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. |