‘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
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
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:
ice cream (1/2 cup) -- 15 grams
fat ice cream (1/2 cup) -- 10 grams
juice bar (3 oz) -- 9 grams
yogurt (1/2 cup) -- 15 grams
(1/2 cup) -- 22 grams
or Jello® sweetened (1/2 cup) -- 19 grams
cereal (1/2 cup) -- 15 grams
(1 slice) -- 15 grams
(1 cup) -- 15 grams
noodle soup (1 cup) -- 9 grams
soup (1 cup) -- 9 grams, (made with water)
soup (1 cup) -- 16 grams, (made with water)
(1/3 cup) -- 15 grams
unsweetened (1/2 cup) -- 14 grams
If you have
a fever, and you're throwing up or have diarrhea, it is very easy to become
dehydrated, which means your body is losing too much fluid. In small sips, try
to drink a cup of fluid each hour. If your blood glucose (sugar) is running too
high, try sugar-free liquids like water, tea, sugar-free ginger ale, or even
broth (chicken, beef, or vegetable). If you need to raise your blood glucose,
try to drink things with about 15 grams of carbohydrate in them. Here are some
juice (1/2 cup) -- 15 grams
juice (1/3 cup) -- 12 grams
cranberry juice cocktail (1/3 cup) -- 12 grams
calorie (light) cranberry juice cocktail (1 cup) -- 10 grams
ale (1/2 cup) -- 10 grams
(1 cup) -- 12 grams
drink (1 cup) -- 14 grams
Regular cola or root beer (1/2 cup) -- 14
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
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.
Active ingredients that may affect diabetes:
Pain and fever reducers: acetaminophen is used in cold and flu
medications for minor aches and fevers.
Acetaminophen can be toxic to liver and kidneys. People with
diabetes who also have kidney complications should check with their doctor
before using acetaminophen.
NSAIDS: (Non-steroidal anti-inflammatory drugs) are used to
treat aches, pains and fevers associated with colds and flu.
Ibuprofen should be used cautiously by people with liver and
kidney problems. It also increases the hypoglycemic effect of insulin and oral
Naproxen should not be used for people with severe cardiovascular
disease, or kidney or liver problems. It may also increase the risk of
hypoglycemia with insulin and oral diabetes medications
Dextromethorphan is an ingredient in many cough preparations and
at recommended doses is safe for people with diabetes.
Guaifenesin is an ingredient that loosens mucus and makes it
easier to cough it up. There are no warnings about guaifenesin and diabetes.
Epinephrine, phenylephrine, and pseudoephedrine are usually
found in nasal sprays, but also some oral cold medicines. They work by drying
up secretions in the nasal passages. It is possible that they could decrease
the effects of insulin or oral diabetes medications. They can also increase
blood pressure and should be used cautiously in people with high blood
Phenylpropanolamine (PPA) is a decongestant that has been
recalled by the FDA as of 2005, due to an increased risk of strokes.
Brompheniramine, chlorpheniramine, and doxylamine are used in
combination with other active ingredients. These antihistimines do not affect
diabetes directly, but elderly people may be more susceptible to side effects.
Diphenhydramine is used alone (marketed as Benedryl) or in combination with
other drugs. It can cause low blood pressure in some people.
is a second generation antihistamine that has recently gone OTC. It does not
cause the sedation associated with the older antihistimines. It does not appear
to cause problems in people with diabetes.
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
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
Stay well this season by being prepared.