Managing illness and diabetes

Illness, infection and surgery can all have an impact on your diabetes management. As your body deals with the extra stress of illness, more glucose is released into your blood stream. Severe illness when you have type 1 can also result in the production of ketones in your blood. If ketone levels get too high it can be very serious.

Illness can mean many things, including nausea and vomiting (throwing up), head or chest cold, flu, pain, diarrhea (loose stool), fever, sore throat, toothache or surgery. When you are ill, you will probably not feel up to shopping for food, drinks and testing supplies. Plan ahead and keep a ‘Sick Kit’ filled with the supplies you would not normally keep in your house. Talk to your pharmacist about what over the counter medications for pain, fever, cold symptoms and nausea would be best for you and add them to your ‘Sick Kit’.

How to manage a sick day

Take your diabetes medications as usual – don’t stop!
Test your blood glucose every four hours. If your blood glucose is above 14 mmol/L, contact your doctor if:
- You vomit more than once in 4 hrs.
- You are unable to eat/drink for 4 hrs.
- You are sick for more than 24 hrs.
If you have type 1 diabetes, your blood glucose is over 13 mmol/L or you are vomiting, check your urine for ketones every 2-4 hours.
Drink at least 8 oz of sugar free fluid an hour (as water, tea, broth, sugar-free pop, Crystal Light). If your stomach is upset, sip small amounts every 15 minutes. Watch for signs of dehydration such as thirst, dry skin or less frequent urination.
Discuss over-the-counter medications with your pharmacist, they can help you choose which products are best for you.
Take 10-15 grams of carbohydrate every hour if unable to eat regular meals. * See below Hourly Carbohydrate Choices chart.

HOURLY CARBOHYDRATE CHOICES
STARCH	6 soda crackers 1 cup soup (water) 1 slice toast 2 digestive cookies	15 carbohydrates
FRUITS & VEGETABLES	1/3 cup apple juice 1/2 cup orange juice 1/2 cup applesauce 1/2 banana	10 carbohydrates
SUGARS	1/2 cup regular pop 1/4 cup regular jello 1/4 cup sherbet 1/2 (1 stick) popsicle	10 carbohydrates

If your stomach is upset and you are unable to eat your regular meals - replace your carbohydrates with fluids for each meal.
* See below for Clear Fluid Meals chart.

EXAMPLES OF FLUID MEALS = 50g Carbohydrates
Example 1	1 can regular pop 1/2 cup regular jello clear tea	30 20 0
Example 2	2/3 cup apple juice 1 cup chicken noodle soup + 2 soda crackers 1/2 (1 stick) popsicle	20 20 10
Example 3	1 cup orange juice 1 cup chicken broth + 4 soda crackers 1/2 cup sherbet	20 10 20

What are ketones?

Ketones are chemicals that the body produces when there is not enough insulin in the blood and instead must use fat for energy.
Ketones are a warning sign that your insulin is low and your cells are not getting enough glucose and this is when the cells will start to burn fat for the energy they need. When this happens, ketones build up in your blood and then spill over into your urine so that your body can flush them out.
Signs to watch for are nausea and vomiting which can lead to dehydration, stomach pains and rapid breathing, flushed face, dry skin and a sweet breath odour. If fluids and insulin are not given immediately there may be serious consequences. Do not ignore the warning signs.

How to check for ketones in your urine.

Ketones are checked by using test strips which change colour when passed through urine.
Your test should be done with fresh urine so before testing empty your bladder.
Drink a glass of water and wait a few minutes.
As you urinate again pass the ketone test strip through the stream or dip stick in urine. The test strip changes colour depending on the concentration of your ketones.
If your test strip is showing ketones call your doctor or diabetes educator as you may need to make some changes in your treatment.
Ketone test strips have an expiry date, so replace them when necessary.

There are now blood glucose meters that can test for ketones ask your pharmacist for further information.