Gretchen Scalpi, RDN

I just got my flu shot a few days ago, and that reminded me to start speaking with my diabetic clients about how to manage sick days. Of course, I hope that no one gets the flu this year, but with the season upon us, it’s better to be safe and know what to do.

People with diabetes need to be especially careful during times of illness, even if the illness seems minor. The mere presence of the cold virus or the flu is cause for an elevation in blood sugar, making  it more difficult to keep blood sugar in range.  Elevated blood sugar can lead to diabetic keto-acidosis, especially in persons with type 1 diabetes or older individuals with type 2 diabetes. Any illness that causes fever or loss of fluids can cause dehydration pretty quickly. Besides getting a flu shot, what else does the person with diabetes need to know about taking care of themselves if they become ill?

Prepare for sick days in advance by working with your diabetes educator or doctor, and learn what to do to have a plan in place.  Your plan should include how often to measure your blood sugar, urine ketones, what to eat or drink,  and when to contact your diabetes team.

Here are some frequently asked questions and tips that  may help:

1. Should I stop my diabetes medications while I am sick?
   No. Unless otherwise instructed by your doctor or diabetes team, you will need to continue to take you diabetes medications:  insulin or oral medications. Because you blood sugar is higher, the insulin or oral medications are still necessary during this time to prevent diabetic ketoacidosis.
2. How much fluid should I consume when I am ill?
   The more the better! Increasing fluids is recommended when you are sick. Fever, diarrhea or vomiting can cause dehydration.  Drink at least 8 oz. of calorie-free fluids (preferably water) every hour while you are awake to stay hydrated.  The extra fluids will help get rid of the extra glucose or ketones in your blood, so drink fluids liberally!
3. My blood sugar is much higher than normal. What should I do?  Understand that an illness or infection increases your blood sugar.  Monitor your blood glucose more often throughout the day; you may need to check every 2-4 hours, especially if you blood glucose is greater than 240.  Check your urine for presence of ketones every 4 hours while your blood sugar is elevated.
4. If I can’t hold down solid foods, what should I do?
   This can be a very big problem during an illness, but it’s important to try and stick with your usual meal plan if possible. If you can’t tolerate solid foods, try getting your calories by eating lighter foods such as (non-diet) Jello, crackers, soups, puddings or applesauce.  Aim for at least 50 grams of carbohydrate every 3-4 hours.  Use foods such as regular soft drinks, juices, sherbet, frozen fruit bars, regular sports drinks such as Gatorade® or pudding to obtain the carbohydrates you need.  Continue to drink plenty of non-calorie fluids.
5. When should I call my doctor or diabetes team?
   • when you have been sick for more than a couple of days and aren’t getting any better
   • when you have been vomiting or had diarrhea for more than 6 hours
   • when your urine ketones show a moderate to large amount
   • when your blood sugar is more than 240, even if you have taken extra insulin as instructed by your doctor or diabetes team
   • when your blood sugar has been more than 240 (before meals) for more than 24 hours, even though you have taken your diabetes pills
   • when you are having symptoms that signal possible dehydration or ketoacidosis

   As with many aspects of managing diabetes, having a plan is in advance is vital. It prevents an illness from becoming a major problem.  Be prepared by knowing what to do, when to call your diabetes team and have the right things on hand so you can care for yourself and get well quickly!

Tags: diabetes, diabetic, ill, illness, sick days