‘Tis the season for the flu!  We know people with diabetes should get flu shots, but what should you do if you still get sick?  This is a question I wrestle with every time I get hit with something as the seasons change.  I never can quite remember the “sick day rules,” nor do I have the energy to find them at the time.  So, for my benefit and yours, I have done a little research that will hopefully keep us all well through this cold and flu season. 

First and foremost, you have to check your blood sugar and check it often!  Because of the hormones associated with infection, you may need to check every two hours.  Last weekend as I battled a stomach virus, I tested almost 30 times!  I know it sounds excessive, but I tend to err on the side “it is better to know than to not know.”  The Mayo Clinic recommends that people with type 2 diabetes check their blood sugar four times a day when they are sick.

In addition to blood sugar testing, it might also be in important to check keytones.  Keytones are toxic acids in the bloodstream.    You check for keytones by using a keytone strip and dipping it in urine.  You can purchase these strips in your local pharmacy. 

If your blood sugar is over 300mg/dl, then you need to check for keytones. Excessively high blood sugar can lead to ketoacidosis.  The Mayo Clinic describes diabetic ketoacidosis as a condition where the sugar/carbs ingested can’t enter the cells of the body, therefore the body begins to break down fat for energy.  This process then deposits toxic acids into the blood called keytones.

In people with type 2 diabetes, a similar condition called diabetic hyperosmolar syndrome can result.  Diabetic hyperosmolar syndrome happens when the blood sugar level tops 600 mg/dl.  When your blood sugar gets this high, your blood become thick and syrupy.  This condition can lead to dehydration because the excess sugar passes from your blood to your urine and then triggers a filtering process that pulls large amounts of fluid out of your body. 

Needless to say, both conditions can cause confusion, difficulty breathing, coma and possibly death.  These are the main reasons why people with diabetes must be extra careful when they are sick.

As you have already gathered by the dangers of allowing your blood sugar to get too high, you should not stop your medication when you are ill.  In fact, often you will have to increase the amount of insulin to counteract the infection in your body.  Your healthcare team will be your guide.  Regardless of your food intake, make sure you continue your medication.

My biggest challenge last weekend was food.  As I mentioned, I had some sort of stomach flu and that left me unable to eat.  Then, when I wanted to eat, I couldn’t figure out what was right for me.  Mainly, I relied on Gatorade and applesauce.  Since feeling better, I have searched online for recommendations of other sick day foods. 

The American Diabetes Association has a great list with carbohydrate counts included on their website.  Here is a web snap shot:

  http://www.diabetes.org/youthzone/surviving-sick-days.jsp

Remember, taking in fluids is key when you are ill.  If you can’t eat, you can drink fluids that include carbohydrates.  Just beware of climbing blood sugars.  And don’t forget to either take your insulin or bolus it on your pump.  (When you are sick that is so easy to neglect!  Beware.)

Something else that always confuses me is what over the counter medications are safe for people with diabetes.   There is some data to back up that acetaminophen can cause blood sugars to rise.  Talk to your healthcare professional.  If you have kidney or liver problems on top of diabetes, you may want to steer clear of this drug.

I found a great list on www.about.com regarding over the counter medications and diabetes. 

http://diabetes.about.com/od/equipmentandbreakthroughs/qt/coldfludiabete.htm

The information is dizzying.  Or maybe that is a lagging effect of my infection! Nonetheless, it is important for us all to be up to speed on what is recommended when we are sick.  Being sick is never fun, and it is definitely not the time to have to be surfing the net to figure out if you should take Tylenol or Advil or Aleve or Motrin.  Save yourself the aggravation and get your sick day kit together when you are well.  Think of it as your at home emergency preparedness kit.  You might want to include some of the foods listed above and the medications that you and your healthcare team feel are right for you.  My kit has all the pain relievers, Imodium, Pepto-Bismol tablets, cough drops, Nasal spray, glucose tablets and cranberry supplements.  I also keep a bottle of light cranberry juice in my refrigerator along with Gatorade.  After my research for this article, I am going to stock up on some sugar free Ginger Ale as well.

Also, make sure to talk to you family members about your kit and about emergency procedures while you are at it.  Do they know what to do if you are low and can’t respond?  Do they know how to help if you are vomiting and unable to eat?  Others need to be prepared as well.   Since I was sick, I have been getting morning check in calls from my family each day.  Families suffer to some degree as well when the person with diabetes is ill.  Much of it is psychological and emotional, but it is still real suffering.  A little open communication and education will help ease some of that pain. 

During a conversation last evening with my father, I learned of his desire to understand glucagon – just in case.  Maybe that is a foreshadow of a future article!

Stay well this season by being prepared.   

Nicole Johnson, MA, MPH, Miss America 1999, is an international diabetes advocate. She travels extensively promoting awareness, prevention, and early detection of the condition she has shared for fifteen years. She has written four books including her autobiography, Living with Diabetes. Nicole serves on numerous advisory boards including the National Institutes of Health (NIH) Council of Public Representatives, the Florida Governor's Diabetes Advisory Council and the Tampa Bay chapters of the American Diabetes Association and the Juvenile Diabetes Research Foundation. She is also a past national board member for the American Diabetes Association. Over the last nine years, Nicole has helped raise approximately $20 million for diabetes research and programs.

Learn more at www.nicolejohnson.com