Managing Diabetes During Sick Days

WHAT YOU SHOULD KNOW:

• When you have diabetes and are sick, your body releases hormones that cause your blood sugar levels to rise. Your blood sugar levels may rise when you have a cold or the flu. They may also rise because of other conditions such as surgery, injury, and emotional stress. It may be harder for you to manage your blood sugar levels while you are sick. You will need to follow a special plan to manage your blood sugar levels. This plan is sometimes called a sick day plan and it is developed by you and your caregiver. This plan will help you to manage your blood sugar levels and prevent dehydration (loss of too much body fluid) and other serious health conditions.
  
  
• Very high blood sugar levels can lead to a buildup of chemicals called ketones in the blood and urine. This buildup of ketones leads to a serious condition called diabetic ketoacidosis (DKA). DKA may happen to people with type 1 or type 2 diabetes. Uncontrolled high blood sugar levels can also lead to dehydration. Dehydration may lead to another serious condition called hyperosmolar hyperglycemic state (HHS). HHS usually happens in older people with type 2 diabetes. However, it can happen in people of any age and in people with type 1 diabetes.

AFTER YOU LEAVE:

Medicines:

• Keep a list of your medicines: Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Do not take any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.
  
  
• Take your medicine as directed: Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver.

Ask your caregiver when to return for a follow-up visit. Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.

What steps should I follow during sick days?

• Check your blood sugar often. You need to check your blood sugar levels at least four times a day if you have type 2 diabetes. You need to check your blood sugar every 4 hours if you have type 1 diabetes.
  
  
• Check for ketones. You can check for ketones in your urine or blood at home. Ketone test kits are sold in pharmacies and some stores. You can also buy meters that measure the amount of ketones in your blood. To check for ketones, follow the instructions that come with the ketone test kit or meter. Ask your caregiver which type of ketone testing is best for you. Your caregiver will tell you when and how often to check ketones.
  
  
• Keep using your insulin or diabetes medicine. Do not stop using your diabetes medicine or insulin or change your usual dose. Diabetes medicine and insulin are needed to lower your blood sugar levels. If you take diabetes medicine, you may also need to use insulin while you are sick. If you already use insulin, you may need extra insulin while you are sick. You caregiver will tell you if you need to make changes to how you use your diabetes medicine or insulin. Talk to your caregiver before taking any over-the-counter medicines.
  
  
• Drink plenty of liquids. Drink about eight ounces (one cup) of liquid each hour. Drink sugar-free liquids such as water, diet soda, or sugar-free powders mixed with water.
  
  
• Follow your usual meal plan as closely as possible. Eat your meals as usual. If you cannot follow your meal plan, eat other foods that are easy for your body to digest (break down). If you are eating less food than normal or cannot eat any foods, drink liquids with calories in them.

What foods may be easier for me to tolerate while I am sick? It may be hard for you to follow your usual meal plan when you are sick. If you are nauseated (feeling sick to your stomach) it may also be hard to keep food down. You may also be vomiting (throwing up). The following are foods that may be easier for you to eat while you are sick. Keep these foods on hand for sick days. Each of the foods listed below has about 10 to 15 grams of carbohydrate.

• Liquids:
  
  
  • One-third to one-half cup of fruit juice. (Check food label for serving size that contains 15 grams of carbohydrate).
    
    
  • One-half cup of regular soda.
    
    
  • One cup of milk.
    
    
  • One double-stick popsicle.
    
    
  • One cup of a sports drink.
  
  
• Foods:
  
  
  • One-half cup of regular gelatin.
    
    
  • One-half cup of cooked, hot cereal.
    
    
  • One-half cup of sugar-free pudding or one-quarter cup of regular pudding.
    
    
  • One-half cup of mashed potatoes.
    
    
  • One-quarter cup of sherbet.
    
    
  • One-half cup of regular ice cream.
    
    
  • One slice of dry toast.
    
    
  • Six saltine crackers.
    
    
  • Three graham crackers.
    
    
  • One-half cup of macaroni or noodles.

What is my sick day plan? You and your caregiver will develop a sick day plan that is right for you. Your sick day plan may also change over time based on your needs. Family or friends who will be helping you while you are sick should also know about your sick day plan. Place your sick day plan in a place that is easy for you or someone else to find.

Risks: If left untreated, DKA can lead to a coma and death. HHS is also very serious and can cause other health problems and lead to death if left untreated.

CONTACT A CAREGIVER IF:

• You have been vomiting and not able to keep food down for more than six hours.
  
  
• You have had diarrhea for more than six hours.
  
  
• You have a fever (increased body temperature).
  
  
• Your ketone levels are higher than what your caregiver has told you they should be.
  
  
• Your blood sugar levels are higher than what caregivers have told you they should be.

SEEK CARE IMMEDIATELY IF:

• You cannot keep food and liquids down.
  
  
• You have trouble breathing.
  
  
• You have signs of dehydration such as:
  
  
  • Drowsiness or confusion.
    
    
  • Dry eyes or mouth.
    
    
  • Irregular or fast breathing, fast or pounding heartbeat, and low blood pressure.
    
    
  • Leg cramps.
    
    
  • Weakness or dizziness.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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