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Taking Care of Your Diabetes When You Are Sick

IMAGE Whether you have a head cold or the flu, being sick can put all of your activities on hold. You are forced to stop and take care of yourself. But, if you have type 1 or type 2 diabetes, this demands extra attention.
Why is that? When you are sick, you are more likely to have a high blood sugar (glucose) level also known as hyperglycemia. This happens because your body creates more hormones to fight infection, and these hormones can counteract the effects of insulin. If insulin cannot do its job, then glucose builds up in the blood.

Test Your Blood Sugar Often

Being sick puts you at risk for hyperglycemia so you should consider checking your blood glucose more often. You may need to test several times a day, even if your normal routine is to test just once a day.
What is considered high? This depends on your target range. According to the American Diabetes Association, you should aim for tight control, keeping glucose levels as close to normal as possible (70-130 milligrams per deciliter [mg/dl] before a meal, less than 180 mg/dl after a meal). But not everyone is able to achieve this. Ask your doctor what levels are right for you and when you should call for additional medical advice.
You also need to know how to adjust your medication to treat high glucose levels. Ask about the amount of insulin you should give yourself to bring the levels down. If you take oral diabetes medication, find out how to adjust the dose. If you do not already have this information, work with your doctor to create a 'sick day plan' so that you will be prepared.
In addition to testing your blood glucose levels, be alert for the symptoms of hyperglycemia such as having to urinate frequently, being very thirsty, and having blurry vision.

Test for Ketoacidosis

If you have diabetes and high glucose levels, you are at risk for a dangerous condition called ketoacidosis, especially if you have type 1 diabetes. Ketoacidosis happens because the body does not have enough insulin, and your body cannot use glucose for fuel. Instead yur body uses protein and fats for fuel. This leads to a build up of a by-product called ketones. When they build up they can make you seriously ill.
Symptoms usually begin with very dry mouth and frequent urination. Later, you may experience fatigue, dry or flushed skin, nausea and vomiting, abdominal pain, difficulty breathing, fruity odor on breath, and confusion. If you have any of these symptoms, CALL 911.
Ketone levels can be checked with urine tests that are sold at drug stores. Ask your doctor whether you should check for ketones while you are sick and when you should test (eg, blood glucose level over 240 mg/dl). Call the doctor if the results show moderate to large amounts of ketones.

Stick to Your Routine

When you are feeling nauseous or vomiting, the last thing you want to do is eat. But when you have diabetes, it is important to stick to your regular meal plan. Your body needs the same amount of carbohydrates that it’s accustomed to.
So how do you do this? Ask your doctor or dietician how to make food exchanges so you get the nutrients that you need. For example, try eating broth-based soups, saltine crackers, and frozen fruit bars. If you have had vomiting or diarrhea, replenish the lost fluids.
Remember to continue taking your insulin even if you are not eating your regular diet. However, your dose of insulin may need to be adjusted. Call your doctor if you have severe vomiting or diarrhea or your eating pattern has changed a lot.
Insulin without adequate food intake can lead to low blood glucose (hypoglycemia). Some of the symptoms of having a low glucose include shakiness, dizziness, headache, sweating, and hunger. When your glucose levels fall below 70 mg/dl you may drink soft drinks (with sugar), juice, and sports drinks (with sugar and carbs). They should help your glucose rise quickly.

Take Your Temperature and Carefully Choose Cold Medicines

Have a thermometer and cold medicine in your medicine cabinet. If your temperature is over 101°F (38°C), call the doctor.
Read the labels carefully on the cold medicines. Some cold medicine medications contain ingredients that can affect your blood glucose. For example, pseudoephedrine in decongestants can raise your blood glucose level. Other medicines have sugar or alcohol. These are usually safe when taken as directed. To be safe, you may want to opt for medications that are sugar-free and alcohol-free.
If you have kidney disease, avoid all products that contain ibuprofen or other nonsteroidal anti-inflammatory medicines. These medications can cause kidney failure. Talk to your doctor about which over-the-counter drugs are safe for you.

Monitor Your Cold

Keep close tabs on your cold. If a couple of days have passed and you don't feel better, call the doctor. Provide details about your illness such as when you got sick, what your symptoms are, what you have been eating and drinking, what your glucose and ketone levels are, and any other important facts. If you have fatigue, stomach or chest pain, or breathing difficulty, call the doctor right away.

Get Your Shots

Avoid the flu by getting the flu shot once a year. They are typically offered starting in the Fall. If you have never been vaccinated against pneumonia, ask your doctor. One shot is all that is needed to protect you from this life-threatening infection.

Make Your Sick Day Plan

If you have not already made a 'sick day plan' with your doctor, schedule an appointment to discuss:
  • What blood glucose levels are considered high for you and when you should call the doctor
  • How to adjust your medication to bring the blood glucose level back into the normal range
  • How often you should test for ketones and when you should call the doctor
  • What food exchanges you can make if you are not feeling well enough to eat your regular diet
  • Which cold medications are safe for you
  • Whether you have had your flu and pneumonia shots
Being prepared can go a long way to help you to cope with your illness and to avoid problems, like hyperglycemia.

RESOURCES

American Diabetes Association http://www.diabetes.org/

National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/

CANADIAN RESOURCES

Canadian Diabetes Association http://www.diabetes.ca/

Public Health Agency of Canada http://www.phac-aspc.gc.ca/cd-mc/diabetes-diabete/index-eng.php/

References

Diabetes and Pneumonia: Get the Facts. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/diabetes/projects/pdfs/eng%5Ffacts.pdf. Accessed November 20, 2012.

Diabetic Ketoacidosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 3, 2012. Accessed November 20, 2012.

Take Charge of Your Diabetes. Center for Disease Control and Prevention website. Available at: http://www.cdc.gov/DIABETES/pubs/tcyd/ktrack.htm. Updated May 21, 2011. Accessed November 20, 2012.

Taking Care of Your Diabetes at Special Times. National Diabetes Information Clearinghouse website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/type1and2/specialtimes.htm. Accessed November 20, 2012.

WhenYour Blood Glucose is Too High or Too Low. National Diabetes Information Clearinghouse website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/type1and2/lowglucose.htm. Accessed November 20, 2012.

When You're Sick. American Diabetes Assocation website. Available at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/who-is-on-your-healthcare-team/when-youre-sick.html. Accessed November 20, 2012.

Type 1 Diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated September 2011. AccessedNovember 20, 2012.

Type 2 Diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated September 2011. Accessed November 20, 2012.

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