DIABETES SICK DAYS
Diabetes sick days are days in which the person who has diabetes now develops another illness that can vary from minor ones like fever, cold and catarrh to more serious ones which may be life threatening. Diabetes sick days can make blood sugar levels difficult to control. People living with diabetes should know well in advance what to do on sick days before such a day comes.
There are four major concerns about diabetes sick days. These include excessive loss of fluid from the body (dehydration), very high blood sugar levels (hyperglycaemia), development of ketoacidosis (high blood levels of chemicals called ketones) and very low blood sugar levels (hypoglycaemia). These four conditions can rapidly become life-threatening if not quickly addressed.
Dehydration can occur if there is inadequate intake of water and other fluids on such days. Also, vomiting, passage of loose stools, excessive sweating and excessive passage of urine can also lead to dehydration. This dehydration can then lead to severe reduction in the ability of the kidneys to produce urine, which if allowed to persist for too long can lead to what is called acute renal failure and subsequent accumulation of toxic wastes in the body which is potentially lethal.
To prevent dehydration on such sick days, adequate intake of at least three litres of water and other fluids is advised. There may also be a need for medications that will stop vomiting and passage of watery stools. Visit to hospital should not be unnecessarily delayed. Adequate intake of fluid prevents a medical condition called shock which can follow dehydration and which can lead to reduced functioning of a lot of organs in the body.
Infections and other causes of illnesses lead to stress within the body. Stress is known to lead to very high blood levels of a chemical called cortisol. This chemical in turn can lead to very high blood sugar levels. During illnesses, there is a need for more frequent checks of the blood sugar level and when found to be high, there will be a need to increase the amount of medications like insulin and other blood sugar lowering medications that are taken.
High levels of ketones in the blood or urine with concurrent high blood sugar levels can lead to an emergency situation called diabetic ketoacidosis.
Ketones are produced when the body breaks down fat for energy instead of using the glucose in the blood. Illnesses can lead to more production of these ketones. This occurs because of lack or ineffectiveness of insulin in the person with diabetes. Thus on sick days, people with diabetes need to check the level of ketones in their blood or urine. Symptoms of ketoacidosis include deep breathing, vomiting, and abdominal pain, a fruity odour of the breath, drowsiness and eventually coma. High levels are dangerous to the body and warrant prompt hospital admission and treatment.
During sick days some individuals may not be able to eat and this may then lead to dangerously low blood sugar levels. Such individuals should be strongly encouraged to eat. Intake of fruit juices will help to prevent both dehydration and low blood sugar levels on such days. Those with low blood sugar levels will need to have the doses of their insulin and other medications reduced drastically. However, individuals with Type 1 diabetes will still require some insulin to prevent formation of ketones.
Individuals with diabetes, their relatives and other caregivers are required to keep a closer watch on the state of the blood sugar and ketone levels during sick days to prevent unnecessary complications. The key to managing sick days appropriately and safely is education about the steps to be taken when such days come.
Self medication should be avoided. Such things to be educated about is the need to avoid sugar containing cough syrups in those that have cough as they can lead to increase in blood sugar levels, instead, sugar free cough syrup and lozenges should be used. Some other over the counter medications can lower or raise blood sugar levels. Prompt contact with healthcare providers and hospital visit can be lifesaving.