When You Are Sick

People with diabetes are well aware of the importance of diabetes control. Management may be difficult during episodes of acute illness (such as a cold or flu) or perhaps surgery. These types of stress cause the body to produce hormones. Release of stress hormones results in increased glucose production by the liver and insulin resistance.

Thus, it is important to have a sick day plan in place to prevent high blood glucose levels from getting out of control, which could lead to unnecessary hospitalizations for DKA or Hyperosmolar Hyperglycemic Nonketotic Syndrome. Meet with your healthcare team to develop guidelines to assist you at these times. When possible, have someone with you for support and assistance as needed. Your sick day plan should include: monitoring; medication; food intake; and when to call for help.

Monitoring:

• Always be sure you have plenty of blood sugar test strips and ketone testing materials that have not expired.
• Check blood sugars every two to four hours around the clock.
• If your blood sugar is over 250 mg/dl, check urine or blood for ketones.

Diabetes Medication:

• If you are on oral medications, take your medication as usual if possible. You may need to have short-acting insulin and syringes available. (Make sure it is not outdated and you or someone else knows how and when to use it.)
• Never omit insulin. Without insulin, your body cannot process sugar properly. You may actually need more insulin to counteract insulin resistance. You should have a protocol to use to help you adjust your doses properly whether you take insulin by injection or use an insulin pump.

Food intake:

• If possible continue with your regular meal plan. It is especially important to eat carbohydrates to prevent lows.
• If you are nauseated or just don’t feel like eating, try eating or drinking small amounts (about 15 grams).
• Replacing fluids is extremely important. Again small sips of things like flat "regular" Coca-Cola, 7-Up, ginger ale, or Gatorade® especially.work well. Sucking on ice chips or Popsicles are also beneficial.
• Foods and liquids that contain 15 grams of carbohydrate:
  • 1 cup chicken soup (broth based)
  • 1 cup cream soup (made with water)
  • 1/2 cup cooked cereal
  • 1/2 cup vanilla ice cream
  • 1/2 cup regular gelatin
  • 1/2 cup ginger ale, 7-UP or cola (not diet)
  • 1/3 cup grape juice
  • 1/2 cup apple juice

Regular Medications:

Some over-the-counter and prescription medications contain carbohydrate, but usually not in large enough amounts to significantly affect blood glucose levels. However, there may be some that do raise them as part of their action. Check with your pharmacist or health care team.

When to call for help:

Even with a sick day plan, you may need assistance from your healthcare team or emergency care. Seek medical assistance if:

• You’re not sure what to do
• You are unable to eat or drink for more than four hours
• You’ve had intractable vomiting or diarrhea
• You have moderate or large ketones
• You have any signs of ketoacidosis
• Your blood glucose levels say high even though you have followed your sick day protocol

Always be ready for a sick day:

• Create a designated area that contains items you need to manage sick days. Make sure it is easily accessible and you check it frequently to make certain you have what you need and nothing is expired. Things you need include:
  • Your sick day plan
  • Monitoring supplies
  • Telephone numbers for your healthcare team and local hospital
  • Something to record monitoring results, food and fluid intake
  • A carb-containing liquid

For more information

Sick_day management From Diabetes Self Management.

Diabetes Sick Days From Web MD

When You're Sick From the ADA