How To Manage Diabetes on Sick Days: Tips

How To Manage Diabetes on Sick Days: Tips


Hello, I am Ty Mason of thediabetescouncil.com,
researcher, writer and I have type 2 diabetes. Today I want to give you some sick day rules
for managing your diabetes. After you watch the video today, I invite
you check out the description box for my new ebook. This is one of the most comprehensive diabetes
meal planning book you can find. It contains diabetes friendly meals/recipes,
recipes for different goals such as 800-1800 calories per day meal plan, diabetes meal
planning tips and tricks. There are also tons of diabetes friendly recipes
for everyone! Your body does some weird things sometimes
when you are ill. One of the ways your body fights infection
is to boost levels of stress hormones which in turn drive up blood sugar levels. Then in an effort to get rid of some offending
diseases, the body decides that vomiting or diarrhea is a good way to rid the system of
certain bacteria and germs. This can do several things, it will cause
us not to want to eat and what food we do keep down is slow to absorb and our blood
sugar plummets. To handle these diabetes control challenges,
experts recommend following “sick-day rules” to ensure blood glucose levels stay safe and
put you on the road to recovery. Check, Check, Check
Each person is different, especially when it comes to how the body responds to illness. Some patients are completely unaffected by
sickness, while others are sensitive to a wide variety of illnesses, says Rachelle Gandica,
MD, a pediatric endocrinologist at the Columbia University Medical Center. Plus, each type of illness can affect a person’s
blood glucose differently. It’s important for insulin users to check
blood glucose every two to three hours when sick. Even non-insulin users should check more often
than usual, says Gandica. A good rule of thumb is to check your blood
glucose every 2 to 3 hours. Medicate
Keep taking your medications while sick, though perhaps with some dose adjustments to compensate
for high blood glucose levels or to avoid low blood glucose if you can’t eat. It is best to discuss exactly what your adjustments
should be with your health care provider. But there are general guidelines. For insulin users, the “rule of thumb is to
continue taking basal and bolus insulin,” says David Dugdale, MD, FACP, professor of
medicine at the University of Washington. But recognize that if you don’t eat, you wouldn’t
take a bolus. Basal or long-acting insulin is needed throughout
illness, and you may need more than usual. For ill people with type 2 diabetes, the insulin
recommendations are the same as for type 1, but figuring out what to do about oral medications
may actually be harder, says Dugdale. “They may take pills that are designed to
offset what they eat. There is no formula for that,” he says. “Some of the pills should be adjusted if [people]
are sick enough that they can’t eat.” For example, sulfonylurea use may need to
be reduced because the medication can increase the risk of hypoglycemia. People with type 2 diabetes using metformin
may need to switch to insulin during a serious illness, such as gastrointestinal flu, because
dehydration and the decreased kidney function that may result increase the risk for a rare
complication, lactic acidosis, associated with metformin use. Dugdale suggests asking your doctor if you
should take a break from amylin (Symlin) while ill. “It just adds another set of variables that
might make it harder to do the right thing,” he says. Mind the Ketones
One of the most serious risks of sickness in people with diabetes is diabetic ketoacidosis
(DKA), a life-threatening condition caused by too little insulin in the body in combination
with the stress hormones associated with illness. Check urine ketones frequently while sick. Urine ketones are indicated on a test strip
as trace, low, moderate, high, and very high. “Any amount should be noted and reported to
the doctor,” says Dugdale. “If it is more than ‘low,’ the patient should
get specific instructions on how to turn things around and may need to get intravenous medication.” Check with your own provider for how to deal
with high ketones, and make a plan for when levels don’t come down. For parents of infants, Gandica offers this
tip: “Put some cotton balls in the diaper, and then when the child voids, you can squeeze
the cotton balls out onto a urine ketone strip.” Hydrate
Dehydration is a risk factor for DKA, so it’s critical to stay well hydrated while ill. A cup of fluid every hour should be enough,
but keep in mind that vomiting and diarrhea increase the risk for dehydration. Dugdale recommends carbohydrate-free fluids,
such as water, to help keep blood glucose levels from rising too high. “I’ve seen people with DKA who kept drinking
sugary fluids without recognizing how much sugar they were taking, which just aggravated
their blood sugar,” he says. “If they take fluids with sugar, they need
to account for that some way.” For people who are sick to their stomach and
not eating, Dugdale says this rule can be bent in order to take in some nourishment. In that situation, Gandica recommends alternating
between sugar-free and sugary fluids or, if drinking is making you nauseous, between sugar-free
and sugary Popsicles. Check OTC Med Label
Most over-the-counter (OTC) cold and flu medications are generally safe for people with diabetes,
says Gandica. People with kidney problems may have certain
restrictions, though. Always check with a doctor to make sure OTC
medications are safe and don’t react with any of your prescription medications, for
diabetes or other conditions. Know When to Get Help
If you have ketones, high blood glucose, or both, and you can’t get them to come down
(especially if you’re using insulin), “that merits a call to the doctor’s office,” says
Dugdale. If you or your child has signs or symptoms
of diabetic ketoacidosis (see below), it’s time for a visit to the emergency room. Being sick increases your risk for developing
diabetic ketoacidosis (DKA). Keep an eye out for these symptoms when sick
and go to the emergency room if you suspect DKA. Early symptoms of diabetes ketoacidosis:
Thirst or a very dry mouth Frequent urination
High blood glucose levels (typically over 250 mg/dl, although ketones can occur at lower
levels) High levels of ketones in the urine or blood Later symptoms of diabetes ketoacidosis:
Constantly feeling tired Dry or flushed skin
Nausea, vomiting, or abdominal pain Difficulty breathing
Fruity odor on the breath A hard time paying attention, or confusion While this is not a comprehensive discussion
on the topic, I hope we have covered the basics. For a very in depth and complete discussion
on this topic, I invite you to visit thediabetescouncil.com. Lianne has done a wonderful job on this topic. Don’t forget to get my new ebook. Like this video and subscribe to our channel
so we can continue to bring you informative videos like this one in the future. Thanks for watching!

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