Undocumented with Type 1 Diabetes - A Three-Part Series

We explore the hurdles to type 1 diabetes that undocumented immigrants, and children of undocumented immigrants, face in the United States.

Blood Sugar Management When You’re Sick to Your Stomach

By Marissa Town (Marissa Town), BSN, RN, CDE, and Jeff Hitchcock (Jeff), founder of Children with Diabetes

The Parent Perspective (Jeff)

When I was a parent of an college-aged child with type 1 diabetes, my greatest worry was that my daughter, Marissa, would go low and be unable to treat herself.

When college started, I met with Marissa’s roommates – all friends of hers from high school – and reviewed with them how to use emergency glucagon. I also Velcroed the glucagon to the side of her bed. Marissa’s friends understood and were able and willing to help.

But we didn’t talk much about high blood sugar levels, and the stomach distress that accompanies it, even though that situation is equally important. Dealing with high blood sugars and stomach distress at the same time can be trying, even for experts. A natural reaction to this high blood sugar is often to take another bolus from the insulin pump, but that’s not always the answer. A combination of an unexplained high blood sugar and stomach distress should be treated as a potential emergency until proven otherwise. That means you need to troubleshoot, which can include measuring for ketones, injecting insulin using a pen or syringe, and changing the insulin pump infusion set.

Looking back on the summer before Marissa went to college, I realize now that we should have done a detailed review of sick day guidelines with her health care team, including what to do in the face of unexplained highs and stomach distress. We’d been doing diabetes care for so long that we didn’t really think about this critical aspect of diabetes self-care.

The Young Adult Perspective – Marissa

One of the factors that went into my choice of college was that it needed to be close to my parents. That way I knew if I needed anything, they were close enough to arrive within an hour.

I also chose my friends from high school as roommates because they already knew I had type 1 diabetes. I thought it would be easier to explain to them how to use glucagon and what to do if I’m high or low than someone who didn’t know me or my history with diabetes.

The first time I got sick in college, after a late night out and some poor choices, I was very scared. Luckily, I had prepped my roommates for such a scenario and told them that I needed to make sure my blood sugar didn’t go low. They helped me check, even while I was sleeping.

Whenever I was really sick, and not just “poor choices” sick, I would go home to my parents to get their help in managing my health. I realize this may make one feel like “less of an adult,” but at the end of the day I would rather call my parents for help than get really sick and risk having to go to the hospital, or worse.

As I got older, I had a boyfriend who was in nursing school with me, and I taught him everything I knew about T1D. It also helped a lot when the first CGMs came onto the market, which provided me the safety of alerts for highs and lows.

From my experiences in college and beyond, I can offer these tips to young adults with type 1 diabetes:

  1. Be independent, but always allow your parents, caregivers, or those in your circle of support to help as much as they are able to with your diabetes. This is a lifelong condition, and it can be easy to get burned out or forget about blood sugar management when you’re young, so let your support system help carry some of the load and keep you safe.
  2.  If you have a CGM with sharing capability, let someone follow you! Don’t be ashamed of your highs and lows to the point that it compromises your safety.
  3.  Don’t be afraid to ask for help when you’re sick! Sometimes you’re not thinking clearly, especially if your blood sugars are out of whack.

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