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Long Lost Member
karenhudson
Total Posts: 3
Registered on: ‎07-03-2011

when stomach flu strikes on a road trip?

How to handle a sudden occurence of vomiting and diarrhea while traveling?
 My autistic son has had diabetes for twenty years, beginning at age 20 (technically Type 2, but he is now insulin-dependent). When we were driving home from a visit to his sister and brother-in-law, a journey of 550 miles, he began to feel ill and vomited a considerable amount---his breakfast and the dinner from the night before. He became pale, weak, and sweaty, and I knew his blood sugar was dropping. He'd had his morning insulin ( 5 units of 24-hour Lantus and 20 of Humulin 70/30). Luckily we weren't far from Sacramento, so when we arrived in that city I sought out an ER where he was given an IV, with liquids and glucose, and anti-nausea medication.
In general, we have found that medical personnel, unless they are trained in diabetes care or have personal experience with relatives and friends, are not entirely knowledgeable about it. The ER doctor seemed to think that if we brought his blood sugar back up, he would be ok, although I tried to explain the insulin would continue to work in his system and if he couldn't eat, his blood sugar would drop dangerously once again. After an hour or so in the ER, he did eat a sandwich and drink some juice, so I was relieved. We set off for home (about 2 1/2 hours over the High Sierras) and after about 45 minutes, he threw up again, losing everything he had eaten. We were then in the mountains. I pushed toward home (although slowed down by highway construction). When we arrived home, he seemed a bit better and drank 16 oz. of orange juice, which stayed down and raised the blood sugar enough so that I thought it would be ok through the night. I checked several times through the night and it was ok. The next morning he was able to eat, so he had his usual insulin shots and went to his sheltered workshop.
Does anyone have any advice or experience about how to treat the stomach flu in a diabetic person while traveling? We had planned to travel more this summer, cross-country, which would involve some long stretches in Nevada, Utah, and Wyoming especially, without facilities. But now I am hesitating.
Thanks so very much, in advance.
mollythed
Total Posts: 5,732
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Registered on: ‎10-31-2009

when stomach flu strikes on a road trip?

Wow!  I no more than think about one aspect of your situation when another question pops up in my mind.

Just for background information, is your son's diabetes normally treated by a primary care doctor or by an endocrinologist?

You are right that many doctors have little experience treating people who are insulin-dependent, whether type 1 or type 2.  They just don't see that many patients, and situations can vary so widely. 

The first question that passed through my mind was how did you decide that it was stomach-flu type symptoms and not high blood sugar with ketones present.  Did others who had eaten the same foods stay well?  Do you have a way to test for ketones?  While they are not as likely to show up for people with type 2 diabetes, they certainly can occur.  What usually protects people with type 2 from ketones is that even when they are dependent on using insulin, they still make a trickle of their own insulin that helps to avoid the development of ketones.  For someone who needs both basal insulin like Lantus and additional daytime insulin to cover meals, it becomes a little more likely that there might be a problem.

Many, perhaps most, people who use insulin daytime insulin these days use just the rapid acting insulins like Novolog, Humalog, or Apidra at each meal.  I wonder why you are using the mix.  It may well be that it fits better for your son, with few injections and less need for insulin to be administered by others during the day when he is normally away from home, so I an not inferring that it is an inferior way to treat him, but as you noted, it does cause more of a problem when you need to change course in midstream, because the insulin lasts so much longer.  I'm just wondering if you got started on a dosage regimen years ago and nobody has ever thought about updating it.

Has your son's doctor ever provided you with glucagon?  It's a shot that can be administered when blood sugar goes dangerouslly low, to force the liver to give up its stored insulin.  It has some rather unpleasant after-effects, but it can be a valuable tool in an emergency, and can sometimes help avoid the need to get to the ER.

Do you carry a cell phone when you travel?  I understand that there are places where no service is available, but in many situations, it would give you easy access to medical help, either in the area where you are traveling, or from your home team.

You could talk to your son's doctor about having an anti-emetic and anti-diarrhea medication available with you for emergencies.

You probably already pack a variety of food and beverages for emergencies.  I would be sure to have both regular and diet drinks available.  Seven-up or ginger-ale might be more gentle on the stomach that juice.  Think about the kinds of bland foods that anyone might find tolerable when recovering from an upset stomach too, like soda crackers.

One of the usual rules for travel is to always take twice as many diabetes supplies as you think you will need.  That means insulin and emergency glucose, but also things like meters and plenty of test strips, so that you can test often if you need to, and well as some of the other things I already mentioned.

Those are just some of the things that came to my mind.  I think it would be worth your time to sit down with a doctor, or better yet, a diabetes educator, to brain-storm an emergency kit, and some emergency guidelines for you follow when traveling.  You might even want to carry some information from your son's doctor about his usual strategy for managing diabetes, so that a new doctor doesn't have to start from square one in an emergency. 

The change of pace is good for all of you, so it is worth the trouble of making it happen in a way that is a stress-free  and well-prepared as possible.

"Molly" (aka mollythed)
Type 2 diabetes diagnosed in 1995, now managed with Lantus, Humalog and Metformin; diet and exercise.
My husband and three adult sons also have type 2 diabetes.





Super Advisor
Pam01
Total Posts: 2,178
Registered on: ‎11-02-2009

when stomach flu strikes on a road trip?

You mention testing overnight, but you don't say anything about actual bg numbers, even at the hospital. Often when I (Type 1) have a stomach bug, my blood sugar goes up (from infection, stress, or adrenaline).  It is not uncommon to have to increase insulin even when I'm not eating!

Alternatively, my husband and I have both noticed the feeling of nausea when our blood sugar is low and dropping -this seems to occur when other typical low blood sugar symptoms are not present, so suddenly I wonder why I don't feel good.  Sipping gingerale or other regular soda is a good way to get the blood sugar back up when eating doesn't seem like an option!

As for the insulin continuing to work.. technically, Lantus should be a background (basal) insulin that is not covering food, but I know nothing about the 70/30 mix.

In 20 years as a diabetic, he must have had a stomach bug, no? Is the  concern now because he is on insulin or because you were travelling? 
Pam

Diagnosed Type 1 at age 16 months, over 45 years now
Minimed pump and cgm since July '09. Metformin (insulin resistance), levothyroxine(thyroid), losartan (BP)

I have traveled cross country, and to Canada, UK, Kenya, Mexico, Jamaica, Equador/Galapagos islands, and lived in Egypt for a year.
Long Lost Member
karenhudson
Total Posts: 3
Registered on: ‎07-03-2011

when stomach flu strikes on a road trip?

Thanks so much for your very detailed and very helpful reply, Molly.
We have a good primary care physician (family friend) who has a special interest in diabetes---we're fortunate.  Yes, Alex is unable to have a shot with his lunch at the workshop (he can't administer it himself and there is no RN on duty to do it), so he has the 70/30 in the morning to get him through the day.  The Lantus was added a few years back because his morning sugar readings were running a little high, and the late afternoon ones were running high.  The Lantus smooths those out.
  Yes, we have  glucagon---I had it with his kit in the car, but decided he should be seen at the ER.  Yes, we carry extra diabetic supplies when we travel.
   I truly appreciate your very useful suggestions!
Long Lost Member
karenhudson
Total Posts: 3
Registered on: ‎07-03-2011

when stomach flu strikes on a road trip?

Thanks, Pam, for your helpful reply. 
Alex usually has a cast-iron stomach (like my husband).  He has thrown up only four or five times in his entire life---he's 40. I'm not sure whether he was having problems with ketones or whether it was a bug---or a combination of the two. (He hasn't had ketone problems before.) He'd had a little fall on the patio the night before, had scraped his elbow and hurt his leg a bit, and I'd bandaged him up and given him an extra strength tylenol for the pain.  His blood sugar was up quite high in the morning, but I thought it might be from pain and stress. I gave him 2 extra units of the 70/30 then.  He has "fragile diabetes"---many  physical and emotional factors affect the blood sugar, and it can fluctuate wildly in a short time.  We have learned to monitor it often, but as for insulin and food intake---we have to be very careful---it's more art than science (which frustrates my husband who is a scientist :-).)
    Thanks again for your thoughtful reply.