Navigating RSV, COVID and the Flu With Type 1 Diabetes

How to deal with respiratory illnesses like RSV, COVID and the Flu when you have Type 1 Diabetes

The CRUD and Type 1 Diabetes

This time of year, it seems like EVERYONE has some type of respiratory illness. Strep throat, Respiratory Syncytial Virus (RSV), flu, COVID-19, bronchitis, laryngitis, pneumonia, and The Crud.

What is “The CRUD?”

The Crud is scientific jargon for ‘some undiagnosed respiratory illness that seems like it could be one of any other diagnosable illness, but tests negative so you have no idea what it is.’

Even though we work and live in different states, over half of our team at IDS have some type of respiratory illness (or illnesses in some cases!) right now.  So, if you are a person with diabetes who happens to have a respiratory illness right now, I hope it helps you to feel a little better knowing that you are not alone!

1. Hydration is key. Drink water. LOTS OF WATER. Drink some fluids with electrolytes, too.  If you have other health issues that require you to follow a fluid restriction, talk with your specialist healthcare provider to find out what your fluid limits are during an illness.
2. You will likely need more insulin. One of the many weird things about having T1D during an illness is that you often can’t predict how much extra insulin you will need, or when you will start to need more, or when you will need to start adjusting down your doses again. There is no scheduled plan you can just tick off on the calendar.  Sometimes you will need more insulin before you even have symptoms of an illness while your immune system is fighting it off. Sometimes you could be sick for several days and suddenly seem to need more insulin.
3. Have ketone checking supplies on hand for when you are ill.  Ketones can occur for the following reasons: 1) not enough insulin in the body to prevent the liver from producing them, 2) not eating food or drinking fluids with carbs (or enough carbs) to prevent starvation ketones from occurring, or with a lot of vomiting or diarrhea.

Clinical rationale for the 3 tips above:

1. Your body needs fluids to be able to support the immune system’s work at fighting off the infection.  You need enough fluids in your bloodstream to help support a healthy blood pressure.
   Also, if you are dehydrated,
   a.) your continuous glucose monitor (CGM), or sensor, cannot work very accurately.  It needs you to have enough fluid in your skin for the sensor to do its job.
   b.) insulin cannot work effectively.  You will increase the doses, and the insulin won’t bring glucose levels down if you are profoundly dehydrated.
2. When ill, the body releases stress hormones to help have energy to fight off the infection. As epinephrine and cortisol levels rise, there is extra growth hormone and glucagon production which both cause increased insulin resistance.  This is why people typically need increased basal rates AND correction factors/insulin sensitivity factors during an illness.  Many people also need to strengthen their carb ratios during illness. If you are not well-practiced at self-adjusting your insulin doses for illness, be sure to be in quick contact with your Endocrinology office, or with the Diabetes Care and Education Specialist you work with.  Getting your doses adjusted quickly can help you to avoid further dehydration and may prevent you from needing to go to the hospital for Diabetic Ketoacidosis (DKA) which is a medical emergency and can be life threatening.   Having more in target, or closer to target, glucose levels during illness puts less stress on the body. This allows the body to use its energy to fight the illness.Many over the counter medicines to help manage the symptoms of respiratory illnesses can raise blood glucose and/or blood pressure.If possible, opt for pill or capsule forms of cold medicines instead of using syrup.  Unfortunately, it can be challenging to find correct carb counts of cold medicines online. If you search and do not find a carb count for a syrup you plan to use, you can call the customer service number for the company that manufactures the product to ask for the carb count.

   If you have elevated blood pressure or take medicine(s) to manage your blood pressure, be sure to check your blood pressure at least one to two times per day during a respiratory illness.  Talk with the healthcare provider that prescribes your blood pressure medication if your blood pressure rises during illness. Ask what level is too high, and don’t be afraid to ask for a temporary increased dose in your blood pressure medication(s) to help keep your blood pressure safe during the stress of the illness.  Ask a pharmacist or your healthcare provider which ingredients in over-the-counter meds raise blood pressure.  Look at cold medicines carefully and select options that do not contain blood pressure raising ingredients.

3. Ketones can appear during an illness at any time.  The most common time for someone with Type 1 Diabetes to need to go to the Emergency Room for DKA is at initial diagnosis (before they know they have T1D).  The second most common reason is due to illness or infection.  If ketones are positive, follow your ketone and insulin adjustment plan and find a way to increase fluids.
   a.) Check for ketones if your glucose is above 250 and you have any symptoms of any illness or infection.
   b.) Also, check for ketones if you are vomiting or have diarrhea, even if your glucose levels are normal or close to normal.

https://integrateddiabetes.com/wp-content/uploads/2024/01/diabetes-and-resiratory-illnesses.webp

Call your doctor if you have ANY of the following symptoms:  

• If you have a high fever
• If you have vomited more than 3 times in the past 24 hours
• If you have diarrhea more than 6 times in the past 24 hours
• If you can’t keep fluids down
• If you have moderate to large ketones
• If your glucose remains elevated despite increasing your insulin doses

Call your doctor if you have ANY of the following symptoms:  

• If you have a high fever
• If you have vomited more than 3 times in the past 24 hours
• If you have diarrhea more than 6 times in the past 24 hours
• If you can’t keep fluids down
• If you have moderate to large ketones
• If your glucose remains elevated despite increasing your insulin doses

Being ill while navigating T1D self-management can be exceptionally challenging and frustrating.  

Having an insulin plan for illness, an insulin plan for ketones, and knowing what to expect can help you get through it safely.  If you need an insulin or ketone plan to help you be prepared for an illness, contact us at Integrated Diabetes Services. We are glad to help!

For more information about ketones, see:

Terri Ryan’s article: How Did I End Up in the ICU with DKA?

Alicia Down’s article: Diabetes Ketoacidosis (DKA) Diagnostic Parameters May Not Be The Same

January 2024 Newsletter

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