Being sick can make your blood glucose level go up very high. It can also cause serious conditions that can put you in a coma.
The best way to prevent a minor illness from becoming a major problem is to work out a plan of action for sick days ahead of time. Then when you become sick, you will feel safe and secure. You will already know what to do and you will have the supplies on hand to do it.
What Happens When You're Sick
When you're sick, you're under stress. To deal with this stress, your body releases hormones that help it fight disease. But these hormones have side effects. They raise blood glucose levels and interfere with the glucose-lowering effects of insulin.
As a result, when you are sick, it is easier to lose control of your diabetes. Ketoacidosis leading to a diabetic coma can develop, particularly in people with type 1 (insulin dependent) diabetes.
People with type 2 (non-insulin dependent) diabetes, especially older people, can develop a similar condition called hyperosmolar hyperglycaemic non-ketotic coma. Both of these conditions are dangerous and can be life-threatening.
Making a Sick-Day Plan
You should prepare a plan for sick days in advance. You, your doctor, and a diabetes educator should work it out together. The plan should tell you when to call the doctor, how often to measure blood glucose and urine ketones, what medicines to take, and how to eat.
Also, you should attach to your plan a list of phone numbers for your doctor, diabetes educator, and dietician. Make sure you also know how to reach them at night and on weekends and holidays. Then, when illness strikes, you will be ready.
When to Call the Doctor
You do not need to call the doctor every time you have a sniffle. But your doctor will probably tell you to call if certain things happen. For example:
You've been sick or have had a fever for a couple of days and aren't getting better.
You're been vomiting or having diarrhoea for more than 6 hours.
You have moderate to large amounts of ketones in your urine.
Your glucose levels are higher than 13.3 mmol/L even though you've taken the extra insulin your sick-day plan calls for.
You take pills for your diabetes and your blood glucose level climbs to more than 13.3 mmol/L before meals and stays there for more than 24 hours.
You have symptoms that might signal ketoacidosis or dehydration or some other serious condition (for example, your chest hurts, you are having trouble breathing, your breath smells fruity, or your lips or tongue are dry and cracked).
You aren't certain what to do to take care of yourself. Be ready to tell the doctor what medicines you've taken and how much, how long you've been sick, whether you can eat and keep food down, whether you've lost weight, and what your temperature, blood glucose level, and urine ketone level are.
To be prepared, you will need to keep written records of all these things as soon as you become sick.
Keep Your Notebook Handy
No matter what kind of diabetes you have, your sick-day plan will tell you to measure your blood glucose and urine ketones more often than usual. If you have type 1 diabetes, you may need to measure blood glucose and urine ketones every four hours.
Measuring ketones is very important because these waste products are more likely to build up when you are sick and lead to ketoacidosis.
If you have type 2 diabetes, checking blood glucose four times a day may be enough. You might only need to measure ketones if your blood glucose is higher than 13.3 mmol/ L. If you do not have a blood glucose meter, you can buy blood-testing strips at the store that give you a visual result, such as a colour change.
Diabetes Medicines
When sick, you will still need to continue medicine for your diabetes. Even if you are throwing up, don't stop your medicines. You need them because your body makes extra glucose when you are sick.
If you have type 1 diabetes, your doctor may have you take extra Regular insulin to bring down the higher glucose levels.
If you have type 2 diabetes, you may be able to take your pills, or you may need to use insulin for a short time. In either case, make sure you understand your doctor's instructions for what to take and how much.
Food
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. If so, 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 diarrhoea. 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 diet? Your sick-day plan should contain a meal plan. Try to take in your normal number of calories by eating easy-on-the-stomach foods like regular (non-diet) gelatine, crackers, soups, and applesauce.
If even these mild foods are too hard to eat, you may have to stick to drinking liquids that contain carbohydrates. You should aim for 50 grams of carbohydrate every three to four hours.
Your doctor may tell you to drink sugared (not diet) soft drinks. Other high-carbohydrate liquids and almost-liquids are juice, frozen juice bars, sherbet, pudding, creamed soups, and fruit-flavoured yoghurt. Broth is also a good choice.
To prepare for sick days, have on hand at home a small stock of non-diet soft drinks, broth, applesauce, and regular gelatine.
Medicines to Watch Out For
You may want to take extra medicines when you are sick. For example, if you have a cold, you may want to take a cough medicine. Always check the label of over-the-counter medicines before you buy them to see if they have sugar.
Small doses of medicines with sugar are usually okay. But to be on the safe side, ask the pharmacist or your doctor about sugar-free medicines.
Many medicines you take for short-term illnesses can affect your blood glucose levels, even if they don't contain sugar. For example, aspirin in large doses can lower blood glucose levels.
Some antibiotics lower blood glucose levels in people with type 2 diabetes who take diabetes pills. Decongestants and some products for treating colds raise blood glucose levels.
If you must go to the emergency room or see a different doctor than usual, be sure to say that you have diabetes or have your identification bracelet in plain view. List all the medicines that you are taking. Your blood glucose level can also be affected by medicines you take for chronic or long-term conditions.
The best way to prevent a minor illness from becoming a major problem is to work out a plan of action for sick days ahead of time. Then when you become sick, you will feel safe and secure. You will already know what to do and you will have the supplies on hand to do it.
What Happens When You're Sick
When you're sick, you're under stress. To deal with this stress, your body releases hormones that help it fight disease. But these hormones have side effects. They raise blood glucose levels and interfere with the glucose-lowering effects of insulin.
As a result, when you are sick, it is easier to lose control of your diabetes. Ketoacidosis leading to a diabetic coma can develop, particularly in people with type 1 (insulin dependent) diabetes.
People with type 2 (non-insulin dependent) diabetes, especially older people, can develop a similar condition called hyperosmolar hyperglycaemic non-ketotic coma. Both of these conditions are dangerous and can be life-threatening.
Making a Sick-Day Plan
You should prepare a plan for sick days in advance. You, your doctor, and a diabetes educator should work it out together. The plan should tell you when to call the doctor, how often to measure blood glucose and urine ketones, what medicines to take, and how to eat.
Also, you should attach to your plan a list of phone numbers for your doctor, diabetes educator, and dietician. Make sure you also know how to reach them at night and on weekends and holidays. Then, when illness strikes, you will be ready.
When to Call the Doctor
You do not need to call the doctor every time you have a sniffle. But your doctor will probably tell you to call if certain things happen. For example:
To be prepared, you will need to keep written records of all these things as soon as you become sick.
Keep Your Notebook Handy
No matter what kind of diabetes you have, your sick-day plan will tell you to measure your blood glucose and urine ketones more often than usual. If you have type 1 diabetes, you may need to measure blood glucose and urine ketones every four hours.
Measuring ketones is very important because these waste products are more likely to build up when you are sick and lead to ketoacidosis.
If you have type 2 diabetes, checking blood glucose four times a day may be enough. You might only need to measure ketones if your blood glucose is higher than 13.3 mmol/ L. If you do not have a blood glucose meter, you can buy blood-testing strips at the store that give you a visual result, such as a colour change.
Diabetes Medicines
When sick, you will still need to continue medicine for your diabetes. Even if you are throwing up, don't stop your medicines. You need them because your body makes extra glucose when you are sick.
If you have type 1 diabetes, your doctor may have you take extra Regular insulin to bring down the higher glucose levels.
If you have type 2 diabetes, you may be able to take your pills, or you may need to use insulin for a short time. In either case, make sure you understand your doctor's instructions for what to take and how much.
Food
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. If so, 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 diarrhoea. 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 diet? Your sick-day plan should contain a meal plan. Try to take in your normal number of calories by eating easy-on-the-stomach foods like regular (non-diet) gelatine, crackers, soups, and applesauce.
If even these mild foods are too hard to eat, you may have to stick to drinking liquids that contain carbohydrates. You should aim for 50 grams of carbohydrate every three to four hours.
Your doctor may tell you to drink sugared (not diet) soft drinks. Other high-carbohydrate liquids and almost-liquids are juice, frozen juice bars, sherbet, pudding, creamed soups, and fruit-flavoured yoghurt. Broth is also a good choice.
To prepare for sick days, have on hand at home a small stock of non-diet soft drinks, broth, applesauce, and regular gelatine.
Medicines to Watch Out For
You may want to take extra medicines when you are sick. For example, if you have a cold, you may want to take a cough medicine. Always check the label of over-the-counter medicines before you buy them to see if they have sugar.
Small doses of medicines with sugar are usually okay. But to be on the safe side, ask the pharmacist or your doctor about sugar-free medicines.
Many medicines you take for short-term illnesses can affect your blood glucose levels, even if they don't contain sugar. For example, aspirin in large doses can lower blood glucose levels.
Some antibiotics lower blood glucose levels in people with type 2 diabetes who take diabetes pills. Decongestants and some products for treating colds raise blood glucose levels.
If you must go to the emergency room or see a different doctor than usual, be sure to say that you have diabetes or have your identification bracelet in plain view. List all the medicines that you are taking. Your blood glucose level can also be affected by medicines you take for chronic or long-term conditions.
