Lee Chung Horn
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   DIABETES MELLITUS

 

ILLNESS

Plan ahead for under-the-weather days

Being sick can make your blood glucose (sugar) 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 diabetes. People with type 2 diabetes, especially older people, can develop a similar condition called hyperosmolar hyperglycemic nonketotic 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 sugar 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 dietitian. 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: 

1 you've been sick or have had a fever for a couple of days and aren't getting better

2 you've been vomiting repeatedly or having diarrhea for more than 6 hours

3 you have moderate to large amounts of ketones in your urine

4 your glucose levels are higher than 18 mM even though you've taken the extra insulin your sick-day plan calls for

5 you take pills for your diabetes and your blood sugar level climbs to more than 18 mM before meals and stays there for more than 24 hours

 6 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)

 7 you aren't certain what to do to take care of yourself

Keep Your Notebook Handy for the Sick Days

No matter what kind of diabetes you have, your sick-day plan will tell you to measure your blood sugar and urine ketones more often than usual. If you have type 1 diabetes, you may need to measure blood sugar and urine ketones every four to six 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 sugar four times a day may be enough. You might only need to measure ketones if your blood sugar is higher than 18 mM. If you do not have a blood glucose meter, talk to your diabetes educator about getting one.

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 (sugar) when you are sick.  If you have type 1 diabetes, your doctor may have you take extra insulin to bring down the higher blood sugar 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 or nauseous. 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 noncaloric liquids (like plain water) to keep from getting dehydrated. 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 sugar (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 easy-on-the-stomach foods like regular (nondiet) gelatin, crackers and soups.

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 or dietitian may tell you to drink sugared (not diet) soft drinks. Other high-carbohydrate liquids and almost-liquids are juice, frozen juice bars, sherbet, pudding and creamed soups. 

Medicines to Watch Out For

You may want to take extra medicines when you are sick. For example, 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 sugar levels, even if they don't contain sugar. Aspirin in large doses can lower blood sugar levels. Some antibiotics lower blood sugar levels in people with type 2 diabetes who take diabetes pills. Decongestants and some products for treating colds raise blood sugar levels.


 

Copyright of Lee Chung Horn Diabetes & Endocrinology 2009