It's important to have a sick-day plan in place for the times someone with type 2 diabetes gets a cold, flu, or other illness, as being sick can boost his blood glucose levels to potentially harmful levels. Follow these eight guidelines to help make sure he manages his diabetes even when he's under the weather.
1. Make a sick-day plan.
Along with his doctor or diabetes educator, help the person in your care prepare for illness by coming up with a strategy to deal with sick days. That way, when trouble strikes, you'll both be ready.
The plan, kept in a handy place such as a sick-day notebook or sheet taped to the fridge, should include information such as:
- How often he should check blood sugar and ketone levels
- What medicines to take
- How to adjust insulin dosage, if he uses insulin
- What kinds of food to eat
- When to call his diabetes team
- Contact details for his doctors, diabetes educator, and dietitian, including emergency and after-hours numbers
- Contact details for a family member or friend who can check in with him often to help monitor his health
Test regularly for flare-ups of type 2 diabetes
2. Check blood glucose often.
When a person is sick, his body is under stress. T o deal with it, his body releases hormones that help fight disease. These can also elevate blood sugar levels and interfere with the effects of insulin, which lowers blood sugar.
This makes it harder for him to keep his blood sugar in his target range during an illness. That's why he needs to check his blood sugar more often so he can keep close tabs on his glucose numbers. His doctor or diabetes educator may recommend measuring blood sugar at least four times a day, every few hours, or at some other interval. Find out in advance, before an illness occurs, how often his healthcare team advises testing. If he's too sick to test himself, you or another caregiver can perform this task.
3. Test urine ketones.
Illness can trigger a buildup of ketones -- acids produced by the body when there's a shortage of insulin -- in the urine. High levels of ketones can lead to two potentially life-threatening ailments: diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic syndrome .
A simple home urine test will alert you to possibly high levels of ketones in a patient's urine. His diabetes doctor may advise measuring ketones if his blood sugar level is higher than 300 milligrams/per deciliter (mg/dL), or she may recommend routine testing during sick days.
Keep up regular type 2 diabetes routines
4. Keep taking diabetes medications.
A patient still needs to take his diabetes medications when he's sick, even if he's throwing up or unable to eat much. His body continues to need these drugs to help make the extra glucose necessary during ill health.
In some situations, he may just need to take his regular diabetes pills; in others he may have to use insulin for a short period of time. As always, any changes in his treatment plan should be discussed with his main diabetes doctor.
5. Drink plenty of water.
Dehydration is a major concern among older, ill adults with diabetes, who may not recognize signs of thirst until their bodies are dangerously depleted of fluids. This can spiral into potentially life-threatening conditions. In addition, it's easy for a patient to get dehydrated if he's vomiting or has diarrhea or a fever.
As a general guide, he should drink eight ounces of calorie-free fluid such as water for every hour he's awake. Offer small sips every 10 to 15 minutes if drinking is a challenge.
6. Stock up on sick-day snacks.
Eating can be tricky when someone is sick -- he may not have an appetite, or he may be unable to keep food down. If he's too sick to stick with his regular meal plan, you need to help him find ways to try to take in a sufficient number of calories. To prepare for such sick days, have a stash of nonperishable, easy-on-the-stomach foods at home, such as vegetable or chicken broth, clear soups, applesauce, crackers, or regular gelatin.
Perishable sick-day snacks to pick up for him include frozen juice bars, sherbet, pudding, yogurt, or similar soft foods or high-carbohydrate liquids. Just make sure to pay attention to the "use by" date on the packaging.
The goal is to try to have a patient eat 50 grams of carbohydrates every three to four hours. As a general guide, one cup of soup, six saltine cr ackers, one-half cup of apple juice, one-half of a banana, and one-third cup of frozen yogurt contain around 15 grams of carbs each.
Medical help for type 2 diabetes
7. Stock the medicine cabinet.
Keep a supply of diabetes-related medical supplies -- glucose meter, lancets, and blood sugar and ketone testing strips (check expiration dates) -- on hand along with other standard supplies, including a thermometer and over-the-counter remedies.
If a patient wants to take extra medicines to deal with a specific illness, always check the label of any over-the-counter drug before he takes it to see if it contains sugar. Small doses of medicines with sugar, such as cold and flu remedies, may be okay. But to be safe, ask his pharmacist or diabetes doctor about sugar-free alternatives.
Be aware, too, that many other medicines a patient takes for a short-term illness can affect blood sugar levels. For instance, aspirin in large doses can lower blood sugar levels. Some antibiotics lower blood sugar levels in people with type 2 diabetes who also take diabetes pills. If you or the person in your care have a concern about whether a prescription or over-the-counter drug may affect his diabetes, discuss this with his health professional before he takes it.
8. Call the doctor.
A patient doesn't need to call his doctor's office every time he gets a mild stomach bug or a case of the sniffles. But he should seek a doctor's advice if:
- He's had a fever for a couple of days, feels unwell, and doesn't seem to be getting better.
- He's been vomiting or has had diarrhea for more than six hours.
- He's taken his diabetes pills, and his blood sugar is above 240 before meals and stays there for 24 hours or more.
- His glucose level is above 240, even after he takes the prescribed extra insulin his sick-day plan may call for.
- He has signs of dehydration, ketoacidosis, or other serious symptoms, such as chest pain, trouble breathing, fruity-smelling breath, urine ketone levels that are moderate to high, or dry and cracked lips and tongue.
- He's ill and you're not sure what to do to help him.
Be ready to share details about his illness. Keep a written record in a sick-day notebook that includes:
- A list of symptoms and how long he's had them
- Medicines taken, how much, and how often
- Whether he can eat or keep food down
- Whether he's lost weight
- What his temperature, blood pressure, pulse, blood sugar, and urine ketone numbers are