Be Prepared: Planning for Sick Days

by Ann S. Williams

Although we all hope to stay healthy year-round, there are always times when you don’t feel well. Especially during the winter and early spring, many people catch a variety of illnesses such as colds, sore throats, and influenza.

While these seasonal illnesses are inconvenient for everyone, they can be potentially dangerous if you have diabetes because when you are sick, the stress of the illness makes your blood glucose (sugar) rise. High blood glucose makes your body’s immune system less effective at fighting germs, and also makes you feel sicker than you would with normal blood glucose. High blood glucose also causes the kidneys to make more urine, which can lead to dehydration. This, in turn, can lead to even higher blood glucose. This can become a vicious cycle, which at its worst can become a medical emergency.

However, most of the time, this vicious cycle can be prevented. Some simple planning can help you keep your blood sugar in control during times of illness so your body can recover quickly. Sick day planning should include 3 parts: First, preventing illness is much better than becoming ill. Next, it’s important to have a set of supplies on hand that you would need if you were sick, so you don’t have to buy them while you’re sick. Finally, you need to know what to do to manage your diabetes during illness.

Preventing Illness
There are a few simple steps you can take to avoid illness, even when it’s “going around”:

You should make sure that all your immunizations are up-to-date. This can be as simple as asking your doctor when you have your regular checkup whether you need to update them. In general, most adults with diabetes should have had the following immunizations at some time in their lives: MMR (measles, mumps and rubella) and chickenpox (if they have not had the diseases); tetanus and diphtheria every 10 years; pneumonia; and influenza every year before the flu season begins. Your doctor may recommend other vaccinations if you have particular risk factors.

The other prevention steps involve common sense and simple low-tech practices. As much as possible, you should avoid being around people who are sick. And throughout the day, you should wash your hands frequently, especially when illness is “going around”. People tend to pick up many illnesses from touching surfaces that have germs from having been touched by people with illnesses. Such surfaces can include doorknobs, telephones, papers, pens, pencils, table tops, etc. It’s impossible to live a normal life without touching such things. However, many studies have shown that by simply washing your hands with plain soap and water, you can greatly decrease your risk of getting sick from these common sources of infection.

Supplies: A Sick-Day Box
You may find it helpful to have a box of supplies that you would need if you become sick. The box itself can be a shoebox, a cardboard box, or a plastic box. It could even be a drawer or shelf where the supplies can remain undisturbed until you need them, or anything else that is large enough to contain the following items:

• The names and phone numbers of your primary care doctor, diabetes doctor, and pharmacy written in large letters and taped inside the lid of the box or sitting on top of everything else.
• A quart or two of calorie-containing clear liquids, such as ginger ale or clear fruit juice.
• A quart or two of non-caloric clear liquids, such as chicken broth, sugar-free gelatin, or diet pop.
• A thermometer.
• An extra box of blood glucose test strips.
• An extra box of lancets.
• An alarm clock, to remind you to check your blood glucose regularly.
• A box of urine ketone test strips.
• Paper, such as a blood glucose record book or notebook, and a pen or pencil for writing blood glucose results and other important records.
• Instructions for sick days. You can include a copy of this article. But it is even better to discuss your personal sick day plan with your doctor, and keep your personal sick day instructions in your sick day box.
• Aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin) to bring down a fever.
• An up-to-date list of all your medical conditions and medications, including usual doses.
• Glucose tablets or glucose gel for treating hypoglycemia.
• If you use insulin you’ll want to include extra syringes, pen needles, or insulin pump supplies, with at least one vial or pen of extra insulin in the refrigerator at all times.

Managing Diabetes During Illness
The following sick day guidelines apply to most people with diabetes. However, your personal situation might call for something slightly different. It’s best to talk with your doctor while you’re well about personal guidelines for if you become sick.

• Continue to take your diabetes medication during illness, even if you are not able to eat. Because illness is a stress on the body, it will cause the blood sugar to rise, so you’ll need your diabetes medication.
• Check your blood glucose at least 4 times a day—before each meal and at bed time.
• If you use insulin, talk with your doctor about a plan for adding extra insulin if your blood sugar is high during illness. Dosing varies by individual, so it’s important to consult your doctor about this.
• If your blood sugar tests above 240:
• Use the urine ketone sticks to check for ketones;
• Check your blood glucose more frequently—about every 2 hours.
• If your blood glucose stays above 240 for 4 or more hours, call your doctor.
• Write down the time and results of all blood glucose and urine tests, as well as your temperature when you take it. Also make a note of any illness symptoms, such as vomiting, diarrhea, rashes, or pain.
• Drink at least 8 ounces (1 cup) of non-caloric liquid every hour while you are awake.
• If you cannot eat solid food, alternate 8 ounces of non-caloric clear liquid
  with 8 ounces of carbohydrate-containing clear liquid, like regular pop or a clear juice.
• Call your doctor:
• If you feel unsure of what to do.
• If you cannot hold down your diabetes medication.
• If you cannot hold down any solid food or liquid.
• You have been vomiting or had diarrhea for more than 2 hours.
• If you have ketones in your urine.
• If your temperature is above 101º F.
• If you have trouble concentrating or staying awake.
• If your blood glucose stays above 240 or below 60.
• If you have symptoms of dehydration or ketosis: sunken eyes; dry cracked lips, mouth or tongue; skin that remains “tented up” after being pinched; fruity-smelling breath; nausea and dizziness; difficulty concentrating.

Preparation Helps!
All of this preparation may seem like a lot of work while you are well. But if you have a serious illness, it will pay off. By having supplies available and knowing what to do, you will be able to recover faster—and you could prevent a very serious illness, a trip to the emergency room, or even a lengthy hospitalization. So be prepared! Put together your sick box and sick day instructions today.

About the Author
Ann S. Williams is an RN, with a PhD in Psychology, and has worked as a diabetes educator for 20 years. She has specialized in teaching independent diabetes self-management for blind people and writes and speaks frequently on this topic for other health care professionals. She was the founder and past chair of the Disabilities Specialty Practice Group of the American Association of Diabetes Educators, and remains an active member of that group.