Diabetes and Sick Days

Nearly one in five people with diabetes are regularly unable to attend a full day at work due to disruption caused by episodes of dangerously low blood sugar, known as a hypoglycaemic event.1 A new survey, focusing on productivity loss following hypoglycaemic events, was published today in the journal Value in Health. The survey was conducted with 1,404 people with type 1 and type 2 diabetes who had reported a hypoglycaemic event in the preceding month, in the US, UK, Germany and France.1

You don’t have to be burdened with sick days and down time. By being aware of how diabetes affects your body and the special needs you have during an illness, you can help avoid the loss of productivity from sick days.

Illness and Blood Glucose

When you are sick, your body releases certain hormones to help fight the illness. The down side of this immune response is that the hormones also increase your blood glucose, making it harder for insulin to work properly and for you to control your blood sugar. Type 1 diabetics are at risk of developing diabetic ketoacidosis, a serious condition caused by elevated levels of glucose and ketones in the blood. Ketones are waste products produced in type I diabetics when the body uses fats as the primary energy source rather than sugars. This occurs when there is not enough insulin for the body to use sugars for energy. Type 2 diabetics are at risk of developing a similar condition called hyperosmolar hyperglycemic nonketotic coma. Both conditions can lead to hospitalization and even death if not treated.

Prevention

All people with diabetes should receive a yearly flu shot. The best time to receive the shot is between the middle of October and the middle of November. To further reduce your risks, people you live with or come in close contact with should also receive a flu shot. Do not get a flu shot if you have an allergy to eggs or egg products.

All older people with diabetes should also receive a pneumonia vaccine. This is especially important if you also have kidney disease. One shot is enough for most people, but some people with diabetes may require shots every 5-6 years. Be sure to talk with your physician about receiving these important, life saving vaccines.

Being Prepared

Work with your physician or diabetes educator to develop specific instructions for you to follow when you get sick. Your plan should include instructions on medication use, eating, and glucose and ketone monitoring. Being prepared in advance can help keep your blood glucose under control. The remainder of this article will provide suggestions on how you can better manage your diabetes during an illness. However, this information cannot replace the advice of your physician or diabetes educator.

Monitoring Your Blood Glucose and Urine Ketones

When you are sick, you will need to monitor your blood glucose more often than usual. You will also need to monitor for the presence of ketones in your urine. If you are a type 1 diabetic, you may need to measure your blood sugar and urine ketones as often as every 2 to 4 hours. Urine ketone test strips report readings in terms such as negative, trace, small, moderate or large rather than specific numbers. Moderate to large amounts of ketones in the urine should be reported to your physician immediately, as this could lead to ketoacidosis. People with type 2 diabetes may be able to measure blood sugar less frequently, and may not have to measure for urine ketones.

Diabetes Medications

Continue all of your diabetes medications during your illness, even if you are not able to eat. If you already take insulin, your physician may have you take more than usual while you are sick. If you take oral medications only, you may be able to continue them, or you may have to use insulin for a short time. Do not take additional doses of diabetes medications or insulin unless specifically instructed by your physician.

Rest

While you are sick, you should avoid strenuous exercise and get plenty of rest. This will help your body recover from the illness.

Nutrition

If possible, do try to stick with your regular diet. If you can not tolerate your regular diet, you must try to consume your normal amount of calories through soft foods or liquids. Consult with your physician or nutritionist for a list of foods that provide the calories you need and are easier to digest during your illness. It is also important to drink extra fluids while you are sick to prevent dehydration. Try to drink 8 ounces of calorie free liquids every hour when you are awake. Be sure to tell your physician if you are unable to keep foods or liquids down without vomiting.

Cough and Cold Medications

Many cough and cold products contain sugar, but there are also a number of sugar-free options. Read labels carefully to be sure. Sugar-free cough drops are available from Robitussin and Halls. Cold-Eeze offers sugar-free tablets for cold relief. Scot-tussin, Diabetic Tussin, and Tussin DM Clear are popular sugar-free cough syrups. Ask about sugar-free cough and cold products at your local pharmacy.

Decongestants such as pseudoephedrine can raise blood sugar and blood pressure; generally nasal spray decongestants are safer than pills. Popular nasal sprays include Afrin Nasal Spray. Acetaminophen (Tylenol) is the preferred pain reliever, since high doses of aspirin can cause low blood sugar.

Try to avoid products that contain alcohol and caffeine as ingredients. Consult with your physician or pharmacist if you are not sure about a product.

When to Call Your Physician

Be sure to consult your physician if you:

• Have been sick for two days and are not getting better
• Have been vomiting or having diarrhea for more than 6 hours
• Have moderate to large amounts of ketones in your urine
• Have a blood glucose more than 240mg/dl even after taking extra insulin
• Have blood glucose readings more than 240mg/dl for 24 hours if taking only oral medications and not insulin
• Have a blood glucose less than 60mg/dl
• Have signs of dehydration such as dry skin or mouth, sunken eyes or weight loss
• Have difficulty breathing, chest or stomach pain, loss or changes in vision
• Have temperature higher than 101 F
• Have any changes in mental status