If you have diabetes, you need to take extra steps to make sure you control your blood glucose levels during the days you are sick. The first step you need to take is to talk with your health care provider or diabetes educator. He or she can help you to develop a plan to put in place when you get sick. You should know what to do about your diabetes medicines, food, blood glucose, and urine ketone checks. If you are prepared to handle common illnesses, you can keep them from altering your blood glucose.
HOW OFTEN TO TEST & WHY?
When you are sick, your body releases hormones that help fight disease. These hormones can cause your blood glucose level to rise. They can also make it harder for your body to use insulin. Your doctor will want you to test your blood glucose and urine ketones more often when you are sick. (Consult your doctor or diabetes educator to make this part of your sick day plan). People with type 1 diabetes who have high blood glucose levels with ketones in their urine are vulnerable to a life-threatening condition called diabetic ketoacidosis (DKA). Symptoms of this condition include thirst, nausea and vomiting, abdominal pain, headache, and drowsiness. People with type 2 diabetes, especially those over 60, should be aware of a similar condition called hyperosmolar hyperglycemic nonketotic coma (HHNK). Both conditions can lead to a coma and should be considered emergency medical situations. Because your blood glucose can rise quickly when you are sick, you need to check your blood glucose more often than usual. If you have type 1 diabetes, you need to check both your blood glucose and your urine ketone levels. You may need to check as often as every 2 hours. If you have type 2 diabetes you may be able to check your blood glucose less frequently, and you may not have to check for urine ketones.
PREVENTION
Everyone with diabetes should receive a yearly flu shot. The best time to receive the shot is in the fall. That way you are covered before the flu season hits. People with whom you live or come in close contact should also have a flu shot, for their benefit - and yours. If you have an allergy to eggs or egg products, then you are not a candidate to receive the flu shot. People that are 65 years or older with or without diabetes should receive a pneumonia vaccine. The pneumonia vaccine is especially important if you have kidney disease. Be sure to talk with your healthcare provider about receiving these important, life saving vaccines.
TAKE IT EASY
Rest. Stay warm. Ask someone to help take care of you. This will help your body to recover more quickly. Do not exercise when you are sick - it can make your blood glucose go down too low or up too high.
WHAT TO EAT & DRINK
Try to eat foods from your usual meal plan. If you can’t stick to your usual foods, follow your sick day plan. It should include foods that are easy on your stomach. Try to eat food with about 15 grams of carbohydrate every hour. If you have a fever, are throwing up, or have diarrhea, you may lose too much fluid. Try to drink a cup of fluid each hour. If your blood glucose level is over 240 mg/dL, drink sugar-free liquids like water, sugar-free ginger ale, or broth.
WHAT MEDICATIONS TO TAKE
Most likely, you will continue your insulin or diabetes pills, and you may even need an extra dose. If you have type 1 diabetes and your glucose levels are going up, your doctor may have you take extra short-acting insulin to bring your blood glucose levels down. If you control your diabetes with an eating plan and exercise or with medications, you may need to take insulin when you are sick. Your doctor may want you to keep a bottle of insulin on hand for sick days. Be sure you know how to give yourself an insulin shot before a sick day happens.
COUGH AND COLD MEDICATIONS
There are several cough medications available without sugar, alcohol, fructose, sorbitol or unnecessary dyes. Cough syrups contain cough suppressants as well as cough expectorants to loosen chest congestion. Some other over-the-counter items to consider on a sick day:
Lozenges. A recent study examined the effects of sugar-free zinc gluconate glycine lozenges on blood glucose control in people with diabetes. After 10 days of dosing, both groups showed modest reductions in blood glucose levels. These changes were not statistically significant. The results led researchers to suggest that sugar-free zinc lozenges can be administered safely to people with diabetes without affecting their blood glucose levels.
Decongestants are available to unstuff a stuffy nose. But these products, such as pseudoephedrine (Sudafed) can raise blood glucose and blood pressure (generally nasal spray decongestants are safer than pills), so avoid medications that contain these ingredients.
If possible, avoid products that have alcohol and caffeine as ingredients. When in doubt about what products to take, speak to your healthcare provider or Walgreens pharmacist for advice.
FOODS FOR YOUR SICK DAY:
Increased fluid intake with calorie-free liquids, such as water Broth-based soup — chicken noodle, chicken rice, or vegetable beef Small cans of apple or cranberry juice (clear liquid)
Crackers
Dry package of regular gelatin
Dry package of pudding
Equipment and Medicines: Ketone testing equipment*
Quick acting insulin+
Thermometer
Cold and fever medicines*+
Anti-vomiting medicines*+
Anti-diarrhea medicines*+
*Ask your doctor to recommend or prescribe.
+Do not take medications past the manufacturer’s expiration date.
