Got questions about life with diabetes? So do we! That's why we offer our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator.

This week, Wil's talking sick days and what to do when your stomach is not happy. An ugly subject, but someone's got to do it...

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Lauralee, type 3 from Washington, writes:I'm mom to a 16-year-old who has had Type 1 for 3 years. Thankfully he has not yet had any sort of stomach bug with vomiting, though at some point I know that might happen. I understand about how the body keeps producing glucose even when one is not eating, and so one still needs to take insulin, and that makes sense. But I have also read that one is supposed to keep on drinking and /or take antiemetics, and don't quite understand why that would be advisable. Is it not better to allow the body to throw up until one has eliminated the offending bug, and the illness has run its course? And drinking anything before things have settled down is just asking for more vomiting. Could you explain the physiology of how the non-diabetic vs. diabetic body handles such illnesses and the resultant ketones? And the best way to manage a short-term, like a day or two, vomiting illness? I know something major like salmonella or E coli would be a whole different issue. I learn a great deal from your columns, have printed out the one about drinking to give to my son as mandatory reading, and really enjoy your wit. Thank you for helping all of us who are affected by diabetes.

Wil@Ask D'Mine answers: You're welcome, and thank you for your kind words! This is a great question, and I hope everyone can stomach talking about vomiting first thing in the morning! Now, you don't too often see the advice to take an antiemtics as part of type 1 sick day management here in the USA (although some pediatric endos like the concept), but it is a common part of the British playbook. And while I'd be hard pressed to say whether it's advisable or not, I can absolutely explain the thinking behind it. Both the antiemetic advice and the "keep drinking" advice are aimed at avoiding dehydration.

Dehydration? Isn't that what kills you if you're unfortunate enough to get lost in the Sahara without a canteen? Yes, the very same thing. Dehydration is simply having a deficit of body fluid. And while it can be caused by getting lost in the Sahara without a canteen, although I couldn't locate any statistics on how many people this happens to, it's much more likely to be caused by garden-variety illness—especially the kind that either makes you throw up or have diarrhea (or both). Either unpleasant experience causes you to lose fluids at a startling rate.

Dehydration, both the lost in the desert kind or the garden-variety illness sort, is deadly dangerous business, especially for the young and the old. Electrolyte imbalances from reduced liquid levels in your tissues can lead to seizures, being short on fluids can cause your kidneys to fail, and low blood volume can cause blood pressure to drop to fatal levels. Need I go on?

How empty does your body's tank need to be for bad crap to happen?  Garden-variety dehydration starts when a teen has lost 3% of his or her fluid volume. Moderate dehydration is defined as a 6% loss, and severe dehydration occurs in teens when they've lost 9% of their fluid volume, which isn't that much if you think about it.

And not only is honest-to-God dehydration a serious medical emergency, but it needs to be treated in a hospital because getting re-hydrated is not as simple as chugging a Gatorade. A common clinical worry is the potassium balance. If your fluid backs up without regulating the potassium levels, it can screw with how the heart beats—to the point where your heart doesn't beat anymore. And worse, your brain can explode. No shit. It's called cerebral edema, and to understand it, you have to think like a dog. If you lock a hungry dog in a dog food warehouse overnight (and please don't), it will eat until it explodes. Thirsty cells are the same. When fluids are re-introduced, they can over-absorb to the point of rupture.

If all of that weren't dangerous enough, hospitalizing 220,000 of our kids and killing 400 of them every year, when it comes to our kind—in this case "our" meaning me and your 16-year-old type 1—being dehydrated just also happens to turbo charge DKA.

Ketones + low fluid levels = quick recipe for a coma.

That's some bad math. So I can see where someone might have thought to advise an antiemetic, but I'm not sure I agree—more on that in a sec. What is 100% certain for all sick day management is that you need to keep the fluids coming. Even if you throw most of them back up, some will get absorbed. If the stomach is really, really, really rocky—suck on sugar-free popsicles all day long to keep fluids coming into the system.

Of course, this is all just a long-winded way of saying the best way to treat dehydration is not to go there in the first place. But if all efforts fail, when should you go to the hospital? The Mayo Clinic has a handy checklist here, but in general, the darker your urine, the more dehydrated you are.

As to the other elements of your question: If you eat a bad tamale, throwing up is probably a good idea. There's some sort of toxin and getting it out of your system is sensible. But when it comes to a virus, you're not going to get it out by vomiting. Throwing up is a side effect of the illness, not a functional defense against it. Throwing up or not throwing up won't speed or slow the course of the illness one way or the other. All throwing up does for you is to cause you to lose fluid. And given the dangers we've already covered, well, if drinking more fluids causes more vomiting, it's still the lesser of evils. Some of the fluid will be absorbed.

When it comes to diabetic vs. non-diabetic ketones, for the most part, non-D-folk don't get ketones—at least not in levels high enough to be dangerous—so it's never really an issue for a sugar-normal person.

Lastly, when it comes to how to manage a short-term stomach bug, by all means keep the fluids coming, we all agree on that. But when it comes to the antiemetic, I think you need to ask your endo. On one hand, I can see where it could settle the stomach and reduce fluid loss. On the other hand, we're talking about adding more meds into a sick kid, and antiemetics are not without side effects of their own.

It's a tough call. Personally, I always figure my body knows what's best for me before my brain does. If I feel the urge to throw up I don't fight it. Then I start drinking.

Oh, but not the kind of drinking I was talking about in the article you printed and gave to your son as mandatory reading.

That has to wait until after the illness has passed!

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.