Ask the Diabetes Team
Q. I'm 15, and the last time I was home sick with strep throat I didn't feel like eating, so I slept in until about noon. I didn't take my insulin in the morning because I figured since I wasn't eating that was the best thing to do. By 5 o'clock when my mom got home, I started vomiting, and she ended up taking me to the Emergency Room. What happened that I got so sick so quickly?
Signed,
Home Sick
A. Dear Home Sick:
The first thing you should do when you are not feeling well is to test your urine for ketones, test your blood sugar and call the Diabetes Center to speak to the doctor or nurse on call. They will help you decide how much insulin you need to take. Your body needs insulin to function, so even though you did not feel like eating we could have guided you on a dose of insulin that may have been better for you. When your body is under stress; physical or emotional, it often needs extra insulin to help healing. When you don't feel like eating, it is very important for a person with diabetes to drink a lot of fluids to prevent dehydration. Sometimes you need fluids with sugar, like juice or regular soda, and other times you need sugar-free fluids like water. When you are home sick, you need to talk to your diabetes team many times throughout the day to make sure you are getting enough insulin and fluids to help prevent you from having to go to the hospital. Your vomiting could have been from ketones your body made because you didn't take any insulin. Ketones are like poison to the body, so your body will try to get rid of them either through your urine or by vomiting. Ketones and high blood sugar make it easy for you to become dehydrated.
So next time you are not feeling well, please call for some help, and we'll do our best to help you get better without a trip the Emergency Room.
Q. When I was in diabetes clinic, my doctor told my mom to test my blood at midnight and 3 a.m. a couple times before our next visit. Why would you do that to me?
Signed,
Tired and Needing Sleep
A. Dear Tired:
Midnight and 3 a.m. blood sugars should be done at least once a week to help our diabetes team determine how best to adjust your insulin. Whether you get your NPH insulin at dinner or bedtime, we need to see if it is effective in keeping your blood sugars in your goal range throughout the night. If you eat a bedtime snack, we may ask you to test at midnight. That reading lets us know if you need some Humalog or regular insulin with your bedtime injection to keep your blood sugar from going too high.
Midnight and 3 a.m. tests should also be done on nights when your pre-bedtime snack blood sugar is under 80. This can help to prevent a severe low blood sugar reaction during the night.
The midnight and 3 a.m. readings can also help us if you are having sugar in your urine in the morning. By improving your blood sugars overnight there is less stress on your kidneys.
So hang in there. We're not trying to make you tired; we want to take the best possible care of you.
