Sick Day Rules for People With Diabetes

How to Prevent an Emergency

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Any type of illness, whether it be the common cold, flu, or something else, puts stress on the body. While the body tries to fight the illness, glucose-raising hormones such as glucagon are released. In addition to raising glucose, these hormones also interfere with the blood-glucose lowering effects of insulin, making diabetes harder to control. How you manage your diabetes when you are sick is important. If not managed correctly, extremely high blood sugars during illness can result in an emergency.

People with type 1 diabetes are at increased risk of developing a hyperglycemic emergency, called ketoacidosis. At high levels this buildup of acid can be toxic. Those who have type 2 diabetes can develop a similar condition called hyperosmolor hyperglycemia nonketotoic coma. Both conditions can be life-threatening.

Having a plan of action can not only prevent an emergency, but can also help alleviate extra stress and enable you to focus on rest and recovery. Once you've developed a plan, make sure to share it with your loved ones and caregivers.

What Is a Sick Day Plan?

Create your sick day plan with your diabetes team, including your primary care physician, endocrinologist, dietitian, or certified diabetes educator. Your plan should include a list of all your doctors' names, numbers, and addresses. You'll want to know how to contact your physicians during an emergency, especially during hours they are outside the office (e.g. holidays, weekends).

In addition, include a list of all the medicines you take and when you take them. Your doctor may even give you instructions on how to adjust your medicines when your blood sugars are elevated. Review how often you should be testing your blood during times of illness and decide with your team when it's important to get in touch with your doctor.

Check Your Blood Sugar

Measuring your blood sugar is an important factor in controlling your diabetes, especially when you are ill. In fact, you may need to test your blood sugar more frequently when you are sick to prevent your blood sugars from spiking. Most people benefit from measuring blood sugar every four hours. Keep a glucose log to identify how your sugar is responding to your medicine, food, and beverage intake. Make medication and food adjustments as needed.

For example, if you are eating a normal diet and taking your normal dose of medicine, and your blood sugars are above goal you may need to increase your insulin. If you have a blood sugar that is greater than 250-300 mg/dL on multiple checks and you've taken your medicine, you should check your urine for ketones. Monitoring your ketones can help to prevent ketoacidosis as well.

What Are Ketones and When Should I Check for Them?

The body uses glucose as its primary source of energy. But, when there is no insulin to transport it out of the cells, the body transforms into an "energy crisis" and starts to break down body fat into ketones as an alternative fuel source. High levels of ketones in the body can be toxic. When you are sick, ketone levels can increase for multiple reasons—you did not inject enough insulin, your insulin needs are higher due to elevated blood sugars, or you are unable to eat enough food.

  • To prevent diabetic ketoacidosis, you should check for ketones if your blood sugars are over 250 mg/dL.
  • If you have type 1 diabetes, you may need to measure blood glucose and urine ketones every four hours.
  • If you have type 2 diabetes, checking blood glucose four times a day may be enough. You might only need to measure ketones if your blood glucose is higher than 300.

Eat and Drink Regularly to Prevent Dehydration

Preventing dehydration when you are sick is important because dehydration and electrolyte imbalance can contribute to excess acid in the bloodstream with dangerously high blood glucose levels. Dehydration often requires in-hospital treatment with intravenous fluids. In order to prevent dehydration, aim to drink and eat your normal diet as best you can. Drink extra, non-calorie beverages (such as water and seltzer) to replace any lost liquids. Adequate fluid intake can also aid in flushing out extra sugar (and possibly ketones) in your blood. Drinking through a straw or sucking on ice chips can be helpful too.

If, however, you are unable to eat a regular diet, try eating bland foods. It may seem counterintuitive to a typical diabetes eating plan, but ingesting dry toast, English muffins, crackers, rice, broths, juice bars, sherbet, pudding, and apple sauce can help to stabilize your blood sugar.

If you absolutely can’t eat, you will need to drink beverages that contain calories, such as sports drinks, regular sweetened ginger ale, apple juice, flavored ice, etc. These types of beverages can provide you with some glucose and electrolytes. Small, frequent sips will help you stay hydrated and increase the likelihood that you'll keep the beverages down. The American Diabetes Association suggests you aim to consume about 50 grams of carbohydrate every three-to-four hours. For example, 28 ounces of Gatorade contains about 49 grams of carbohydrate, meaning you'd have to drink about 7 ounces every hour or so.

If you are just too sick to consume any food or beverage and you are losing weight, you should call your doctor.

Take Your Diabetes Medicines

Because being sick naturally increases your blood sugar, skipping your medicine can cause your blood sugars to increase even higher. Unless directed otherwise by your doctor, it's important to take your medicine, insulin or oral medicine, as directed. Even if you are vomiting and are unable to eat, you will still need to take your medicine. In fact, some people who take insulin may need to increase their doses during times of illness. Understandably this can be confusing and even a bit scary. Therefore, if you feel uneasy about taking your medicine, call your physician to confirm if your doses need to be adjusted.

Be Cautious With Over-the-Counter Medicines

Over-the-counter medicines contain active and inactive ingredients that can make your blood sugar go up or down. For example, cough syrup generally contains sugar, which naturally raises blood sugars. Before purchasing any new medication, discuss the effects with your pharmacist. Or better yet, ask your doctor to include which medicines are safe and which you should avoid in your sick day plan. You will want to know what to look out for so that you can be prepared.

Know When to Call Your Doctor

You don't have to call your doctor every time you get sick. Nonetheless, the American Diabetes Association and the CDC, recommends that call your doctor for the following reasons:

  • You are unable to eat and have not been able to keep food down for more than 6 hours
  • You have been sick or have had a fever for more than a few days and are not getting better
  • You have a fever of 101 or higher
  • You have diarrhea or are vomiting
  • Your blood sugar is <60mg
  • Your blood sugar is >240mg/dL for multiple checks even though you have taken your medicine
  • You take oral pills for your diabetes and your blood glucose level climbs to more than 240 before meals and stays there for more than 24 hours
  • You have moderate or large ketones in your urine (this increases your risk of developing ketoacidosis)
  • You have symptoms of ketoacidosis or dehydration: your breath smells fruity, your chest hurts, you have trouble breathing, your lips are dry and cracked
  • You lose 5 lbs or more
  • You are sleepy or not sure how to take care of yourself

Know When It Is an Emergency

If you are a caregiver of a child or elderly person with diabetes, it's particularly important that you know the signs and symptoms of diabetic ketoacidosis, especially if she cannot express her feelings or needs clearly. Some of these can be confused with just feeling sick, but it's important to be aware of them anyway. 

Early signs include:

  • Feeling tired or fatigued
  • Excessive thirst and/or excessive urination
  • Signs of dehydration such as dry mouth

Later signs include:

  • Weight loss
  • Nausea/vomiting
  • Abdominal pain
  • Chest pain
  • Confusion
  • Rapid, deep, labored breathing (Kussmaul's respirations)
  • Breath that smells fruity
  • Fever
  • Unconsciousness

If you notice any of these signs, you'll want to check for ketones and call her physician right away.

Wear Your Medical ID

If you have to be sent to the emergency room, you should be wearing your diabetes ID so that personnel can identify you as someone who has diabetes. If you don’t have an ID, make sure you or your loved ones communicate with the physicians and staff, alerting them that you have diabetes and listing which medications you take.

If you don't have a medical ID and are looking for something stylish, check out Lauren's Hope Medical ID Jewelry.

A Word From Verywell

Being sick can increase your blood sugars by increasing glucose-raising hormones and inhibiting insulin's glucose-lowering effect. But, that doesn't mean just because you are sick that you can't manage your blood sugar safely and effectively. Having a sick day plan can help you to focus on healing, while preventing a diabetes emergency. Including information such as, physician names, numbers, and contact information during off hours is very important. Additionally, you'll want to know how often you should test your blood sugars, what foods and drinks you should be consuming, when you should test for ketones, and how to identify a hyperglycemic emergency. Taking these precautions before you get sick will enable you to focus on getting healthy without overworrying about your diabetes.

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