# How do I cope with sickness and diabetes



## Shanghaiblue (Feb 10, 2015)

Hi everyone, I would be really grateful for your knowledge on two areas.  My daughter is type 1 since July so it's all new to us.

Currently, at her school there is a vomiting bug and kids generally feeling unwell.  I know these kids shouldn't be at school but unfortunately they still get sent in.  My daughter is fine at the moment but I feel my knowledge is just not good enough if she gets this bug.  What do I do firstly if she feels she is ill and doesn't want to eat? She is on an omnipod pump.  I know the basal rate is not suppose to send her low and if she doesn't eat she should be ok.  But back in the real world a 14 year old has a lot of changes going on and the BG level is not stable.  Currently, she is in lows and I am trying to adjust basal rate to combat this.  So I suppose the question is, if she is having lows and won't eat because she feels unwell what do I do? My gut says turn off the pump completely but could someone with experience help me on this.  The second question is; what do I do if she is feeling ok has eaten, pumped insulin and within a couple of hours starts vomiting?  Thats bound to be dangerous right?


My final question is about insulin storage.  When we were in the hospital they said once the insulin bottle is open it only needs to be stored at room temperature and not back in the fridge.  This has worked fine up until now.  But speaking to the school nurse today she was surprised I did this.  What is the general view on insulin storage.

Really really grateful for any help.


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## Copepod (Feb 10, 2015)

I'm surprised that your hospital clinic didn't give you any information when your daughter got her pump, but a quick search found this document, which seems to cover most of what you want to know: http://www.uclh.nhs.uk/PandV/PIL/Pa...ets/Sick day rules - insulin pump therapy.pdf

For definitive answer about insulin storage, check the patient information leaflet what comes with the bottle. That should confirm "out of fridge" times, so show that to school nurse.


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## Redkite (Feb 10, 2015)

Hi,

First the easy question - insulin in current use can be kept at room temperature, and spare insulin needs to be kept in fridge.

For vomiting bugs (and indeed any illness), NEVER withdraw insulin altogether.  You will most likely need to reduce basals and boluses, but this will depend on BG levels and blood ketone levels.  Have you got a blood ketone meter and strips?  (Urine ketone tests are useless because they only tell you whether ketones were high hours ago, not what they are at the current time).  Vomiting bugs are awful for people with diabetes, as you can end up with low BGs and high ketones (these are dangerous, as can result in life threatening DKA if allowed to rise too high - usually they are associated with high BGs due to a lack of insulin, but in vomiting bugs you can get starvation ketones - the body is breaking down fat to use as fuel - which are chemically identical and equally dangerous to people with type 1).  When you have ketones, you need extra insulin and fluids.  The problem is if you are already low/hypo you wouldn't normally want to take more insulin....so you would need to take frequent sips of sugary drinks that you can then give small amounts of insulin for the carbs (e.g. ribena, flat lucozade, sugary jelly).  If you can't manage at home (hypos+high ketones) you MUST go to hospital for IV glucose and insulin.

My clinic has produced a really useful series of charts to manage illness (scroll down):

https://www.uclh.nhs.uk/PandV/PIL/P...ets/Sick day rules - insulin pump therapy.pdf


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## Shanghaiblue (Feb 10, 2015)

Wow - great replies. I didn't even know there is such a thing as a blood ketone meter? We only have the urine ketone tests. Which up to now have been fine.  I will check out the link provided. Thanks also re insulin info.  I felt I was right but needed to check.  I am coming from totally clueless on diabetes to trying to gain as much knowledge asap.  I live in Germany but I am not with the forces.  Our german is not good enough for reading instructions so I have to get this info from other sources. Thanks again.


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## Shanghaiblue (Feb 10, 2015)

Hi Redkite, I just looked up the link you suggested and the info is excellent.  I have printed it out. Thanks for your help. There are some great tables to refer to for action. I just have one more question on this.  The measure for blood glucose in the UK is mmol/l where as here we are using mg/dl.  Any ideas where I would get a reliable conversion on this.  I am just going to google it but thought I would also ask here. thanks again


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## Copepod (Feb 10, 2015)

The PDF in post #2 is from the same clinic as Redkite's link. 

Any online conversion will work between blood glucose units, mmol/l to mg/dl. I'd also recommend printing out a small table of conversion of various units, then laminate it to carry in the blood glucose meter - that's what I did when travelling in South America and South Atlantic. I never needed it for myself, but it did assist communication between a Chilean man with T2D who broke his hip on a cruise ship off South Georgia and was transferred to a Royal Navy ship, whose medical officer didn't know much about diabetes.


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## Northerner (Feb 10, 2015)

Shanghaiblue said:


> Hi Redkite, I just looked up the link you suggested and the info is excellent.  I have printed it out. Thanks for your help. There are some great tables to refer to for action. I just have one more question on this.  The measure for blood glucose in the UK is mmol/l where as here we are using mg/dl.  Any ideas where I would get a reliable conversion on this.  I am just going to google it but thought I would also ask here. thanks again



You divide mg.dl by 18 to get the equivalent mmol/l, and vice versa. So, 72 mg/dl = 4.0 mmol/l  I always find this saves having to look it up.


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## Shanghaiblue (Feb 11, 2015)

Fantastic thanks again. I have done the conversion, in case I need the info in a hurry.


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