Useful Diabetes Information








Sick Day Management


Introduction

Living with Diabetes can be challenging enough on a good day. When you're sick, managing Diabetes becomes even more difficult.


When you are coughing, sneezing, or feeling nauseous, probably the last thing you want to do is worry about your diabetes. However, when you are sick, your blood glucose levels go up, so you need to be extra careful with your diabetes management.


What Happens When You're Sick


When you are sick, your body reacts by releasing hormones to fight infection. But these hormones raise blood sugar levels and at the same time make it more difficult for insulin to lower blood sugar. When you have Diabetes, even a minor illness can lead to dangerously high blood sugar. This may cause life-threatening complications, such as Diabetic ketoacidosis or a hyperosmolar state.



Making a Sick-Day Plan


Everybody has a high release of stress hormones when they’re battling or about to battle an illness. Typically, stress hormones cause a rise in blood glucose level because they cause the liver to release more glucose than normal into the bloodstream. People who don’t have diabetes can compensate by releasing more insulin, but people who have diabetes may produce no insulin, or their bodies may not use insulin efficiently, so blood glucose levels stay high unless something is done (such as taking insulin) to lower them.

The release of stress hormones and consequent rise in blood glucose level is why people with diabetes are advised to continue taking their Diabetes Medicines, Insulin or oral medicines, when they are sick, even if they’re vomiting. Monitoring blood glucose levels every 2—4 hours and sipping liquids every 15 minutes to stay hydrated are also important.

Not taking diabetes medicines during an illness raises the risk of developing diabetic ketoacidosis (DKA), a medical emergency characterized by high blood glucose levels, the presence of ketones in the blood and urine, and dehydration. When the body doesn’t have enough insulin available to use glucose as its primary fuel source, it breaks down stored fat for energy, which leads to the production of acidic metabolic by-products called ketones. An accumulation of ketones causes the blood, and eventually the body’s tissues, to become acidic, throwing off the delicate mechanisms that regulate bodily functioning.


Food and Beverages


Eating and drinking can be a big problem when you're sick. But it's important to stick to your normal meal plan if you can. In addition to your normal meals, drink lots of non-caloric liquids to keep from getting dehydrated. These are liquids like water and diet soft drinks. It's easy to run low on fluids when you are vomiting or have a fever or diarrhea. Extra fluids will also help get rid of the extra glucose (and possibly, ketones) in your blood.


But what if you can't stick to your normal meal plan? Your sick-day plan should contain a meal plan. Try to take in your normal number of calories by eating foods which can be easily digested, such as regular (non-diet) gelatin, crackers, soups and applesauce.



    General checklist for sick days:


  • Monitor blood glucose every 2-4 hours (Type 1) or 4 to 12 (Type 2) or as recommended by your provider.
  • Consult with your health care provider about medication or insulin dose changes.
  • Drink plenty of fluids, including those that have salt, such as soup bouillon.
  • Check urine or blood ketones, especially if your blood glucose is high or if you are nauseated and vomiting. If ketone levels are elevated, you need to seek immediate medical attention.

    You need immediate medical attention if you have:


  • Persistent nausea, vomiting or diarrhea
  • Difficulty breathing
  • Trouble moving arms or legs
  • Vision, speech or balance problems
  • Feel you are unable to take care of yourself
  • Persistent blood glucose levels of more than 250 mg/dl
  • Persistent fever or signs of worsening infection
  • Urine or blood ketones above normal

People often wait too long to get medical care and may become very ill. Delay in seeking care can be life-threatening.



Your Sick Day Kit


Going shopping for supplies is the last thing you want to do when you’re sick, so plan ahead by putting together a sick-day kit while you’re well. you may now need all of these supplies every time you get a cold or flu, but preparing your "kit" while you are well will remove a lot of unnecessary stree when you have a cold or flu.


  • List of important phone numbers, including health-care providers and friends or relatives you can call on for help
  • An up-to-date list of all your medical conditions and medications, including usual doses.
  • Pen or pencil, and a journal or note book
  • Thermometer
  • Tissues
  • Plastic bags (for disposing of used tissues)
  • Hand sanitizer
  • Alarm clock or timer to help you monitor blood glucose levels and ketones regularly
  • Sugar-free cough drops, syrups, and throat lozenges
  • 8-ounce measuring cup to help make sure you’re drinking enough liquids
  • Manual can opener
  • Nonsteroidal pain and fever relievers, such as acetaminophen, ibuprofen, and aspirin
  • Anti-diarrhea and anti-vomiting medicines
  • Blood Glucose Meter, and a Log book to record your blood sugar values
  • Instructions for sick days. Discuss your personal sick day plan with your doctor, and keep your personal sick day instructions in your sick day box
  • An extra box of blood glucose test strips.
  • An extra box of lancets.
  • Ketone test strips
  • Glucose tablets or gel
  • Insulin and Insulin Syringes
  • Small sharps container
  • Insulin pump supplies if you use a pump
  • Glucagon emergency kit
  • Shelf-stable foods such as unopened jars of applesauce, canned soup, peanut butter, canned tuna, and powdered milk
  • Shelf-stable liquids such as bottled water, boxed juice, and powdered gelatin, sports drinks, and sugar-free beverage

    When you are sick, remember to:


  • Continue to take your diabetes medication during illness, even if you are not able to eat. Because illness is a stress on the body, it will cause the blood sugar to rise, so you’ll need your diabetes medication.
  • Check your blood glucose at least 4 times a day—before each meal and at bed time.
  • If you use insulin, talk with your doctor about a plan for adding extra insulin if your blood sugar is high during illness. Dosing varies by individual, so it’s important to consult your doctor about this.

If your blood sugar tests above 240:


  • Use the urine ketone sticks to check for ketones
  • Check your blood glucose more frequently, about every 2 hours.
  • If your blood glucose stays above 240 for 4 or more hours, call your doctor.
  • Write down the time and results of all blood glucose and urine tests, as well as your temperature when you take it. Also make a note of any illness symptoms, such as voiting, diarrhea, rashes, or pain.
  • Drink at least 8 ounces (1 cup) of non-caloric liquid every hour while you are awake.
  • If you cannot eat solid food, alternate 8 ounces of non-caloric clear liquid with 8 ounces of carbohydrate-containing clear liquid, like regular pop or a clear juice.


    Call your doctor, if:
  • If you feel unsure of what to do.
  • If you cannot hold down your diabetes medication.
  • If you cannot hold down any solid food or liquid.
  • You have been vomiting or had diarrhea for more than 2 hours.
  • If you have ketones in your urine.
  • If your temperature is above 101º F.
  • If you have trouble concentrating or staying awake.
  • If your blood glucose stays above 240 or below 60.
  • If you have symptoms of dehydration or ketosis: sunken eyes; dry cracked lips, mouth or tongue; skin that remains “tented up” after being pinched; fruity-smelling breath; nausea and dizziness; difficulty concentrating.

Conclusion


Being sick is never fun. When you are a Type 1 or Type 2 Person with Diabetes, it becomes a greater risk, and managing it can become difficult, at best, and life-threatening, at it's worse. Being prepared can help you get better more quicky.