Diabetes Self-Management Education

Anytime you are sick, even with a cold or the flu, you can get high blood sugar. If you have diabetes, it is very important to plan ahead. When you are sick your blood sugar can go very high. The high blood sugar could lead to very serious problems. Having a plan before you are sick will help you prevent more serious problems.

What Happens When You Are Sick

Your stress level goes up when you are sick. This causes your body to release a hormone to help fight the disease. In addition to fighting the disease, the hormones also make your blood sugar higher and keep the insulin from working.

High blood sugar can cause ketoacidosis in people with Type 1 diabetes and hyperosmolar hyperglycemic non-ketotic coma in people with Type 2 diabetes. Both of these conditions are very serious and can be life-threatening.

Make a "Sick Day Plan." Use the Plan to Help You. 

• Talk with your provider about when you should call
• Talk with your provider about if you should take your medicine
• Ask the provider how often you should check your blood sugar and urine ketones
• Ask your provider what medicine to take
• Ask your provider when you should eat
• Know how to talk with a provider on weekends, holidays and at night
• Use your sick day worksheet to list your information and keep it in a safe place

ALWAYS ASK A PHARMACIST FOR HELP PICKING AN OVER-THE-COUNTER MEDICINE.

 ALL DIABETICS SHOULD HAVE THE FOLLOWING THS ON HAND: 

• Sugar-free cough medicine 
• Aspirin and non-aspirin pain medicine (ask your provider which ones you can take) •
• Antacids 
• Medicine for diarrhea and vomiting 
• Thermometer 
• Your glucometer and strip

WHEN SHOULD YOU MEASURE YOUR TEMPERATURE, BLOOD SUGAR, AND KETONES IF YOU ARE SICK?

People with Type 1 diabetes should monitor their blood sugar and ketones every four hours. People with Type 2 diabetes should check their blood sugar every two to four hours and check for ketones if the blood sugar is over 240mg/dl. Check your temperature every four hours and continue to monitor until you feel better.

Use your sick day record to record your blood sugars, urine ketones, temperature, and your symptoms. Also include what you have had to eat and what medicine you have taken. 

DIABETES MEDICINE

When you are sick you still need to take your medicine. Even if you are throwing up, do not stop your medicine unless your provider tells you not to take it. If you cannot take your pills, you may need insulin. The body makes extra glucose (sugar) when you are sick. Make sure you understand your provider’s instructions for what to take and how much.

Dehydration can be a problem if you do not replace your fluids or if you have diarrhea and vomiting.

Signs and Symptoms of Dehydration

• Dry mouth
• Thirst
• Decreased urination 
• Dry, flushed skin
• Dry lips
• Higher than normal body temperature

If you notice these signs of dehydration, drink clear liquids until signs go away.

If you can’t sip fluids call your provider immediately!

Medicine

When you are sick, you may want to take over-the-counter medicines. Always check the label for sugar before you buy them. Tell the pharmacist your medical problems (diabetes, hypertension, etc.) and ask for help to find sugar-free medicine. Many medicines can affect your blood sugar level. 

•  Some antibiotics can lower blood sugar levels in people with Type 2 diabetes. 
•  Decongestants and products to treat colds can increase your blood sugar level and blood pressure.

WHAT SHOULD YOU EAT WHEN YOU ARE SICK?

It is best if you can eat and drink your regular diet. Add plenty of fluids by drinking one half to one cup of sugar free liquids every one to two hours.

Some examples are: water, tea without sugar, instant broth, diet sodas, sugar- free Popsicles®, sugar-free Jell-O®, and soups. 

If you cannot eat and drink your regular food then eat or sip about 15 grams of carbohydrates every hour.

Examples are:

• If you want more than one of the above in an hour, use sugar-free foods
• It is easier for your body to digest carbohydrates than proteins and fat
• Small frequent feedings are quickly absorbed and quickly changed to blood glucose
• Keep a record of how much you eat and drink 
• Have someone check in on you 

If you have been very sick to your stomach, start drinking clear liquids like broth, tea, apple juice or grape juice, eating Jell-O®, or Popsicles®. When you tolerate this, move on to full liquids like tomato or orange juice, ice cream, and cream soups.

When Do I Call My Provider?

• If you have blood sugar levels of 200 to 400 mg/dl and have symptoms call the clinic or your provider.
• If you have blood sugar levels above 400 always call your provider.
• If you have blood sugar levels under 70 mg/dl for two readings in a row and you have symptoms.
• If you have an upset stomach, vomiting, or diarrhea for more than four to six hours.
• If you have a temperature of 101 or more for more than 24 hours.
• If you have dry mouth, thirst, decreased urination and dry, flushed skin.
• If you have pain that does not go away.
• If you are sick for more than two days.
• If you are not sure about something.

Sick Day Record

Be sure to keep accurate notes in your "Sick Day Record" and have them with you when you call your provider.

• Temperature (time and temperature)
• Blood sugar (time and number)
• Medicine you have taken (time taken and if it helped)
• What you have eaten and had to drink
• How many times you have vomited or had diarrhea

If you go to the emergency room be sure to tell them you have diabetes and take the above information with you.

Wear a medical alert bracelet or have information with you at all times that you have diabetes.

Be sure to get a flu shot every year, the flu can be dangerous. Ask your provider if you should get a pneumonia shot

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The educational information and materials in this module 
were adapted from the RWJF Diabetes Initiative. Thank you!