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Diabetes Sick Day Rules Handout

Sick-day Guidelines For People With Diabetes - Topic Overview

Sick-day Guidelines For People With Diabetes - Topic Overview

What happens when you are sick When you are sick, your body reacts by releasing hormones to fight infection. But these hormones raise blood sugar levels and at the same time make it more difficult for insulin to lower blood sugar. When you have diabetes, even a minor illness can lead to dangerously high blood sugar. This may cause life-threatening complications, such as diabetic ketoacidosis or a hyperosmolar state. Plan ahead Work with your doctor or diabetes educator to make a sick-day plan for you or your child who has diabetes. Discuss your target blood sugar goal during an illness, how you should adjust your insulin dose and timing (if you take insulin), and when you need to contact your doctor for help. Also, make sure you know how often to check your blood sugar and your ketone levels. Keep your plan in a convenient place, and include contact information in case you need to reach your doctor at night or on the weekends. Steps to take during an illness Here are some general sick-day guidelines: Continue taking your diabetes medicine even if you are vomiting and having trouble eating or drinking. Your blood sugar may continue to rise because of your illness. If you cannot take your medicines, call your doctor and discuss whether you need to adjust your insulin dose or other medicine. Try to eat your normal types and amounts of food and to drink extra fluids. Ask your doctor how often and how much you should eat and drink when you are sick. If your blood sugar level is higher than the blood sugar level your doctor recommends, for example, 240 mg/dL, drink extra liquids that do not contain sugar, such as water or sugar-free cola. If you cannot eat the foods in your regular diet, a general guideline is to try to eat or drink 50 grams (g) of carbohydrate every 3 to 4 h Continue reading >>

Sick Day Rules For Type 1 Diabetes

Sick Day Rules For Type 1 Diabetes

Coping when you are Ill Treated With Multiple Daily Injections It is very important that you know what to do when you are ill. We refer to this as "sick day rules". Remember - Never stop taking your insulin. When you are ill your body becomes much more resistant to the insulin you produce or take by injection. This means your blood glucose levels can raise. You therefore need to monitor your blood glucose and ketone levels and decide if you need more insulin. It is likely that you will need to increase your insulin dose (see flow chart for guidance). Although you may not feel like it, it is very important to monitor your diabetes closely to prevent diabetic ketoacidosis developing. We divide the sick day rules into those for: Minor illness- where blood glucose may be within normal range or raised but ketones remain negative ( e.g. minor viral infection or minor injury) and those for Severe illness- where blood glucose is raised and ketones are present ( e.g. chest infection or high temperature). For advice on how to manage either of these conditions, see over. Tips for staying safe during Illness: If you are vomiting, you do not need to eat until you feel well enough to try, but keep sipping fluids to prevent dehydration. If you not feel like eating normal meals, try to eat foods that are easy to digest, e.g. soup, ice-cream, milk, puddings. If your blood glucose falls below the normal range, sip sugary drinks eg fruit juice, sweetened tea, lucozade or ice lollies. Adjusting you insulin doses will help to control blood glucose levels (see guidance in the flow charts below) If you have an infection that is not resolving, you should make an appointment to see your GP to determine whether you need further treatment. If you continue to vomit, are unable to keep fluids down, Continue reading >>

Sick-day Guidelines For People With Diabetes

Sick-day Guidelines For People With Diabetes

Topic Overview When you are sick, your body reacts by releasing hormones to fight infection. But these hormones raise blood sugar levels and at the same time make it more difficult for insulin to lower blood sugar. When you have diabetes, even a minor illness can lead to dangerously high blood sugar. This may cause life-threatening complications, such as diabetic ketoacidosis or a hyperosmolar hyperglycemic state (HHS). Plan ahead Work with your doctor to make a sick-day plan for you or your child with diabetes. Discuss your target blood sugar goal during an illness, how you should adjust your insulin dose and timing (if you take insulin), and when you need to contact your doctor for help. Also, make sure you know how often to check your blood sugar and your ketone levels. Keep your plan in a convenient place, and include contact information in case you need to reach your doctor at night or on the weekends. Steps to take during an illness Here are some general sick-day guidelines: Continue taking your diabetes medicine even if you are vomiting and having trouble eating or drinking. Your blood sugar may continue to rise because of your illness. If you cannot take your medicines, call your doctor and discuss whether you need to adjust your insulin dose or other medicine. Try to eat your normal types and amounts of food. Drink 1 cup (250mL) or more of sugar free fluid every hour, such as water, weak tea or herbal tea, caffeine-free diet pop or broth. Try to drink at least 9 cups (2.2L) of fluid daily to prevent dehydration. If you are not able to eat the foods in your regular diet, try to eat and drink light foods or fluids that contain 10 to 15grams of carbohydrate every hour. Examples of light foods and fluids that contain 10 to 15grams of carbohydrate include: 1 slice o Continue reading >>

Sick-day Rules For Managing Your Diabetes

Sick-day Rules For Managing Your Diabetes

When people come down with minor illnesses such as flu, cold, urinary tract infection, or intestinal problems, they usually lose their appetites and have very low energy levels. Most would want to stay in bed, take some over-the-counter medication, sleep, and let the medication and their immune systems do their jobs to kick the illness to the curb. However, for individuals with diabetes, a common sickness or infection is not as easy to fight off. Without careful care management, the fluctuation of glucose and ketone levels can trigger severe complications. If left unattended, these complications can become life-threatening medical emergency cases such as diabetic coma. To avoid such daunting situations, the best way to cope with a minor illness is to learn, plan, and prepare ahead of time. So when you do become sick, you will know exactly what to expect and what protocols to follow under different scenarios. At the same time, you will already have all the supplies at home. This way, you will feel safe and secure, and you can concentrate on getting better. In order to help you prepare for a sick day management plan and kit, this article will cover these topics: What Happens to Your Body and Your Blood Glucose When You Are Sick? Depending on general health, age, and hormonal differences, each person reacts slightly different to illness. But generally, when you are sick, you are under stress. To counteract, your body releases stress hormones such as adrenaline and cortisone into the bloodstream to activate glucose production in the liver. This reaction leads to a rise of blood glucose levels above normal level and desensitization of the blood glucose-lowering effects of insulin. Under these circumstances, even the most stable diabetes becomes much harder to control within Continue reading >>

Coping With Illness: Sick Days

Coping With Illness: Sick Days

Newly revised information booklets for "Managing diabetes when you are ill and have Type 1 and Type 2 diabetes" What happens if you are ill? People with diabetes don’t get ill any more often than other people, but illness and infections tend to push up blood glucose and can often make you feel more unwell. Simple illnesses such as: The common cold or flu Stomach upsets- particularly food poisoning Urinary tract infections Infections All the above may result in hospital admission for the person with diabetes. What happens to your blood glucose when you are ill When you are ill especially with a fever, your blood glucose levels tend to rise, even if you cannot eat or are being sick. However occasionally your blood glucose levels may be low, so regular blood glucose monitoring (at least 4 times a day every 2-3 hours) to help you decide whether changes to your tablets and insulin’s are needed. The sick day rules for people with diabetes Never stop taking your insulin if you have Type 1 Diabetes Continue to take your tablets and/ or insulin even if you are not eating much Drink plenty of non-sugary fluids (4-6 pints per day) between meals to avoid dehydration What to eat when you are unwell - General advice When you are ill you may not want to eat. You might have to eat more fatty or sugary foods than normal, but you don’t have to worry about that. Try cereals, toast, soups, milk puddings, light meals based on meat or fish and chicken, avoid fried and spicy foods. It may be easier to manage regular snacks and drinks rather than 3 main meals try: Ice cream, sugar free jelly and tinned fruit in natural juice Plain biscuits If you are unable to eat download our patient leaflets for alternatives. Monitoring ketones, Diabetic Ketoacidosis, is a serious complication - read m Continue reading >>

Sick Days

Sick Days

Sick days can make blood sugars hard to control. Here are some things you can do to speed up your recovery. Ahead of Time Ask your medical team about handling sick days before you get ill. Also train one or two family members or friends in blood glucose monitoring and other ways to help when you are sick. Keep a box filled with medicines and easy-to-fix foods. If you wait until you are sick, you may not have the energy to collect all the things you need. Good choices are: Milk of magnesia A pain reliever Medicine to control diarrhea A thermometer Antacids Suppositories for vomiting If you cannot eat meals, you will need about 50 grams of carbohydrate every 4 hours. Foods you may want to keep on hand are: Sports drinks Instant cooked cereals Small juice containers Crackers Canned soup Instant pudding Regular gelatin Canned applesauce Regular soft drinks You can add other, more perishable, foods like toast, yogurt, ice cream, or milk when you are sick. While You Are Sick Even if you cannot eat normally, you will need to take your diabetes medicine. In fact, you may need to increase or change your medicine because your blood sugar may go higher. While you are sick, your medical team may ask you to test your blood sugar more often. Keep good written records about your blood sugar levels, medicines, temperature, and weight. You may need to test your urine for ketones if your blood sugar goes very high. Drink plenty of fluids to prevent dehydration. Keep a pitcher of water or other non-caloric drink by your bed, so that you can drink 4 to 6 ounces every half hour. You may also need to drink beverages with sugar if you cannot get 50 grams of carbohydrate through other food choices. The portions of these sweet beverages must be controlled, as you don’t want your blood sugar t Continue reading >>

Sick Days

Sick Days

What Are They? “My Doctor Says I Should Learn Sick Day Rules...†BD Getting Started™ 1 What’s different about being sick because I have diabetes? When most people are sick with a cold or the flu, they usually rest, drink tea or eat chicken soup. If they do not start to feel better in a couple of days, they will usually call their doctor. When you have diabetes, not feeling well affects your eating patterns and how your blood sugar reacts to your usual dose of insulin or diabetes pills. When you are sick, your body will release hormones that work to help your body fight against your illness, but they will also make your blood sugar levels rise. This means that your diabetes will be more difficult to control when you are sick. That is why it is so important to plan ahead and be prepared in case of illness. Sickness can include: a cold, flu-like symptoms such as vomiting, diarrhea, sore throat, and infections such as ear, teeth or bladder, or more serious illnesses like pneumonia or a foot infection. 2 What happens when I am sick? Illness puts your body in a state of stress. When you don’t feel well, your body produces stress hormones. These hormones work to help your body fight the infection or injury that is making you sick. They send a signal to your liver to release sugar to help in the fight. This makes your blood sugar rise. In people without diabetes, when the liver releases sugar to help the body fight against the illness, the pancreas also makes extra insulin. This allows the body to use the sugar for energy and the blood sugar remains within a normal range. However, if you have diabetes, your body cannot make the extra insulin needed and your blood sugar will go up. The stress hormones also work against insulin. Together, the sugar p Continue reading >>

Sick Days

Sick Days

Take special care when you are sick. Your body releases extra stress hormones that cause your blood sugar to rise during illness. Monitor your blood sugar closely. When you’re feeling ill, don’t assume that diabetes or its management is to blame. There are many causes of illness. For example, you could have flu, pneumonia, appendicitis, heart attack or stroke, for which you need specialized care. Do not assume that all illnesses are related to diabetes or its management. Always be safe and seek medical evaluation. Having diabetes requires you to take special care when you are sick. When you are sick, your body releases extra stress hormones that cause your blood sugar to rise, and increase your risk of Hyperglycemic Hyperosmolar States (HHS) (Type 2 only) and very rarely Diabetic Ketoacidosis (DKA). Be sure to monitor your blood sugar. If your blood sugar is high or you are very ill or vomiting, you need to contact your medical provider or go to the Emergency Department at your nearest hospital. Ask your provider for sick day guidelines specific for you. General checklist for sick days: Monitor blood glucose every 2-4 hours (Type 1) or 4 to 12 (Type 2) or as recommended by your provider. Consult with your health care provider about medication or insulin dose changes. Drink plenty of fluids, including those that have salt, such as soup bouillon. Check urine or blood ketones, especially if your blood glucose is high or if you are nauseated and vomiting. If ketone levels are elevated, you need to seek immediate medical attention. You need immediate medical attention if you have: Persistent nausea, vomiting or diarrhea Difficulty breathing Trouble moving arms or legs Vision, speech or balance problems Feel you are unable to take care of yourself Persistent blood glucose Continue reading >>

Sick Day Care For People With Diabetes

Sick Day Care For People With Diabetes

An illness such as the flu, fever, cold, nausea, vomiting, diarrhea, or an infection might cause your blood sugar to go up. To stay out of the hospital, you need to take special care of yourself. Follow these guidelines when you are sick: Check your blood sugar every two to four hours. Do not stop taking your diabetes pills and/or insulin, even if you cannot eat. Make sure you are drinking liquids. If you are unable to keep down solid food, drink 1 cup of water every hour and have one serving (15 grams) of a carbohydrate every hour you are awake. Examples of carbohydrate fluids are: ½ cup juice ½ cup regular, caffeine-free soft drink (not diet) 1 cup sports drink 1 cup broth-based soup ½ cup regular gelatin 1 double-stick Popsicle® If you are able to keep down solid food, eat your regular meal plan and drink 1 cup of calorie-free fluid every hour. Examples of fluids are: Water Caffeine-free diet soft drinks Plain tea Bouillon Take your temperature. Check your urine for ketones* using special ketone strips. Do this every four hours when: Your blood sugar level is higher than 250 mg/dl You are vomiting You have diarrhea *If your body is not able to use sugar for energy, it will break down its own fat for energy. When fat is used, ketones can appear in your urine. Ketones in your urine can be dangerous. If you need an over-the-counter medicine, ask your doctor or pharmacist for a list of sugar-free products. Call your doctor if: Your blood sugar is higher than 250 mg/dl or lower than 70 mg/dl two times in a row. There are ketones in your urine. You have a fever (temperature above 100.3 degrees F or 37.9 degrees C) . You have vomited more than once. You have diarrhea more than five times or for longer than 24 hours. You have other signs of infection, including: Sweats o Continue reading >>

Sick Days

Sick Days

When you are coughing, sneezing, or feeling nauseous, probably the last thing you want to do is worry about your diabetes. However, when you are sick, your blood glucose levels go up, so you need to be extra careful with your diabetes management. We spoke with Martin J. Abrahamson, M.D., Medical Director, Joslin Clinic, to get some tips on managing both sickness and diabetes. Before you get sick Make a “sick day plan” with your diabetes team. This may include a special meal plan for when you are having trouble keeping food down. Ask your doctor if there are any over the counter medications you should avoid, or if you need to follow any special precautions. When you are sick Always take your diabetes medication. If you are having trouble keeping the medicine down (vomiting), call your doctor. Check your blood glucose levels at least 4 times a day. If you are too sick to test it yourself, have someone else do it. Write your levels down in case you need to call your doctor. Check for ketones if your blood glucose is 250 or higher. Write levels down in case you need to call your doctor. Stick to your normal meal plan, if possible. Drink lots of sugar free liquids to prevent dehydration When to call your doctor Call your doctor if you have any of the following: A fever above 100.5 Vomiting or diarrhea for over 2 hours Blood glucose levels above 250mg after two checks, or if levels do not go down after extra insulin Moderate or large ketones Continue reading >>

When Counseling Clients About Sick Day Management, Consider The Following Strategies:

When Counseling Clients About Sick Day Management, Consider The Following Strategies:

Sick Days Note to the Health Care Professional: Topics in this handout are discussed in Chapter 19 of the American Dietetic Association Guide to Diabetes Medical Nutrition Therapy and Education (1). Emphasizing that clients should continue to use medications and insulin when they are sick Explaining that clients may need to adjust or add insulin to control their blood glucose Discussing use of urinary ketone testing when ill Helping clients develop a plan for what to do in the event of illness Discussing times when they need to contact their health care team Reference 1. Warshaw HS. Advanced topics in diabetes nutrition management. In: Ross TA, Boucher JL, O’Connell BS, eds. American Dietetic Association Guide to Diabetes Medical Nutrition Therapy and Education. Chicago, IL: American Dietetic Association; 2005:218-226. ° ° ° ° ° Copyright © 2008 American Dietetic Association. This handout may be reproduced for patient education. Copyright © 2008 American Dietetic Association. This handout may be reproduced for patient education. Sick Days Illness and Blood Glucose For people with diabetes, being sick with the flu or another illness can raise blood glucose to unsafe levels. Sometimes, your blood glucose may go up before you start to feel sick. The medications you take when you are ill also may raise your blood glucose. People with diabetes need to plan ahead for when they get sick. Following a sick-day plan will help you keep your blood glucose in target ranges and feel better faster. What to Do When You Are Sick Keep taking any medications that are part of your diabetes treatment plan. Talk with your doctor about using insulin when you are sick. You may need more insulin when you are ill. People who don’t use insulin may need it when t Continue reading >>

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