When my daughter was growing up with type 1 diabetes on board, few things could send shivers of fear down my spine more than hearing the words: “There’s a stomach bug going around.”
It seemed as though she caught every one, and, for those living with type 1 or type 2 diabetes, a stomach bug can quickly become serious. In time, we learned what to anticipate, when to call the doctor, when to hit the hospital, and how to survive the crazy storm that is the stomach bug with diabetes.
How to know what to do and when to act? It can be more complicated than you might think. According to Kelly Cerasuolo, RN, MSN, CPNP of Texas Children’s Hospital and Baylor College of Medicine, the best thing a patient or caregiver can do when facing the stomach bug/diabetes combo is reach out, and reach out early, to your diabetes care team. Vomiting or diarrhea – together or separately – can directly affect blood sugar, and can quickly lead to dehydration, so these symptoms should always be taken seriously.
“Don’t feel silly calling in, especially if this is new to you or if you have not experienced this it in a while,” she said. “What harm is there in a phone call?”
Cerasuolo said that in her experience, stomach illnesses can be dealt with in one of three ways, and often they progress through those levels. First comes dealing with it at home. Second comes dealing with it at home with medical input and oversight. And the third, of course, is getting the patient to a place where the medical team can help you deal with it in person.
Intervention of some kind is needed in four situations combined with a stomach bug: hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), diabetic ketoacidosis (DKA), and ketosis independent of hyperglycemia. And while stomach bug management for those living with diabetes differs from person to person, she said, the goal of the management is to avoid any of those four situations.
“It’s important to immediately increase the frequency of blood glucose readings,” she said, “to about every two to four hours. Urine ketones should be checked every time the person voids.” But no matter what you are seeing on a meter, she stresses you should also check those ketones. Ketones are a chemical produced when there is a shortage of insulin in the blood (often caused by high blood sugar) and the body breaks down fat for energy. Illness and infections may cause high blood sugar, so it’s especially important to check ketone levels when you’re sick.
Cerasuolo also makes a point that may seem obvious, but needs to be restated: Never, ever leave a child with symptoms of a stomach bug alone to deal with it. Even teens, she said, need an adult helping them. Adults may take a hint from this too: if you have diabetes and a stomach bug, bring a friend or loved one into the loop so you are sure to be safe and watched over, even from a distance.
At what point do you call your medical team if you have not yet? For any young child, she said, a call should go in right from the start. In other cases, check with your healthcare team for any of the following symptoms:
- A fever above 100.5 degrees
- When you either see a marked increase or decrease in blood glucose, or a constant presence of ketones
- Vomiting or diarrhea for over two hours
- Blood glucose levels above 250mg after two checks, or if levels do not go down after extra insulin
- Moderate or large ketones
And, remember, when things feel frightening or out of hand, it’s time to head in. There’s no shame in that.
“It is important to realize at that moment that you haven’t failed at anything,” says Cerasuolo. “Stomach bugs and diabetes are really often just a case of, ‘life happens, we’re sorry, now come on in and we’ll help fix it.’ A doctor’s visit or ER trip does not mean you’ve failed at your job of managing diabetes.”
So when the bug hits, be ready. Have your meter strips out, your ketone strips in stock, and your healthcare team on speed dial. With patience and some expert help, this too may be managed.
Moira McCarthy is an acclaimed writer, author, and public speaker who has shared her story – and lessons – on raising a child living with type 1 diabetes in the media, through books, and on her popular blog, despitediabetes.com. McCarthy has appeared on CNN Live, Good Morning America, and Fox News. She was recently recognized as the JDRF International Volunteer of the Year. Her six books include the top-selling The Everything Parent’s Guide to Children With Juvenile Diabetesand the upcoming Raising Teens With Diabetes: A Survival Guide For Parents. McCarthy is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor, and not of Sanofi US, its employees, agencies, or affiliates.
© 2013 The DX: The Diabetes Experience