Adjusting Insulin When you are sick?

[TommyC1]

First time I've had to deal with this sort of thing. I'm hoping some of you may have some insight for me.

I'm on MDI Lantus and Novalog.
Friday AM I started feeling an itchy rash on the back of my neck. By Friday evening it was going pretty good. Two hours after dinner my BS was 315 mgdl (17.5 mmol) for no reason that I could fathom except for the rash?
It took until noon yesterday eating nothing and a lot more novalog than I normally take to get it down below 120 (6.7).

Eating very little and doubling my novalog held me around 135 (7.5) until bedtime when I took my usual dose of Lantus.
This AM I was back up to 200 (11) and I'm fighting to get it down again.

I'm wondering if I should try increasing my Lantus until this is over. So far it seems to be fairly steady in increasing my insulin needs. I am concerned that it may stop with the extra lantus still running and send me hypo.

A co worker had a case of shingles last week so I went to a GP yesterday just in case. No fever. No symptoms other that this itchy rash on my neck. She pretty sure it's not shingles or chicken pox but had no other suggestions.
I made it clear I was not asking for her advise on the insulin. She seemed relieved.
If it keeps up I'll call my Endo tomorrow but some real life experience would be good to hear.

Thanks,
Tommy

[owlyn]

It is best to make corrections with the fast-acting insulin rather than the long-acting, so yes, make corrections with the Novolog. Regarding sickness days- with em it varies. Sometimes being sick raises my BG, other time it has no effect at all. I believe I have it narrowed down as to whether there is a bacterial infection or not. When there is, my BG runs high.

[Subby]

I've found there is a definite risk of that happening with long acting, Tommy. I find that short term resistance from getting sick can clear up quickly and catch me unawares. So do be careful and don't put it up too much, and have extra hypo fixes around, if you do take that route. Hope you're feeling better.

[Scratch]

It's best to use the fast-acting to counter elevated blood sugars while ill. When I had gastro last December, it was a pain but I kept my Lantus the same and just worked with using blood sugar results and Novolog to try to keep my blood sugar somewhere between 120 and 160. On one day of it, it took me about 35 units of Novolog to keep my blood sugar in that area and I didn't eat anything until a small amount of soup for dinner. I would have had to increase my Lantus by 2.33x to provide that coverage.

So even if I had increase a smaller amount, I still would have been needing to inject Novolog for corrections, I would have been in essentially the same situation but with a potential difficulty of having my body going back to normal and then the chance of having an extended period of too much Lantus in my system.

Test and use the Novolog.

[Mich]

Hey Tommy,

That makes four of us. Keep your basal the same and test every few hours (depending on how you/re running, you may want to test every two hours) and correct with your fast-acting insulin.

You never know when it will turn into an upset stomach and you can't keep food down and you'd have to worry about 24 hours of being overloaded with insulin, rather than three. Also, sometimes you get well quicker than you thought and don't need the increase for as long as you planned.

Mich

[TommyC1]

Thanks All.
Guess I'll be leaving the basal alone and correcting as needed.
Don't know if I'll make that 1 AM correction though?

Tommy

[Lizzie G]

Hi Tommy

Sorry to hear you are feeling so bad. To be honest I do tend to put my basal up a little (around 10%) when Im unwell as well as more corrections....as others have said things can bump down to normal pretty quickly but I do think being aggressive with the insulin at times like this pays as it also helps you fight off infection more quickly, but thats just my opinion, everyone is comfortable with something slightly different; I hope you feel better soon

Liz

[TommyC1]

Lizzie,
Are you pumping or on MDI?

I managed to hit 250 (14) last night at bedtime Grr!, took my standard Lantus and a little more than my standard correction bolus and still was at 225 (12.5) when I checked at 3 AM.
Double Grr!
So I took twice my standard correction and was a nice 105 (6)at 5 AM when I got up.
Running a little high so far today 130-140. (7.2 - 7.8)
If I had to deal with this much I'd be chasing a pump for sure.

Tommy