Managing Diabetes During Sick Days

Living with diabetes is not easy for most people, even on good days. There are always many things to think about, like carbohydrate intake, checking your blood glucose, and taking medications as prescribed by your doctor. As you probably know, managing diabetes when sick can be very difficult. It is common to be distracted, inactive, and overall fatigued when you are sick. This makes managing your diabetes even more challenging, especially because there are some unique considerations that need to be thought about. We’ll review some of the most common questions about managing diabetes when sick.

How Sickness Affects Blood Sugar

Under normal circumstances, people with diabetes are accustomed to taking their medications, and those medications have expected effects. For example, you know how much your blood glucose will drop when you take 10 units of long-acting insulin, or you know how you will feel when you take your glipizide before lunch. However, when you are sick, your blood sugar can be very hard to manage. There are a couple of different reasons for this. The first reason is that you probably won’t have regular eating habits. It’s going to be more challenging to make yourself eat, and this can be a problem if you are at risk of low blood sugar. 

Another reason is that being sick causes your body to release stress hormones, which can cause your blood sugar to go up. This can make keeping your glucose levels within your recommended range much more complicated. The most worrisome complication that can develop when you get sick is diabetic ketoacidosis (DKA). Usually, insulin helps your body absorb sugar, which is used for energy. However, in DKA, your system does not have enough insulin to absorb sugar. This causes the body to start breaking down fats for energy, producing molecules called ketones. Too many ketones can make the blood very acidic, which can be life-threatening.

Diabetes Sick Day Guidelines

Even before you get unwell, you should have a sick-day plan developed with your health care team so that you can have clear guidance on what your blood sugar goal should be, and how to adjust your medication and insulin doses to stay close to that goal. Every patient is different, so instructions from their health care provider will also vary. However, there are some general sick-day guidelines that everyone can follow.

1. Prepare before you get ill by gathering common medicines and supplies. It would be a good idea to stock up on medications that regulate your bowel movements. Milk of magnesia helps alleviate constipation, while a medication like loperamide helps alleviate acute diarrhea. Another type of medications you may consider is pain relievers. Acetaminophen and NSAIDs such as ibuprofen and naproxen can help with the pain. It would likely be better to get these in tablet form, if possible, due to the presence of sugars in syrups and other liquid formulations. When it comes to supplies: make sure you have a thermometer to check your temperature, and enough test strips for your glucometer as this is an important step to take. You don’t want to be caught without a means to track your blood sugars if they are trending up.
2. Stock up on foods that are easy to eat and digest. Foods like sports drinks, juice boxes, canned soup, regular gelatin, regular soft drinks, oatmeal, crackers, instant pudding, and unsweetened applesauce are a good place to start. You want a good mixture of foods that you can use to raise your blood sugar if needed. Similarly, you need foods that are low in sugar as well, in order to control any rising levels.
3. Try to continue taking your diabetes medicine even if you are vomiting and/or having trouble eating. Due to the stress hormones that your body produces while you are sick, your blood sugar may continue to rise, and you need to take your medications. If you find yourself unable to do that, this is where you and your health care provider’s sick day plan comes in handy.
4. If possible, try to eat like you normally would. This will make it easier to control your blood glucose, and it will make it less likely that you will experience low blood sugar. Moreover, be sure to drink plenty of water, so that you don’t become dehydrated.
5. Check your blood sugar every 4 hours, or more often if you notice that it is rising. If you are not clear about taking extra insulin doses, be sure to contact your doctor for clarification.

Do All Colds Have The Same Effect?

In general, any type of cold or flu will affect people with diabetes the same way. The more severe the cold/flu, the more precautions need to be taken to keep blood sugars within a safe range. This is because your body will respond with the same stress hormones mentioned above, which can raise your blood glucose. Common ailments that will need your special attention are the common cold, especially if you get a fever, the flu, COVID-19, sinus infections, and any type of pneumonia from viral or bacterial causes. Eventually, everyone gets sick so it is important to have a plan with your health care team on how you will manage your diabetes.

Over The Counter (OTC) Medications to Avoid

There are many OTC medications available that can make having a cold or flu a bit more bearable. However, not all of these medications are entirely safe for patients with diabetes, because many of them, especially liquids, have added sugar. Be sure to look for sugar-free options to make it easier to control your blood glucose. Other medications may have alcohol in them, which you want to avoid. Alcohol can lower your blood sugar, which can be dangerous if your physician advised you to increase your insulin dose while sick. Lastly, the decongestant pseudoephedrine can increase blood pressure and blood sugar levels, so it is best to avoid it. It’s a good idea to always check the ingredients list of brand-name OTC drugs and look for ones without pseudoephedrine. 

Symptoms of Diabetic Ketoacidosis (DKA)

DKA can be a very severe complication of diabetes, especially when one gets sick. The following symptoms should serve as a warning of developing DKA, and if you experience any of these, you should contact your doctor right away:

• High blood glucose
• High ketones
• Thirst or dry mouth
• Frequent urination
• Drowsiness
• Dry or flushed skin
• Nausea, vomiting, or abdominal pain
• Difficulty breathing
• Fruity odor on breath
• Confusion

Ignoring symptoms of DKA and not treating it can lead to coma or death, so it is vital to be aware of these symptoms. Also, patients with Type 1 diabetes are at a much higher risk of DKA than patients with Type 2 diabetes.

Can Digital Devices Help?

In today’s age of smartphones and digital apps, you now have many tools at your disposal to help you manage your diabetes when ill. For example, Diabetes:M is a diabetes management app that can help you control your diabetes on healthy days and sick days. The Bolus Advisor feature helps you calculate the insulin units you should take for specific meals, and you can even save these calculations for future reference. This is a great tool that you can use together with your health care team to individualize your diabetes care and develop specific diabetes sick day guidelines for you.

Conclusion

Having diabetes and being sick can be difficult and scary if you don’t have a plan. Be sure to talk to your health care provider about your diabetes sick days management plan and explore digital options such as Diabetes:M to take better control of your blood glucose. These actions can give you peace of mind the next time you find yourself with a cold or flu.

Dr. Vicente Aparicio, Doctor of Pharmacy

Vicente is a residency-trained board-certified clinical pharmacist practicing in Texas, USA. He has a background in primary care and loves educating patients about their diseases and how medications can be an important part of getting healthy.