2 Responses

  1. pwd doc
    pwd doc December 14, 2013 at 3:18 pm | | Reply

    I’d like to add some caveats

    When you vomit, you loose electrolytes (salt, etc). You need to drink something with electrolytes like a sports drink or clear broth or else not only will you become dehydrated, you will develop low sodium in the blood which makes the fluid loss even more dangerous.

    Not only do you need fluid, you need some carboydrate. If no carbohydrate is ingested, people with and without diabetes can develop “starvation ketosis” – like in the Atkins diet – the body breaks down fat to get energy and produces ketones. The blood sugar may not be high or may even be low, but ketones increase nausea and should be avoided.

    If your sugar is high (which it can be even if you are throwing up all your food because the stress of being sick can pull sugar out of the liver), you need to first get it down to at least < 200 with extra insulin (best not to shoot too low if you can't eat to bring it up if you overshoot). Then you need to drink fluid with carbohydrate and take extra insulin if the blood sugar goes to high. I tell patients to watch TV and drink juice, real soda, or a sports drink with sugar through a straw. Maximum 1-2 sips every commercial (about every 10 minutes). You won't shoot your blood sugar up sky high having sips every 10-15 minutes the same way you would if you drank 4 – 8 oz all at once. You are less apt to vomit if you drink small amounts frequently than larger amounts less frequently. Depending on your blood sugar, you can adjust the sugar concentration from sugar free, intermediate amount of sugar (most sport drinks) to more concentrated sugar (fruit juice – avoid orange juice or milk – they upset the stomach more), If the blood sugar goes too low and you can't drink, it can be treated with cake decorating gel put against the side of the mouth or if necessary using "low dose" glucagon (dose should be from own physician).

    Avoid foods with protein and fat. You don't need them for a day or two and they are more apt to cause vomiting. All you need is fluid and carbohydrate for a day or too.

    Also, it should be noted that people with diabetes may develop dehydration faster than people without diabetes if their blood sugar is high causing them to urinate more (loosing even more fluid). When blood sugar is high causing excess urination, urine color, frequency of urination, and amount of urination may be misleading when trying to estimate if someone is dehydrated.

    Also, when you are sick, you may need more insulin than usual to treat a low blood sugar. If the amount of insulin you normally use to treat a high blood sugar is not working, you may need to take bigger doses. If you aren't using a pump with an insulin on board feature/active insulin feature, be careful not to take extra insulin too frequently because some of the insulin from a previous recent correction dose may still be in your body and may still lower your blood sugar in addition to the dose you are about to take. Insulin on board/active insulin features subtract this insulin left from a previous correction dose when it recommends a dose you are about to take based on your insulin/sensitivity/correction factor. Contact your health care provider if your normal doses aren't bringing you down.

  2. mikeC
    mikeC December 16, 2013 at 2:17 pm | | Reply

    I believe you are mixing up your Keto-issues. I agree with you that Ketoacidosis can exacerbate nausea, but I disagree whole- heartedly about Ketosis. I stay in Ketosis all the time and have had sickness (and vomiting) while in it. There is nothing medically wrong with using fat for energy and why are carbohydrates needed when dehydrated? In the hospital they don’t put throwing up diabetics on a glucose drip, they put them on saline.

    “Avoid foods with protein and fat. You don’t need them for a day or two and they are more apt to cause vomiting. All you need is fluid and carbohydrate for a day or too.” – I have never experienced this.

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