Diabetes management: Creating your sick-day plan

You don't feel well. Your temperature is high, you're tired and you've lost your appetite. Perhaps you're coming down with a cold or the stomach bug that's going around the office. Having diabetes only adds to your concerns.

When you're sick, your body produces hormones to help fight the illness. These hormones raise your blood sugar by preventing insulin from working effectively. In people without diabetes, the additional sugar helps promote healing. But when you have diabetes, the fluctuations can result in dangerous diabetes complications.

To help prevent a medical emergency, make a comprehensive sick-day plan part of your diabetes management.

Start with your health care team

Talk to your doctor and other members of your diabetes care team about your sick-day plan. Your plan should take into account your overall health, including any conditions other than diabetes that require medication. Make sure your sick-day plan includes:

• What medications to take
• How often to measure your blood sugar and urine ketones
• How to adjust your insulin dosage, if you need insulin
• How to adjust your insulin dosage, if you need insulin
• When to call your doctor

• Also identify a loved one or friend who can contact your doctor or help you seek emergency care if you experience diabetes complications.

  Diabetes sick-day plan (PDF file requiring Adobe Reader)

  Keep close track of your blood sugar and urine ketone levels

  Continue taking your diabetes medication when you're sick, and remember to test your blood sugar often. You may need to adjust your insulin doses or other medications. If your blood sugar is higher than 300 milligrams per deciliter (mg/dL) or you're unable to keep fluids down, consult your doctor.

  Here are some general guidelines:

  • Type 1 diabetes. Check your blood sugar and urine ketone levels every four hours.
  • Type 2 diabetes. Check your blood sugar levels four times a day. If your blood sugar is higher than 300 mg/dL, check your urine for ketones. Make sure your test strips haven't expired.

  Excessively high blood sugar can lead to ketoacidosis, especially in people who have type 1 diabetes. People who have type 2 diabetes — particularly older adults — may develop a similar condition called hyperosmolar nonketotic coma. Both conditions can cause confusion, difficulty breathing or coma. Sometimes these conditions can be fatal.

  Stick to your diabetes meal plan

  With a minor illness such as a cold, you may be able to stick to your diabetes meal plan — which will help ensure blood sugar stability. Remember to check the sugar content of any over-the-counter medications you take. Many cough syrups and other liquid cold preparations are high in sugar.

  If you have nausea, vomiting or diarrhea, you may not be able to eat your regular foods. But it's still important to get enough carbohydrates. Try these foods, which contain about 10 to 15 grams of carbohydrates:

  • 1 double-stick frozen fruit pop
  • 1 cup milk
  • 1/2 cup fruit juice
  • 1/2 cup regular soda (not diet)
  • 6 saltine crackers
  • 3 graham crackers
  • 1 slice dry toast
  • 1/2 cup regular (not artificially sweetened) gelatin

  In addition to sipping fruit juice or sweetened beverages, drink at least 8 ounces of water or other calorie-free liquid every hour you're awake. If you're not able to keep anything down, remember to monitor your blood sugar closely and consult your doctor.

  Know when to contact your doctor

  Diabetes complications can quickly become dangerous. Contact your doctor if:

  • Your blood sugar is higher than 300 mg/dL
  • Your blood sugar is higher than 240 mg/dL for more than 24 hours
  • Your urine ketone level is moderate to large
  • You feel sleepier than usual or can't think clearly
  • You vomit for more than six hours
  • You have diarrhea for more than six hours
  • You feel confused and can't think clearly
  • Your lips and tongue appear dry and cracked

  Think prevention

  High blood sugar can weaken your immune system. This makes you more likely to get a cold or the flu — and more vulnerable to serious effects of common illnesses. To reduce the risk of getting sick:

  • Get vaccinated against pneumococcal pneumonia and the flu.
  • Wash your hands often.
  • Don't touch your eyes or nose with your fingers.
  • Avoid crowds during flu season.
  • Wear a mask if you must be around someone with an upper respiratory infection.

  No one plans to get sick, but it happens. Feel confident and secure in your ability to manage your diabetes by following your sick-day plan.

• http://www.mayoclinic.com/print/diabetes-management