Diabetic Sick Day
Apr 22, 2013
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
In this world of GPSs, cell phones, satellite communications and instantaneous internet chat, it is easy to forget there are remote and in hospitable places on our planet. I was listening to a documentary about an around the world solo sailing race. The competitors talked about huge waves and storms, the incredible wild life they ran into and Point Nemo. I had never heard of Point Nemo before. Point Nemo is the farthest you can get from land anywhere in the ocean. At Point Nemo in the Southern Pacific Ocean you are over 2000 km from any land and any people. Point Nemo is far away from normal shipping lanes. In fact, if the International Space Station flies over you at 400 km up, the closest living human to you at Point Nemo is an astronaut in orbit. So if you get in trouble, help is a long, long way away and you better have a plan on how to look after yourself. Although not nearly as dramatic, if you are diabetic and you get a stomach flu, you also should have a plan in place to look after yourself.
In the March 2013 Pharmacists Letter I found an excellent article on sick day management in diabetes. It seems like in the last few weeks everyone I know has had some flu bug or other. The care homes in Dauphin have had flu-like symptom outbreaks. Stomach flus have gone through several of the seniors complexes. My parents even came back from Texas just in time to be stuck in the house for a few days with flu-like symptoms. What should people do if they have nausea, vomiting and diarrhea and also have diabetes?
Ideally, before the person gets sick they should have a sick day plan made up. This can be made up with the patients doctor, but often it would be made up with the patients diabetic educator which can be a nurse, dietician, pharmacist or other health care professional with extra diabetes training. The patient and educator will discuss when holding medications is wise, what to eat when you are nauseous and when to get to the hospital.
In general, if a person with diabetes gets sick, it is important to check their blood sugars. Just the stress of being sick will probably make their blood sugars go up. To make matters more complicated, if a person with the flu doesnt feel like eating, their blood sugar may go down. So especially if a person takes insulin, they should check their sugars every 2 to 4 hours when they are sick. Even if a diabetic isnt on insulin, they should still check their sugars 2 to 4 times a day when they are sick. If a diabetic uses insulin, they may be told to check their ketones every 4-6 hours while they are sick and if their blood sugars go above 14. If their ketones are high, they should contact their doctor.
Diabetics with the flu should be careful to prevent dehydration. They should try to consume to 1 cup of water every hour while they are awake. If they are vomiting a lot, they can try to take small sips every 5 to 15 minutes. If possible, the diabetic with the flu should try to eat their regular meals and snacks. If they cant eat and their blood sugar is 14 or less they can try to eat 15 g of carbs per hour. That is about cup of juice, cup of regular pop, a cup of Jello, a twin popsicle or about 6 saltine crackers. If their sugar is higher than 14, the diabetic with the flu should just drink water, broth, sugar free jello, ice chips and sugar free popsicles.
If the diabetic with the flus sugar goes below 4 they should drink or eat about 15 g of carbs. That could be honey, regular pop, fruit juice, life savers or glucose tablets. Their blood sugar should be checked again in 15 minutes. If it is still low, eat or drink another 15 g of carbs. If that doesnt work or the patient loses consciousness, consider using glucagon if available and seek medical attention immediately.
Usually during a sick day, a diabetic will continue to use their medication and insulin the same way as when they are well. With their doctors advanced permission, a diabetic may be told to hold their metformin when they are sick. If a patient has nausea, vomiting and diarrhea they have a theoretical risk of getting lactic acidosis if they are on metformin. If the diabetic with the flu cant consume enough carbs, the might be instructed to reduce or with hold their fast acting insulin. They will keep using their long acting insulin, though. Again, this should be a plan you and your doctor or educator should have discussed before you get sick.
If a person who takes insulin keeps getting sugar levels above 14, their doctor may have them take extra doses of their fast acting insulin. And again they will probably be told to check their ketones while their sugars are high and to contact their doctor if their ketones are too high.
If you type in the latitude and longitude of Point Nemo into Google Earth or Google Maps you will see a dot in the Ocean and the word Nemo. I cant imagine how much preparation and planning it must take to be able to sail by yourself in that most remote location. Preparation and planning for a sick day if you are diabetic is not nearly so onerous. Before you get sick, talk to your doctor and diabetes educator about what to do if you get sick. Planning for a diabetic sick day is much easier before your head is in the toilet. So plan ahead with your doctor or diabetes educator and may sailing over your Point Nemo be smooth.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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