Past Feature Article

Managing Your Diabetes: Sick Days

Written by: Terrence T. Towers, R.Ph. Rite Aid Pharmacist and Diabetes Care Specialist at Rite Aid Store 2796 in Corinth, NY

Whenever people with diabetes acquire an illness such as the flu, the common cold, or any infection, their blood glucose readings may increase. These ?Sick Days? can make it difficult to keep blood glucose levels within target range.

The body is under stress when you are sick. This stress causes the release of specific disease fighting hormones which will raise blood sugar levels and decrease the glucose lowering effects of insulin or your diabetes medications. Extra precautions must be taken to prepare yourself for an illness.

A sick day plan should be developed with your health care team before illness occurs. The plan should include:

Taking your medications as usual. Your physician may advise you to add or increase insulin to make up for higher blood glucose levels. If you are on oral medications, you should continue taking them as you normally do, unless your physician advises you to do otherwise. You should also discuss appropriate over the counter medications for relief of cold symptoms with your physician and have these products on hand. When selecting products, be sure to check labels for sugar content ? other inactive ingredients used for sugar include dextrose, glucose, fructose and dextrin. If you are vomiting and taking oral diabetic agents, consult your physician.
Monitoring blood glucose and ketones more often than usual. If you have type 1 diabetes you should check both your blood glucose levels and ketones every 4 hours. If you are a person with type 2 diabetes, blood sugar should be checked 4 times a day and urine ketones should be checked if your blood sugar is greater than 300mg/dl unless your doctor advises otherwise.
Maintaining diet as usual (at least 45 to 50g of carbohydrates every three to four hours). You should eat mild foods which are easy on the stomach such as non-diet gelatin, soups, cooked cereals, toast, crackers and applesauce. If these are even difficult to eat, use foods which are liquid based but contain carbohydrates including fruit juice, non-diet soda, sports drink, frozen juice bars, sherbet, fruit flavored yogurt, milk, pudding, broth and creamed soups. (i.e. 1 cup of clear soup, 1/2 cup of regular gelatin, ? cup of regular soft drink, 1/2 Popsicle, ? cup of unsweetened applesauce, 1/3 cup of the apple juice, 1/2 cup of sports drink).
You should avoid dehydration by drinking plenty of liquids. If you are eating whole foods, stick to calorie-free liquids such as water, tea without sugar and diet soft drinks. If you are unable to consume regular food, meet your carbohydrate goals with calorie-containing liquids, such as juice, regular soda, and sports drinks (goal of 1/2 cup (4 ounces) to 3/4 cup (6 ounces) every half hour to hour). In addition, remember to use diabetic exchanges: each starch/bread exchange contains 15 grams of carbohydrates; each fruit exchange contains 15 grams of carbohydrates; each milk exchange contains 12 grams of carbohydrates.
When to call your health care team. You should contact your healthcare provider if you have:
- moderate to large amounts of ketones persist for more than twelve hours
- blood glucose greater than 240mg/dl despite giving yourself extra insulin
- blood glucose greater than 240mg/dl before meals and stays there for more than 24 hours (diabetics who take oral medications)
- vomiting or diarrhea that has lasted for > 6 hours and you feel too sick to eat
- fever of 101.5 or higher, if fever is rising, or if you have had a fever for more than 24 hours
- stomach pain, vomiting, rapid breathing, or sweet, fruit-smelling breath

Make sure to record pertinent information for your health care provider such as how long you were sick, any weight loss, temperature readings, blood sugar readings, urine ketone levels, medications taken and eating habits.

References

Anonymous. American Diabetes Association: When you?re sick (www.diabetes.org). Accessed on 12 October 2004.
Anonymous. Diabetes and Sick Days. (http://www.clevelandclinic.org/health/health-info /docs/0100/0105.asp?index=4104). Accessed on 13 October 2004.
Anonymous. Managing Sick Days. (http://my.webmd.com/content/article
/46/1667_50929.htm?lastselectedguid=
{5FE84E90-BC77-4056-A91C-9531713CA348}). Accessed on 13 October 2004.
Anonymous. Taking Charge of Your Diabetes. (http://www.cdc.gov/ diabetes/pubs/tcyd/ktrack.htm). Accessed 12 October 2004.