons to share tears of Joy, you can reach Doctor EREDIAWA OKOH on his email address:drerediawaherbs@gmail.com or his WhatsApp Number: +2348159412586.

  3. Nicki February 24, 2018 at 12:59 am - Reply

    This was awesome to read. Thanks for the honestly, especially about the ER part, I thought nobody on earth understood that. This really helped me. – Girl with the damn flu

    • T1D Living March 1, 2018 at 3:29 pm - Reply

      Thank you! I hope you recover fast! <3

  4. DKA in Portland March 22, 2018 at 5:48 pm - Reply

    I just got out of the ER and ICU yesterday. This is no joke! I have been t1d for 20 years and zero Dka on my record. I had a stomach virus and vomiting pursued for 24 hours every 30 minutes. So at some point I went from puking from flu to DKA with no warning. I remember checking my blood sugar during all of this and it was at one point 500 – I took enough insulin to bring it down to 100 and 2 hours later after I called an ambulance it was still 480. I was so dehydrated that the body could not absorb the insulin. Very scary. I am going to buy ketone test kit tomorrow and if I am ever sick with a stomach bug again that will tell me when it is time to get help. I will also ( as the Dr told me) not let myself go 6 or more hours of throwing up. Get help fast!

    • T1D Living April 3, 2018 at 10:58 am - Reply

      It’s scary how fast it can happen. I’m glad you’re ok and doing better <3

  5. Melissa April 6, 2018 at 12:31 pm - Reply

    I am an endocrinology NP, trying to find resources for my patients. I like your blog. It is very helpful but I am wondering about the activated charcoal. I do not see any research from any reputable sites including uptodate that support activated charcoal for diabetes care with illness. It appears that you are claiming it helps to be able to keep foods or medicines down? Can you support this? My experience with activated charcoal is ER only with drug overdoses. It can cause vomiting and causes diarrhea. It prevents the absorption of anything in the stomach. I have resourced other endocrinology providers I work with and they did not have any experience with activated charcoal or these claims and could not verify how it would be useful. Help me understand this claim. Thank you so much!!

    • T1D Living April 9, 2018 at 4:41 pm - Reply

      My experience with activated charcoal has been great in stopping vomiting. It’s a favorite family remedy of our ours 🙂 and heavily used in the homeopathic realm to stop both vomiting and diarrhea. I can’t speak to how they use it in the ER, but if you’re looking for more info on it, I would look down the homeopathic route. I hope this helps!

  6. Dan Dascalescu September 4, 2018 at 8:33 pm - Reply

    Thanks for the article! Can you please remove the embarrassing spam from Lisa Dave? And no need to publish this comment 🙂

  7. David November 18, 2018 at 10:44 pm - Reply

    This might be off topic, though trying to find out if others have had similar experiences. We are two years in with my seven year old daughter’s TD1. She’s had gastroenteritis twice. First time took two ER visits (boluses after meal, got sock 10 minutes after). Just finished second round and fought through with Glucagon (though sat in hospital parking lot at 3:30AM waiting to see if she could keep down some carbs before going through IV and all that).. Both times we were battling BG lows. Both times now her pancreas seems to come back online after the flu/vomiting. Any insulin at all and she is super low, eats whatever without any insulin stays under 100. Any one else experience this? She is out of honeymoon, so not sure why she stops being T1D for a few days after being sick. Also, no ketones.

    • Rich January 2, 2019 at 7:04 am - Reply

      David, I am 4 years diagnosed T1D and had a very minor stomach bug a week ago – and I am experiecing the exact same phenomenon of essentially “no longer being T1D” at the moment, presumably because of my stomach bug. I can literally eat anything and not need any bolus shots and my long acting insulin is reduced by half.

      How long was it until your daughter was back to her “normal” insulin requirements?

      • Allie December 30, 2019 at 11:59 pm - Reply

        I wish others had responded to how long this whole change in blood sugar lasts. My son is on the opposite end of the endocrine spectrum. He has Hyperinsulinism, which is not an autoimmune disease, but his pancreas produces too much insulin, so he is on meds that inhibit insulin production. He was sick last week and had high blood sugars for someone with HI (fasted and was in the 120s). The following day, Christmas Day of all days, he woke up with a blood sugar in the 40s. We have been struggling to keep him up for 4.5 days now.

        Nothing he eats raises his sugars above the upper 60s and low 70s. We’re used to him being 100% stable on the same dose of medicine he’s been on for 7 months. He was needing less and less medicine over the year and I was feeling optimistic. Now we’ve had to increase his meds and his sugars are still not acting normal. We’re used to food raising his sugars significantly to where we only check him first thing in the morning. This whole ordeal has made me very anxious and terrified. Especially since he’s only 22 months and can’t communicate what’s wrong and doesn’t understand that he has to eat.

        I believe he had some sort of gastrointestinal issue last Monday. He cried for 3 hours and we took him to the ER. They couldn’t figure out what was wrong but he had loose stools when we got back and 6 other times. I’m not sure if I can confirm it was from that because we took him to the doctor on Thursday and, because he hadn’t had a bowel movement since Monday, she told us to give him Miralax stool softener. He barely had any, so it’s hard to say if that’s what caused it.

        Either way, he’s had hardly any appetite, is rejecting almost all of his favorite foods, eats more if we give him Tylenol, and just isn’t fully himself. Other parents of children who have Hyperinsulinism say stomach bugs can take a heavy toll on their kids, causing high blood sugars during the battle with the virus, followed by a drastic crash in sugars. Many have to go to the hospital until they can tolerate feeds and their guys can properly absorb the medicine and food. It can take as long as 2 weeks for some kids. I’m starting to worry my son’s sugars aren’t going to recover and something permanently changed. Everyone I’ve spoken with says their kids go back to normal after the crash but that it can take time. It still has me very nervous while I wait.

        Long story short… If anyone has any personal experience with gastrointestinal illnesses and how long it takes for blood sugars to return to normal, please, please share.

        • T1D Living January 3, 2020 at 2:17 pm - Reply

          Not sure if this helps, but when I have any kind of cold/virus it takes me about 2-3 days, after my illness is gone, for my blood sugars to recover.

      • Meredith December 23, 2021 at 3:23 pm - Reply

        Curious to know what happened

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