Insulin needs changed after the stomach flu...anyone else?

belyro · #1 (**permalink**) 11-30-2008, 01:34 PM

Hi guys. It's been a while since I posted, but I'm experiencing something very strange lately and wondering if there's anyone else out there who has experienced the same thing or might have an idea as to what is wrong with me.

Early last week I came down with a TERRIBLE stomach flu. I puked a number of times, but the biggest problem was 48 hours of TERRIBLE runs. (Gross, sorry.) I even had to go to the ER to get rehydrated at one point. By Thursday morning I was feeling a fair bit better, but ever since I got sick, my insulin requirements have been SO MUCH lower than usual. My basal needs dropped a bit, but it's my bolus needs that really changed. A 30g carb breakfast used to require 4u of basal, but earlier last week I took 2u for it and dropped to 2.7 (49)! I stayed at 2.7 (49) for about 45 min. despite eating glucose tabs, gatorade, and gingerale. Finally after about 90g carb I went up to about 6.5 (117). I didn't even skyrocket after that. I'm very slowly seeing my insulin needs go up since then, but I'm still operating at about 1/2 the I:C ratios I was at prior to being sick - or less. Last night for dinner I had about 55g of carbs and needed only 2u of bolus. Normally 55g carbs for dinner would run me at about 8-9u bolus. I'm feeling a lot better, and I can handle eating my regular foods (just in smaller quantities), but my diabetes is totally screwed up now.

The other factor in all of this is that I'm 3 months pregnant. My understanding has always been that, typically, insulin needs drop drastically in the 1st trimester and then increase in the 2nd and 3rd. For me, I actually had slightly increased insulin needs in the 1st. I suppose this drop now could be related to starting the 2nd trimester, but it just seems too strange that it happened exactly when I got sick. (And trust me, this wasn't morning sickness - this was something else.)

Does anyone have any suggestions as to what could be causing this? It's pretty scary. I had a pretty good handle on my bloodsugars prior to this and now I feel like I'm dealing with a whole bunch of unknowns. I feel like I'm managing someone else's diabetes - not mine. I'm also worried that it might be an indication that something ELSE could still be wrong - and that it could be something potentially problematic for the baby. I emailed my endo, but I guess she doesn't check her emails over the weekend. Hopefully she'll get back to me tomorrow. If not, I'll probably call her. In the meantime, I'm hoping someone out there has some ideas......

Thanks.

duck · #2 (**permalink**) 11-30-2008, 02:06 PM

Beth,

When did you stop being "sick"? The point being, you might feel better, but your body is still recovering, rebuilding, replenishing, etc. If you are losing fluids, your electrolyte balance will be completely out of whack, and contrary to common belief, re-establishing that balance takes a little while: you can't just drink a bunch of Gatorade and be okay.

From your symptoms, I would guess you are still "rebuilding", hence your sugars running low. For example, your body needs the energy, sort of like you are working out strenuously.

Give it another week; try and take it easy in the meantime, and keep monitoring your blood sugars. Increase your protein intake if you can.

And no, I did not address anything about your Bundle of Joy and how that can be affecting things...that is above my Pay Rate.

belyro · #3 (**permalink**) 11-30-2008, 02:11 PM

Quote:

Originally Posted by duck

Beth,

When did you stop being "sick"? The point being, you might feel better, but your body is still recovering, rebuilding, replenishing, etc. If you are losing fluids, your electrolyte balance will be completely out of whack, and contrary to common belief, re-establishing that balance takes a little while: you can't just drink a bunch of Gatorade and be okay.

From your symptoms, I would guess you are still "rebuilding", hence your sugars running low. For example, your body needs the energy, sort of like you are working out strenuously.

Give it another week; try and take it easy in the meantime, and keep monitoring your blood sugars. Increase your protein intake if you can.

And no, I did not address anything about your Bundle of Joy and how that can be affecting things...that is above my Pay Rate.

Thanks Duck

I stopped "being sick" on Thursday, but I'm definitely still in the "rebuilding" phase. I am still very tired and can tell that my body is definitely not back to normal, even though the virus itself has been gone for a while. I'm guessing it will take longer and be more strenuous for my body because of the "Little Bundle" too.

Increased protein, eh? I've been focusing on carbs to keep my bloodsugars high enough, but I guess if I'm rebuilding, protein makes sense too.....

Thanks again!

mazea · #4 (**permalink**) 11-30-2008, 02:34 PM

It sounds like it could be 3 things, getting over your illness,blood sugars changing in a honeymoon(if you still have good natural insulin sometimes it changes from time to time) or your pregnancy is changing your insulin requirements. I think which ever one, you probably need to contact your endo ASAP. Doesn't she have an emergency number because being pregnant it is vital you have an emergency number I think.

I can't really give medical advice just an opinion, which would be to contact a hospital endocrinologist( they can usually be contacted in emergencies) if you can't get in contact with your endo.

I recently had a massive overnight change in my blood sugar levels (Levemir went from 3 to 10 in one night). My endo suggested to change my basal and bolus and she gave me some numbers to take. I think running the risk of falling unconsious due to a hypo is not something that would be good for pregnancy and if it were me, I would be monitoring like aggressively, measuring before and 2 after meals and many more times, and lowering my basal insulin doses quite aggressively.

belyro · #5 (**permalink**) 11-30-2008, 02:38 PM

Quote:

Originally Posted by mazea

It sounds like it could be 3 things, getting over your illness,blood sugars changing in a honeymoon(if you still have good natural insulin sometimes it changes from time to time) or your pregnancy is changing your insulin requirements. I think which ever one, you probably need to contact your endo ASAP. Doesn't she have an emergency number because being pregnant it is vital you have an emergency number I think.

I can't really give medical advice just an opinion, which would be to contact a hospital endocrinologist( they can usually be contacted in emergencies) if you can't get in contact with your endo.

I recently had a massive overnight change in my blood sugar levels (Levemir went from 3 to 10 in one night). My endo suggested to change my basal and bolus and she gave me some numbers to take. I think running the risk of falling unconsious due to a hypo is not something that would be good for pregnancy and if it were me, I would be monitoring like aggressively, measuring before and 2 after meals and many more times, and lowering my basal insulin doses quite aggressively.

I'm definitely not honeymooning...I'm going on 27 years with diabetes now.

I'm monitoring often enough that I'm not worried about sudden hypos, plus I'm on a CGMS, so I should be fine to wait until tomorrow to talk to the endo, but I do definitely want to talk to her then.

Thanks for the input!

mazea · #6 (**permalink**) 11-30-2008, 02:50 PM

I hope you get some answers soon. Being pregnant and having your numbers jumping all all the place is a normal thing. It sounds like your monitoring a lot which is good and will help you keep the levels stable. Are you eating small amounts of food to keep your blood sugar levels up or is it staying up on it's own. How are you managing sleep time?

belyro · #7 (**permalink**) 11-30-2008, 02:57 PM

Quote:

Originally Posted by mazea

I hope you get some answers soon. Being pregnant and having your numbers jumping all all the place is a normal thing. It sounds like your monitoring a lot which is good and will help you keep the levels stable. Are you eating small amounts of food to keep your blood sugar levels up or is it staying up on it's own. How are you managing sleep time?

I'm eating small amounts often, but I've also backed off significantly on my insulin. I've dropped my overnight basals, but I also check during the night a lot. I tend to wake up often (since being pregnant), but I also have been setting an alarm to test part way through the night for the last few days. I'm not letting it run even close to dangerously low.

fgummett · #8 (**permalink**) 11-30-2008, 02:59 PM

Hey Bethany,
I agree with Duck that you need to give this more time to settle down - especially with being pregnant (congrats by the way!) and especially with having diabetes

In our modern society we seem to try and shrug off illness - maybe with the advent of antibiotics we have less respect for how much toll it can take on our bodies

In the meantime keep testing and adjusting insulin as you are, take good care of yourself - plenty of chicken soup and rest! - and milk it for all it is worth with anyone around who will pamper you

belyro · #9 (**permalink**) 11-30-2008, 03:04 PM

Quote:

Originally Posted by fgummett

Hey Bethany,
I agree with Duck that you need to give this more time to settle down - especially with being pregnant (congrats by the way!) and especially with having diabetes

In our modern society we seem to try and shrug off illness - maybe with the advent of antibiotics we have less respect for how much toll it can take on our bodies

In the meantime keep testing and adjusting insulin as you are, take good care of yourself - plenty of chicken soup and rest! - and milk it for all it is worth with anyone around who will pamper you

Thanks Frank. My husband is already being absolutely WONDERFUL about everything, so I'm going to do my best not to take advantage.

I'm sure you and Duck are right - I"m just being impatient. :P

mazea · #10 (**permalink**) 11-30-2008, 03:14 PM

Quote:

I'm eating small amounts often, but I've also backed off significantly on my insulin. I've dropped my overnight basals, but I also check during the night a lot. I tend to wake up often (since being pregnant), but I also have been setting an alarm to test part way through the night for the last few days. I'm not letting it run even close to dangerously low.

It think you are doing all the right things. Having a supportive husband can help at times like this. Congratulations on your pregnancy. Let us know what the endo says.

xMenace · #11 (**permalink**) 11-30-2008, 03:52 PM

Of course you know "mileage varies." I'm sure there's variability in behavior during pregnancy. Like anything else we face, the meter is the judge and jury!

belyro · #12 (**permalink**) 12-01-2008, 08:21 AM

I heard back from my endo first thing this morning. She says that what I'm experiencing is most likely a combination of the effects of pregnancy on my bloodsugars and an impaired and/or delayed stomach emptying because of the bug I had. She doesn't seem worried, but said to let her know if it persists. I'm already seeing some significant improvement, so it looks like it should be OK. Whew.

mortis505 · #13 (**permalink**) 12-01-2008, 09:26 AM

My $0.02. Your pregnancy combined with the Flu is making your body work double if not triple time, hence the lower doses required. Relax and enjoy. Rest while you can because the bundle of joy is going to need all your attention in about 6-8 months. My advice, get some comfy shoes for when he/she learns to walk. You are going to be chasing the little one alot.