HELP ON DIABETES

Diabetes Management while Sick

When you have diabetes and also develop another illness, you must take extra pre­cautions. When you are ill, a number of different factors will impact your glucose control:

• Your body’s stress hormones rise, and this can raise your glucose levels unless you adjust your diabetes medications appropriately. 
• Being less active while ill can raise your glucose levels. 
• You may not eat as much, so you may need less diabetes medication for the food. 
• Medicines that you take for your illness may affect your glucose levels— for example, prednisone for an asthma attack. 

What to Do if You Get Sick and Are on Insulin

Do not stop your insulin—depending on the severity of the illness you may need the same or more insulin. If you have type 1 diabetes and you stop the insulin, you will go into DKA. If you are on a basal-bolus insulin regimen, take the same amount of the long-acting insulin as you normally do. If you are on a pump, keep the basal rates the same. Cover your carbohydrates with insulin in the usual way. If you have vomiting and you are not sure if you will keep the food down, you can give the insulin for the carbohydrates afterward. Correct any high glucose lev­els with fast-acting insulin analogs.

If you have type 2 diabetes and are on premixed insulins twice a day, you may take the same amount of insulin if you know that you can keep some food down. If you are not sure that you will be able to eat, check with your doctor—you may need to cut back on your premixed insulin to 50 to 75 percent of the dose.

Be sure to also do the following:

• Check the blood glucose frequently—every two to four hours. 
• Drink plenty of fluids: sips of water, diet soda, sugar-free lemonade, sugar-free Popsicles, and broth are all acceptable. 
• If you cannot eat solid foods, drink juices, regular sodas, or Gatorade or eat Jell-O. 
• Check ketones—either in the urine or in the blood—at least once or twice a day. 
• It is fine to take over-the-counter cough medicines: don’t worry about the sugar in these medicines. 
• Contact your medical team or go to the emergency room if you cannot keep down fluids, if your blood glucose levels remain high (more than 250) despite taking extra insulin, if you have high levels of ketones in blood or urine, or if you have abdominal pain, shortness of breath, or sleepiness. 
• For children who cannot keep down carbohydrates and whose glucose is getting low, the parent can give a glucagon injection.
  

If You Get Sick and Are on Oral Diabetes Medicines or Exenatide

If you are able to eat and keep down food, you can take your usual oral medications or exenatide injections for the diabetes. If you have significant nausea and vomiting, call your doctor to get specific instructions—for example, you may need to hold off on the exenatide injections. Sometimes illnesses significantly raise the glucose lev­els and the oral medications are not very effective. In this case, you may need some insulin temporarily.

Drink plenty of fluids, and if you cannot eat solid foods drink juices, regular sodas, and broth.

Monitor blood glucose levels frequently—every four to six hours.