Author Topic: Very high glucose and illness  (Read 1221 times)

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Offline Filobabe

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Very high glucose and illness
« on: 07 January 2017, 07:54:10 PM »
I am struggling with extremely high readings at moment.
I have a chest infection and am on antibiotics and steroids (not a good thing for my diabetes control).
I've not been below 16 mmol fasting and last day been high on my meter most of the time.(reads up to 27.8mmol)
I am giving 10-20% bonuses regularly but now feeling very nauseous, stomach pains and very thirsty/constant toilet visits.
what else can I do?

Offline Pattidevans

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Re: Very high glucose and illness
« Reply #1 on: 07 January 2017, 09:25:59 PM »
Hi and welcome.


 You do not say but I presume you are T1?
Whatever type you are, if you are feeling nauseous with blood sugars in the high teens and 20s you do need to go to hospital very quickly.


Please do not delay and go to A&E As soon as you can.

Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Filobabe

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Re: Very high glucose and illness
« Reply #2 on: 07 January 2017, 09:35:29 PM »
Thanks.
Yes I am a type 1 diabetic.
I'm just not sure I  can face going to the emergency department as there are really long waits at the moment and I'd rather be at home resting.
Sure it's not DKA but wondered what else I can do?

Offline sedge

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Re: Very high glucose and illness
« Reply #3 on: 07 January 2017, 09:39:07 PM »
Test your blood or pee for ketones - high BG and nausea normally = ketones - and if your BG isn't coming down - before you know it you could be in DKA.  Drink plain water to try and flush some of them out.

I think I'd want to increase my basal as well as 'normal' sickday rules on using extra bolus insulin, which you appear to be following - but they are only intended to deal with transient glitches, not those which are going to last more than a couple of days.  I can't tell you how much to increase it -  I've never been on steroids so haven't a clue except to know that they do cause problems.   If your BG doesn't start to improve after 12 hours after increasing your basal and continuing to bolus extra every few hours - I can only suggest ring 111 for advice, as your normal hospital clinic obviously won't be open.

I'm just astonished because if I know this about steroids, then surely to God any qualified doctor must also know it - so in which case - why don't they issue instructions on where to start adjusting doses, when prescribing them?
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Filobabe

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Re: Very high glucose and illness
« Reply #4 on: 07 January 2017, 09:44:43 PM »
Most GP's have no idea how to sort out insulin. I rely on the diabetes specialist nurses instructions mostly. Of course being a weekend now they're all closed.
Also all hospitals have massive long waits at moment and I'd rather be at home than on a trolley for hours 😕😣.

Offline Pattidevans

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Re: Very high glucose and illness
« Reply #5 on: 07 January 2017, 11:08:50 PM »
I see your point about long waits, but please at least drink tons of water and ring 111.  Methinks you would have priority at A&E if DKA was suspected.

Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Pattidevans

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Re: Very high glucose and illness
« Reply #6 on: 08 January 2017, 01:49:50 PM »
I wonder what has happened to this lady?  I hope she is OK.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline Filobabe

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Re: Very high glucose and illness
« Reply #7 on: 08 January 2017, 02:15:36 PM »
I'm still at home. Still feel rough.
Haven't really eaten today as still nauseous and have back and abdo pain. Ketones are variable.
Blood glucose still over 20. Drinking lots.
Hoping feel better tomorrow.

Offline Pattidevans

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Re: Very high glucose and illness
« Reply #8 on: 08 January 2017, 03:32:08 PM »
glad to hear you are still there, but not to hear that you are still feeling rough.  Have you increased your basal at all?
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline nytquill17

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Re: Very high glucose and illness
« Reply #9 on: 08 January 2017, 03:42:39 PM »
I'm glad to hear from you!

As someone who has spent 9+ hours sitting in an ER waiting room in pain (serious but non life-threatening condition + major accident on the road that kept all the ER docs busy), I know that it's not a trivial thing to go in and have to wait, and I can understand why you want to avoid it and stay home. Unfortunately I think that you really do need to go. It sounds to me like you may already be in the beginning stages of DKA. Your ketones are variable, but you do have them at least sometimes, and that back and abdominal pain is worrying - it's a symptom, I had it when I was hospitalized for DKA years ago. It can mean that your kidneys are struggling.

The thing is, DKA can come on so fast. Especially when you're already weakened from a long and it sounds like nasty illness, and when you already feel so bad all the time anyway that you may not recognize the early signs. At first, it just feels like high BGs and the usual feeling awful that goes along with it - by the time it gets to a point where it feels distinctly different from regular high BGs, you may very quickly not be able to get help on your own, and you may not even realize that you're incapacitated. I was a kid at the time, and from the time my parents realized I was seriously ill and should go to the hospital, to the time it took us to get to the hospital (about an hour's drive as we lived in a remote area and didn't feel I needed an ambulance at the time we left), I became completely incoherent and incapacitated. I thought I had been conscious all the way to the hospital, but I don't remember half of the things my dad said I did or said in the car.

In any case, whether or not DKA is an issue, the fact is that you are an insulin-dependent diabetic who has a serious infection that has rendered you, for the moment, unable to control your blood sugar with insulin. That by itself means you need hospital care. Plus, your body is already unable to fight this infection on its own, hence the antibiotics and steroids. With such raging high BGs, it's even less capable of fighting off this infection, which in itself means BGs are likely to stay high (to say nothing of the effect of the steroids) so it becomes a vicious cycle that you may not be able to get out of on your own. Staying home and toughing it out is not likely to see you getting better any time soon.

Coming in as an insulin-dependent diabetic with uncontrollable high BGS and ketones should put you very high up the priority list as you have a potentially life-threatening condition at that point, so barring something like a major road accident that ties up A&E with people on death's door (god forbid), or gross incompetence (also god forbid) you should not have to wait very long once you go.
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
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Offline sedge

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Re: Very high glucose and illness
« Reply #10 on: 08 January 2017, 04:09:21 PM »
Thanks Nytquil !

Yes Filobabe - you need to do this, please.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Lucy

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Re: Very high glucose and illness
« Reply #11 on: 08 January 2017, 10:18:48 PM »
The one time i went to A+E and reported a bg of HI there was no waiting whatsoever, i was straight through to someone who checked it and also got HI then straight through to check pee and blood etc. What i'm saying is you'd probably be higher priority than some of the other things they see in A+E. Even if you aren't, whats a few hours sat in a+e - if you feel rubbish then you'd probably not be doing anything that productive with the time anyway, just sat around feeling rubbish elsewhere. Even if you are busy, your health is important.

With high bg, ketones, nausea, and feeling rubbish consistently for a couple of days despite extra insulin, and likely to stay high whilst you are on the steroids, you need some swift help from somewhere. Whether via A+E, or a regular dr / diabetes nurse you can see or speak to.
Type: Lucy. A1C 44 / 6.0% Jan17.
Lantus, Victoza and Apidra. Metformin XR, Bisoprolol (for SVT). Dexcom G4 with xdrip and nightscout.

Offline Pattidevans

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Re: Very high glucose and illness
« Reply #12 on: 08 January 2017, 10:48:44 PM »
Thanks others for chipping in... I totally agree, it needs someone to check properly and I do think you'll have priority in A&E.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline everydayupsanddowns

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Re: Very high glucose and illness
« Reply #13 on: 09 January 2017, 10:25:46 AM »
Agree that A&E seems essential.

In the meantime keep increasing insulin doses (the current ones are clearly not doing enough) with more basal and more bolus, drink lots and lots of fluids and test BG regularly. Have you tried fresh insulin pens (just in case te old ones have gone off or anything?)

But PLEASE do go to A&E - things like this can go wrong very quickly.
Mike

Type 1 since: 1991 Last HBA1c: 45 (6.3%)  Total Chol 5.0 (1.9HDL / 2.8LDL / Trigs 0.7)
Pumping NovoRapid in a MiniMed 640G
Blogging at: www.everydayupsanddowns.co.uk

Offline Filobabe

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Re: Very high glucose and illness
« Reply #14 on: 09 January 2017, 01:07:31 PM »
Errr nope.  Sat in ED and no priority here.
Bm 25