Interact: Callum’s experience

Callum didn’t think much about packing until about a week before he was due to leave. He already had his clothes and comfy boots, and he’d bought a new rucksack a few months previously. He has a valid passport, and he’s only going to Europe so he’s pretty sure he doesn’t need any vaccinations. His mum kept telling him to get his diabetes kit organised, but he didn’t see why she was making a big issue of it, as his blood glucose was normally well controlled.

He knew he had to order a prescription from his GP, and took the advice to get extra supplies in. He even gave a spare set of supplies to one of his friends, just in case a bag got lost. He figured he’d be fine to store his insulin abroad, as most of the places he was going to stay in had fridges.

He went to his diabetes clinic to collect a spare blood glucose meter, finger pricker and ketone meter, and he also got pens for his fast-acting and long-acting insulin. Although he didn’t normally use pens, he was told they could be more convenient to carry and dispose of.

What hasn’t Callum thought enough about?

Callum was excited to be going on holiday, but he also felt a bit nervous as this was his first holiday abroad without his parents. He was also stressed about getting his diabetes things through security, even though he was carrying a prescription. It didn’t help that they ended up running late and had to rush for the bus to the airport!

They first went through security, and Callum was relieved to find that that there was no problem taking his diabetes supplies through. After that they grabbed breakfast, and Callum took his normal fast-acting insulin dose. They had an hour or so to wait before getting on the plane, so they bought a few snacks to eat on the plane and then decided to have a drink. Callum ended up drinking two pints of beer. He then decided to check his blood glucose and found it was 11 mmol/l, which he put down to the beer.

On the three hour flight to Prague from Edinburgh, Callum felt quite tired and irritable. He checked his blood glucose and found it was 14 mmol/l. This was a bit high for him, and he was a bit surprised. He mentioned it to his friends and together they tried to work out what had caused it.

Callum ate a bag of crisps and a cereal bar that he’d bought at the airport as a light lunch and counted his carbs as usual. He added a correction dose of 2 units of fast-acting insulin since his last blood glucose reading had been so high.

Which of the following do you think contributed to Callum’s high blood sugar?

Callum tested his blood glucose again before he got off the plane. This time it was 9.4 mmol/l, which he was happy with. He headed off with his friends to collect their baggage and figure out how to get to their hotel.

Why do you think Callum was happy with his blood sugar at 9.4 mmol/l?

Callum started off having a great time on holiday. His glucose levels weren’t too bad, though he had quite a few mild hypos due to all the walking around he was doing as well as drinking beer most nights. After a week or so in Prague, they headed to Spain.

Callum had checked his blood glucose that morning and it was 9 mmol/l, which seemed good given the mild hypos he’d been having. The group was planning to have a proper night out later. They wanted to grab some food before heading out and ended up finding a food stall selling paella – a famous Spanish dish made from rice and often containing seafood. Callum worked out the total carbs in the dish, and injected himself with a little more fast-acting insulin than usual because of the portion size. This was around 7.30pm.

Around an hour later, Callum and one of his friends started to feel sick. They’d both eaten the paella, and realised that maybe it hadn’t been a good idea to eat a seafood dish that could have been sitting out all day. They both felt too ill to keep going, so the group headed back to their hostel.

Callum vomited once he got back to the room, and he was worried he’d have a hypo. He’d thrown up much of what he ate and he thought that rice was absorbed quite slowly. He also started to get diarrhoea. While he had medication that would stop it, he thought it would be better to not take it and just let the bad food go through him as quickly as possible.

Which of the following is it important for Callum to do now?

Callum was tired and felt terrible, but he knew he had to monitor his blood glucose and ketones regularly, so he set an alarm to check his blood glucose every hour. He first measured his blood glucose at 9pm and found it was 11 mmol/l, but since he hadn’t tested it before he last ate, he wasn’t sure if it was rising or falling.

At 10pm his blood glucose was 8 mmol/l. He’d stopped vomiting but still had diarrhoea. He’d managed to drink some water, but not to eat anything.

What’s the most likely reason for his blood glucose to have dropped?

By 11pm his blood glucose was 15 mmol/l. He still hadn’t managed to eat anything, so this rise was due either to some remaining rice being slowly absorbed or to an infection. He knew his sick day guidance said he should keep taking his insulin, so he took his usual evening dose of long-acting insulin.

At midnight, his blood glucose was 21 mmol/l. He checked for ketones and found that thankfully they were within safe levels at 0.3. He knew he needed to take a correction dose, but was worried that he’d have a hypo while he wasn’t able to eat anything. He thought about how long it had been since his last meal, and worked out it had been 4.5 hours ago. This was reassuring – he wouldn’t have much meal insulin in his body.

His correction factor is 1 unit of insulin for 3 mmol/l of blood glucose.

His current blood glucose is 21 mmol/l.   His target is 8 mmol/l.

How much insulin should Callum take as a correcting dose?

Callum was shattered by 1am and really wanted to go to sleep. His blood glucose was 19 mmol/l. He still felt sick but hadn’t needed to go to the toilet for an hour. He kept sipping water and checked for ketones, which were still 0.3.   He set his alarm to go off in an hour and had a nap.

At 2am he woke up and checked his blood glucose – 15 mmol/l. He was happy with this, and decided to wait two hours before testing again.

At 4am his blood glucose was 17 mmol/l, which he knew might be down to absorbing some food and possibly having an infection. His ketone level was a safe 0.1. As it had been four hours since his last correction dose, he knew it was safe to have another one.

His correction factor is 1 unit of insulin for 3 mmol/l of blood glucose.

His current blood glucose is 17 mmol/l.  His target is 8 mmol/l

How much insulin should Callum take as a correcting dose?

At 7am, Callum’s blood glucose was 10 mmol/l, and he hadn’t needed to go to the toilet again. He kept drinking water and he managed to eat breakfast. He was on the mend, and managed to enjoy the rest of his holiday.

Callum managed his diabetes well in this scenario – since his ketones weren’t high, he could self-treat. He remembered that this involved testing his blood glucose and ketones regularly, taking his insulin as normal, plus correction doses when needed and drinking plenty of water.

If Callum had had persistent vomiting or high ketones, his illness couldn’t have been self-managed, as these symptoms wouldn’t have gone away on their own and would have made him much more ill. He would have needed urgent medical attention.

What would Callum have been at risk of, if he had had persistent vomiting or raised ketones?