Guest post by Eva Kapp.
My carefully laid training plans were recently axed by a “stinking cold” that seemed to go round amongst colleagues and friends.
What started off with body aches on a Friday, feeling cold and having headaches on a Saturday, had turned into a proper cold by Sunday with all the common symptoms: Runny nose, cough, congestion, headaches, sneezing and feeling generally quite lousy. And with that started a new challenge altogether: Managing my diabetes!
From incubation to outbreak – Blood sugar observations
As the weekend progressed, my sugar levels became gradually harder to manage until, eventually, with the outbreak of the cold, they were staying up at around 200-220mg/dl (11-12mmol/l).
Any slow-release carbohydrates I would eat and cover with short-acting insulin (bolus) would send levels even higher within 30-60 minutes of injecting. My body had become highly insulin resistant and my diabetes an uncontrollable beast!
Real life example: Day 2 of the cold and blood sugar levels
My target range is shown in gray; levels between 85-140mg/dl (4.7-7.5mmol/l). I generally have good control with HbA1c results of ca 6.2%. When illness strikes however, chaos rules: Below graph shows how elevated glucose levels were despite:
- A temporary basal rate at 140-150% from waking up throughout the day until early evening
- an additional circa 15 -20 units of correction with short-acting insulin over the course of the day
- Little carbohydrate intake
Notice the spike from 160mg/dl (8.9mmol/l) to 271mg/dl (15mmol/l) around 19:00 (7 pm)? This came after eating 12 grams of COH in form of Pumpernickel bread – and carbohydrates were measured correctly. This required significant correction with short-acting insulin (no ketones present). Illness, food and Type 1 don’t go well together.
The body’s response to illness
Having a bad cold or illness in general and having to manage blood sugar levels is no fun. Type 1 diabetes becomes sheer unmanageable because of the body’s response to fighting the cold (or any sickness).
Whilst the body is battling out the illness, it releases a huge amount of stress hormones, e.g. adrenaline, cortisol, which cause the liver to release more glucose into the bloodstream (by a process called glycogenolysis) resulting in rising blood glucose levels.
High blood glucose leads to greater insulin resistance, and in turn to higher blood sugar levels. That’s why glucose levels are usually significantly higher during illness and the normal amount of insulin injected is in most cases not enough.
In addition, I didn’t feel like leaving the bed, let alone do any form of exercise. Bearing in mind, that even if I didn’t train, I would at least walk/ cycle to work, my insulin demand is inevitably greater too when I am not doing very much.
Over the days of the cold having made its appearance and my body fighting it, my insulin demand had risen from my normal 30-35 units (of which 14 units is basal insulin and ca 15-20 is bolus) to a whopping 40-50 units!
Taming the blood sugar beast
- Increasing the temporary basal rate: At first, I was quite conservative and increased the rate by only 30% during the day and going into the night. On day 2 with still significantly raised BS levels, I increased it by 50% in the morning going into the afternoon.
- Testing blood sugar often: I was wearing my Freestyle Libre which measures glucose continuously and helped heaps to see where levels were and if they were heading up or down without the need of finger pricking every two hours. I even checked levels a couple of times throughout the night when my blood sugar was high when I went to bed.
- Food and liquid intake: I wasn’t particularly hungry during the first few days and it seemed that no matter how slow-release the carbohydrates I ate were, blood glucose sky-rocketed. One evening, I managed to get levels down to 160mg/dl (8.8mmol/l), had half a slice of ‘Pumpernickel’ bread (10 grams COH) with some salad and within 35 minutes, my levels had sky-rocketed to 270mg/dl (15mmol/l)! Whilst hunger was very small, I felt thirsty a lot and made sure that I drank lots of water and herbal/fruit teas (no added sugar). Dehydration is common when you’re sick and is intensified by high blood sugar levels. The body tries to take water from the largest source of fluid in the body, the bloodstream. As water then diffuses out of the blood, glucose is left behind. The overall blood volume is lower and the blood glucose concentration is higher. High blood glucose leads to greater insulin resistance and even higher sugar levels. All in all, no good when you already have elevated sugar levels due to illness, so making sure you drink plenty of fluids is quite important.
- Diabetic ketoacidosis (DKA): With a blood sugar like mine above, I immediately checked for ketones in my urine but this was negative, which meant I just kept correcting with my normal correction bolus dose. However, with continuously elevated glucose levels and a greater demand for insulin, there is also the danger of developing ketoacidosis.
- Training and exercise: It is rare that I don’t want to be active and train, but on occasions like this, there is absolutely no point to force it. As I was gradually getting better but still felt sluggish, I went for longer walks to try and get sugar levels down. No miracle or quick solution, but something to help the high levels.
- Crash-landing: With all that extra insulin, there is bound to be a mega low at some point. Typically, I would correct carefully and correct again during the day, have the basal rate set to 140-150% from the morning hours to late afternoon, but it seemed the insulin was somehow leaking out of my body as nothing happened. Then in the middle of the night, I woke up to a monster hypo of 45 mg/dl (2.5 mmol/l)!
Finally, I know my body is a pretty cool thing, so, eventually, it will have battled the cold successfully. Until then, all I can do is to try and help it by riding the blood sugar roller coaster until it is over …
Suggested next post: How to Manage Your Blood Sugars When Exercising with Diabetes
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