Planning for Sick Days
Illness is a form of stress that-like emotional stress-rouses the body's defenses.
One effect is that the liver steps up glucose production to provide more energy. At the same time, stress hormones are released that make cells more insulin resistant. The net result is that blood sugar can rise dramatically when you’re ill. Among the serious problems that can result are:
- Ketoacidosis. If available insulin isn’t enough to move glucose into cells (mostly a problem with type 1 diabetes), the body will start tapping its fat stores, releasing toxic ketones and putting you at risk of a coma.
- Hyperosmolar nonketotic coma. When blood sugar in type 2 patients gets too high, the body tries to get rid of glucose through the urine, which can produce severe dehydration that can also lead to coma.
To keep your blood sugar in check when you’re ill and help yourself feel better faster, follow these steps:
- Step up your monitoring. It’s more important than ever to keep careful track of your blood-sugar levels, so you’ll probably need to test yourself more often than you usually do-at least every three to four hours. If your blood sugar goes higher than 240 mg/dl, do a urine ketone test as well. If ketone results are positive-or if your blood sugar consistently hovers above 240-call your doctor.
- Noodle with your nourishment. Illness can ruin your appetite (especially if you have trouble keeping food down), but you need to eat enough to provide your body with the energy it needs. Work with your dietitian to develop a sick-day menu that fits in with your eating plan-perhaps one that features foods like oatmeal, toast, and steamy soup, which offer good nutrition but are easy on the stomach. If you find meals unappetizing, try eating small amounts frequently throughout the day.
- Get plenty of fluids. This familiar advice is doubly critical when you have diabetes because water is drawn into excess glucose and excreted in the urine, which can cause dehydration. Aim to drink a cup of fluid (which includes soup broth) every half hour or so. If lack of appetite is making it difficult for you to consume enough food to meet your energy needs, sip sugared drinks like non-diet soda, fruit juices, or sports beverages instead of plain water to make sure you’re getting at least some calories into your body.
- Stay the drug course. Unless your doctor instructs you otherwise, it’s important to keep taking your medications or giving yourself insulin even if you’re not up to eating. In fact, your doctor may want you to take more insulin when you’re feeling under the weather, if certain symptoms of diabetes are acting up, with the exact amounts depending on your blood-sugar readings and how sick you are. Even if you have type 2 diabetes and don’t normally take insulin, it’s wise to keep a vial of short-acting insulin on hand in case your doctor feels it’s necessary when illness strikes.
- Watch the OTC remedies. Some common over-the-counter medicines, such as decongestants with pseudoephedrine, can raise blood sugar. Check with your doctor before taking any drug, herbal remedy, or dietary supplement when you’re ill.
- Keep alert to danger. Know the signs of ketoacidosis (which include stomach pain, vomiting, chest pain, difficulty breathing, feelings of weakness, sleepiness, fruity-smelling breath, blurry vision) and of dehydration (extreme thirst, dry mouth, cracked lips, sunken eyes, mental confusion, dry skin). Call your doctor right away if you experience symptoms of either of these conditions.