Sick Days

When you are a diabetic sick days mean much more than calling in sick to work and crawling under the covers.

Planning is the most important part of your sick day regime.

• Talk to your physician now– about how after hours calls are handled.
• Review your health insurance. Does your provider require a notification phone call for an emergency room visit? What exactly are the parameters of your insurance coverage co-pay and deductible?
• Who is your designated emergency contact besides your health care team? Who will you call if you need a ride to the doctor’s office or you need someone to give you your insulin injections?

Illness stresses the body, making your glucose levels rise. The same hormones that fight illness will also raise your glucose and block insulin from reducing glucose. In addition, many simple over-the-counter medications (OTC), such as cough syrups, cough drops, and decongestants and can contribute to this problem. Talk to your pharmacist about which products are sugar-free or better OTC choices.

Most diabetes sources recommend some sort of sick day kit. Along with routine supplies such as a thermometer, you will want to keep extra blood test strips, ketone test strips, sick day medications, lists of emergency contacts, and carb lists. This would be a good place for back up supplies such as batteries for your glucose meter.

Ask your health care provider or a member of your diabetes team what parameters they suggest for maintaining carbohydrate intake when you are having difficulty keeping solid food down. Review this before you get sick and keep supplies on hand along with a list in your sick day kit. The University of Michigan Health System provides a list of carbs and values for sick days on their site, as does BD Diabetes . com. Print these up now and keep them in your sick day kit.

General guidelines :

Stay hydrated. If you are keeping meals down, and resting most of the time, drink 8 ounces of calorie-free, caffeine free beverages every hour when you are awake, or set the alarm clock to remind yourself. Avoid milk and milk products if you are nauseated. Stick to clear liquids (flat lemon-lime soda, or ginger ale, Popsicles) and graduate slowly to fluids with higher nutritional value (Gatorade, Pedialyte, clear soups). Avoid caffeinated products which will increase dehydration.

Don’t stop taking your routine diabetes medication unless you absolutely are unable to or your physician instructs you otherwise. Do keep a closer eye on your glucose levels.

If you don’t have a glucose monitor, get one for sick days. The Mayo Clinic suggests this plan for checking your glucose levels on sick days:

• Type 1 diabetes. Check your blood sugar and urine ketone levels every four hours.
• Type 2 diabetes. Check your blood sugar levels four times a day. If your blood sugar level is higher than 300 mg/dL, check your urine for ketones. Make sure your test strips haven’t expired.

The American Diabetes Association recommends you call your health care provider or team when:

• you’ve been sick or have had a fever for a couple of days and aren’t getting better
• you’ve been vomiting or having diarrhea for more than 6 hours
• you have moderate to large amounts of ketones in your urine
• your glucose levels are higher than 240 even though you’ve taken the extra insulin your sick-day plan calls for
• you take pills for your diabetes and your blood sugar level climbs to more than 240 before meals and stays there for more than 24 hours
• you have symptoms that might signal ketoacidosis or dehydration or some other serious condition (for example, your chest hurts, you are having trouble breathing, your breath smells fruity, or your lips or tongue are dry and cracked)
• you aren’t certain what to do to take care of yourself

Again, planning ahead is critical. Keep your freezer and pantry stocked with sick day supplies. Have that call list where you or your contacts can find it when you are sick. Plan now for inevitable sick days ahead.