One in the eye for sick days – Sugar Surf through it!

One in the eye for sick days – Sugar Surf through it!
One in the eye for sick days – Sugar Surf through it!

As a T1, having a cold comes with a number of additional aspects that most non-diabetics don’t see. These are as a consequence of your body reacting to things slightly differently.

First up there is the early warning, where you have randomly elevated blood glucose levels that don’t have any apparent cause. The only way to deal with them is take extra insulin, but at hopefully you know something is coming. Or it could be that you put it down to that curry you ate last night being slowly released due to the fat content. either way it requires more insulin, and if you are aware enough, you can start the sick day protocol…

Then there’s the sick days themselves.  Sick day protocol is described in numerous places on the web. Here are a few of them:

All of these tend towards the same point, which is that when you are ill, you will need to take more insulin.
My favourite flowchart is this extremely comprehensive one  from Leicestershire NHS:
Now for me, when I have a heavy cold and inflated tonsils, like I’ve spent the last week with, the uplift numbers tend to make no difference so I have found (through trial and error, like most things) that I need to increase my amounts by around 50%. What I’ve also found to be beneficial is that when I know I am properly running on sick day levels, is that I need to up my basal level of insulin by between 25% and 40%.
I’m not sure how the NHS would view this as it is somewhat contra to what’s shown above. 
The other side that the NHS would argue is that by increasing my basal, it makes it much harder to identify when you no longer need it and avoid hypos as your body’s requirements come back down into normal realms. 
I agree that if you follow the standard testing approach that is normal NHS guidance then managing this would be much harder. This is where Dynamic Diabetes Management comes in to play. 
If I am statically managing my diabetes with set blood test patterns and rigid bolusing models, it’s extremely difficult to manage the sick day model. You are working on a best guess theory with limited information and low information inputs. The model works but it’s difficult to manage.
When I follow a dynamic management model, I keep an eye on what’s going on at a much more granular level. The CGM or FGM that I use means that I am able to observe much more carefully what my sugars are doing, and I can more aggressively manage my BG level down. I have earlier warning of when I am heading slightly low and I can adjust in both directions. The increased basal as I get better is therefore not really an issue.
The key issue for sick days is un-noticed DKA, and no-one wants that, but if you and any carer if you are unable to care for yourself, are observing your BG levels much more carefully, e.g. Nightscout and CGM in the Web, there should be a much more limited risk of high ketones and DKA. This is, after all, a side effect of not taking enough insulin, and dynamic management makes sure you have enough. 
So yes, sick days suck, and you feel rubbish, but the tools of dynamic diabetes management and Sugar Surfing mean that they no longer need to be the royal pain of days gone by!

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