When I first developed diabetes, I worried about many things: travel, work and how to fit my new life into it, and what I would do if I got sick. I had worked with many youngsters who had diabetes and knew the perils I might face, so I set about to make sure I was never caught without the foods or medications I would need for the flu or a cold. I read up on the subject because, as we have said many times, “We don’t want bad surprises, only good ones”.
One thing I found out right away is that if you are ill, you’re blood glucose levels can go straight up. It can also be life threatening so when you become ill, it is important to have a plan that you understand and can put into action. You need to have the right supplies in terms of medications and food and in the later fall and winter when the flu is everywhere, I make sure I have extras of all of the medications that I routinely take.
I wanted to know why blood glucose levels rose when ill. Your body is stressed when you become sick. To deal with this stress, your body releases hormones that help you fight the illness, 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 ill, it is easier to lose control of your diabetes.
Ketoacidosis leading to a diabetic coma can become a real possibility for 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 can be life-threatening.
So what can you do before hand? Prepare a plan for sick days in advance. You might sit down with your physician or diabetes educator and work it out together. Make sure you come with questions that you need answered. If you’ve had diabetes for a while, you’ll have plenty of these from past experiences. I for one, like to know the why’s and the how’s of what is happening to me so I can feel I’m in control. You may want to share the control with someone at home who will care for the flu victim, you, when it hits.
The basics of the plan should include:
- when to call the doctor
- how often to take you blood glucose level
- when to take urine ketones
- what medications to take
- how to eat
- phone numbers for doctor and diabetes educator during the week and on weekends and holidays
- phone number of pharmacy that delivers if possible
I remember the first cold I got. It was scary for me but for no one else. Luckily, my doctor was a friend and my husband knew when to call, so I did not go off the deep end. I did learn.
When to make that call:
- You have a fever that doesn’t get better for a few days
- You are in peril of dehydration from vomiting or diarrhea for more than 6 hours.
- You have moderate to large amounts of ketones in your urine.
If you are a type 1 diabetic and your blood glucose levels are higher than 240 mg/dl before meals and stay high for more than a day even though you are taking extra insulin as prescribed by your sick days plan.
If you are a type 2 diabetic and take oral medication and your blood glucose levels remain above 240 mg/dl before meals for more than 24 hours.
You have symptoms that might signal ketoacidosis of dehydration or some other serious condition such as heart, kidney, or lung disease. Ask for help if you breath smells fruity, or your lips or tongue are dry and cracked.
Finally, call if you just don’t know what to do. Most doctors want to know when you’re ill and not getting better. It’s easier to treat someone who isn’t in a crisis.
Be ready to tell the doctor what concerns you. Have all of your medications handy so you can share what you are taking. Share how long you’ve been ill, whether you have lost weight, your blood glucose levels, your temperature, what you are eating and if you are able to keep it down.
As part of your sick day provisions, have a note book ready with your notes on how to care for yourself. You will also need a place in the book for a record of your blood glucose levels. When you’re sick you may need to take your levels every 4 hours and also measure for ketones. When you’re sick these waste products are more likely to build up. If you have type 2 diabetes you may have to check your blood glucose levels four times a day as well as your ketones, especially if your blood glucose levels remain high.
When you’re sick and if you have either type 1 or type 2 diabetes, you need to continue to take your medications. You may have to increase the amount of insulin you take if you’re a type 1 diabetic. If you’re a type 2 diabetic you may have to take insulin for the short haul to get your diabetes under control. In either case, follow your doctor’s instructions. and let him or her know how you are doing.
Food can be a problem when you are ill. Both eating and drinking can a part of the problem, but you will need to try to continue to eat normal meals if you can. Also you should try to drink more noncaloric liquids (like water or diet soda) so that you don’t become dehydrated Extra liquids help you get rid of the extra sugar (and possibly ketones) in your blood. If you can’t keep to your meal plan, try to take in your normal number of calories by substituting regular soda, sherbet, creamed soups, yogurt, juice and frozen juice bars. Keep applesauce and regular gelatin on hand as they are good to eat when you are ill. I know, you’re saying that you could have given your right hand for some good sherbet when you weren’t ill, but remember you have taken your meds and need to eat the correct number of calories. What you don’t need is the extra burden of hypoglycemia.
Now we need to talk about over-the-counter medications that you may want to take to control the symptoms of a cold or flu. Many medications you take to control these can effect blood glucose levels. Many have sugar, although a small amount may not be a disaster. But think of it, aspirin in large doses can lower blood glucose levels. Some antibiotics lower blood glucose levels in people with type 2 diabetes who take certain oral agents. Decongestants and some other cold medications can raise blood glucose levels. These are the facts you need to know about so that you can get answers from your physician as to how to treat colds and the flu before you get sick. If you go to the emergency room, make sure you let them know you have diabetes and the type you have. Presumably, you are wearing a medial alert bracelet or necklace, but a word to those who treat you is well worth it.
There are two injections that all of us should have, the flu shot yearly, and the pneumonia shot. For most people, one pneumonia shot is enough: for those of us with diabetes one every 6 years is a good idea. Having the flu can be dangerous for anyone, but is extra serious for those with diabetes or other chronic diseases. Make sure you get a flu shot in the fall. These are not 100% protection, but they do make it harder to catch it for about 6 months after your inoculation. It is recommended that those you live with get the flu shot also as if they are protected you won’t have as much as a chance to come down with it. Don’t take a flu shot if you have a respiratory illness. Also, don’t take a flu shot if you are allergic to eggs.
Older people tend to get pneumonia more easily and those with kidney disease may be at particular risk. The AMA suggests that diabetics receive inoculation. My thought is that if I don’t have to have this disease again, that’s fine with me. Once when my children were young was enough.
Let’s go through all of this information one more time. Talk to your health care provider before the fall flu and cold season so that you are in the know about how to care for yourself. Educate others in the home about sick days precautions and treatments. Keep medications and food stuffs on hand. Get a flu shot and make sure others in your home are also protected. Have a booklet with all information in one place. In it have listed interventions, doctors phone numbers for during the week and weekends and holidays, and place for your increased blood glucose monitoring numbers. We all get colds, but with this type of information, you should be able to get through it with little stress and less time off of your feet.