Ugh. Some days diabetes is sickening... and some days we just get sick! Welcome to another edition of our diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

Send us your queries related to life with diabetes — nothing is off-limits here! (except ofcourse specific medical instructions for your own care; that's what doctors are for)

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Elisheva from Israel, type 1, asks: Do I need to bolus for cough syrup? I'm using Benylin Dry Cough Regular Strength.

Wil@Ask D'Mine answers: The answer lies in the name of the product. Cough syrup. What's syrup? Yeppers. A thick liquid sugar. A yummy camouflage to hide the nasty taste of the meds for your dry cough.

Benylin is an overseas brand name for Johnson & Johnson products (who also make Benadryl here in the states). As bad luck would have it, the link on their Canadian website that gives us the contents of the bottle you use is dead, and the UK website doesn't list contents at all. But the "Tickly Throat & Cough" version of the same product has an unspecified "artificial sweetener enhancer," plus sorbitol (a sugar alcohol that has less impact than sugar or corn syrup, but will still raise your blood glucose), and of course red dye number 33 and red dye number 40. I see that it has around 8 calories in five milliliters. An adult dose is 10 mL, so it would be 16 calories. Calories to carbs aren't a clear-cut relationship; but where there's smoke there's fire, and where there's calories there's carbs.

Reviewing everything I could find in the medicine cabinet here at home, and poking around online, I find that most cough products seem to have both high fructose corn syrup and sorbitol, so you can expect them to raise your blood sugar if you don't cover them. Of course the devil is in the details, and in this case the details are how much to bolus.

Here in the U.S., cough syrups come with a "Drug Facts" label, rather than a "Nutrition Facts" label. This lets you see that there's corn syrup in the cough syrup, but not how much.

The drug company's websites aren't too helpful either, but third-party carb sites like Calorie King generally show the carb count of most cough syrups at north of five carbs per dose. You could use that as a starting point and work it out on a trial and error basis from there.

Of course, there're also "diabetic friendly" sugar-free cough syrups from many different companies you could try for bolus-free cough suppression. Any that use sugar alcohols will still need some insulin coverage, but many others, like Robitussin Peak Cold, are sweetened with saccharin and shouldn't require any insulin coverage.

And if it makes you feel any better, you're not the only one under the weather.


Tricia from Massachusetts, brand new LADA type 1, writes: I had a scary stomach flu last night with vomiting/diarrhea (ewww) and didn't/don't know yet how to care for myself as I'm not on insulin yet. I saw my BG's go to 221 before I fell asleep. This morning my BG was at 150, just now I'm 113. I feel so disconnected on how to take care of myself, any suggestions??  Today I've had basically broth, but feel scared to eat/not eat... Thanks!

Wil@Ask D'Mine answers:  Well, it's good news that your sugar dropped overnight, and dropped even more as the day has gone on. The main thing with stomach bugs is to be sure to drink lots of fluids to replace the ones you are losing out of... you know... both ends of your system.

Food wise, it's actually OK to stick to just broth for a couple of days; it'll keep you going. But don't be afraid to eat. Once your stomach isn't so rocky, you can look to low-carb foods for a week or so to keep your blood sugars low while the virus clears from your system. Low-carb food is anything that used to crawl, walk, run, fly, swim, or slither. So any meat, in modest portions, won't raise your blood sugar. Neither will green leafy veggies and most cheeses.

Actually, as far as sick days go, your life will be easier once you do start insulin. Insulin is a blessing because it's the ultimate in scalable medications. If an illness raises your blood sugar for a while, you just increase your insulin dose. As you get well again, you just lower your dose again. It's actually as simple and safe as it sounds!


And speaking of illness and insulin...


Chris from Maryland, type 1 on a CGM and a pump, writes: Within the last week, I have been experiencing quite a few high blood sugar readings and have started bolusing pretty aggressively to combat that. In doing so, my daily insulin uptake has jumped from 25-30 units to 35-40 units daily, and I'm still running on the high side of things. I've rotated my pump sites with no effect and the vial of insulin I'm using is just 2 weeks old. I just got over a bad cold, so I feel that may have caused some abnormally high readings, but it's been a few days since I've experienced any cold symptoms. It sort of feels like a switch went off in my body that drastically changed my metabolism or insulin sensitivity. Is that possible?

Wil@Ask D'Mine answers:  Anything is possible. Have I ever heard of an instant insulin sensitivity switch? No. I haven't.

But here are a few things to think about: just 'cause the symptoms are gone, doesn't mean that the cold is. That's actually one of the causes of the new antibiotic-resistant strains of bacteria we're seeing out in the world—people stop taking their antibiotics when they start feeling better, and the only remaining bugs in their systems are the tougher ones that survived the initial onslaught of the meds. Stopping treatment early lets these stronger super-bugs reproduce in greater numbers, eventually leading to drug-resistant strains. That's why the bottle has a label that says to finish the whole frickin' bottle, even if you feel better. Now that has nothing to do with you, other than to show that it's possible for a cold to outlive the symptoms.

So you might still be a little bit sick. Enough so that your body is still on high alert.

Or it might be because the moon is in Leo, the wind is blowing from the northwest, and the barometric pressure is rising. Because all things, great and small, can affect your insulin needs.

I recently attended a conference hosted by the Joslin Diabetes Center, one of the themes was brittle-bashing. For those of you who don't know, "brittle" is an old-fashioned and out-of-favor term for impossible-to-control diabetes. Doctors Richard Beaser and Philip Levy who were the seminar's hosts, refused to take brittle for an answer. They felt that for physicians to fall back on brittle was an excuse for not looking hard enough, or close enough, for the real answers.

At first I disagreed with that notion, because I sometimes view myself as brittle. But the more I thought about it, the more I found myself re-thinking. Maybe brittle is a cop-out. And I finally decided there's always a cause behind mystery blood sugar but it may be too remote to view, or too complex to comprehend, or it may be too many little things working together for us to connect the dots.

I don't know what flipped your switch. We may never know. But, you're blessed to have both a pump and CGM. You've already bumped up your insulin. Sounds like an even bigger bump may be in order, at least for the time being.

And in the end, does it really matter what caused the surge? I mean, it would be nice to know why all of a sudden you need more insulin; but you don't really need to know why to do something about it. The simple solution is to keep increasing your insulin until your numbers get back where they belong.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.