The Practical Aspects

Sick-Day Management of Diabetes

Keeping diabetes in check requires daily monitoring and medication. Add a common cold or flu to the equation, and an already complex health regimen becomes even more complicated.

Difference between type 1 and type 2 diabetes

Type 1 diabetes usually affects children or young adults, and is characterized by the body's inability to produce insulin. The body ordinarily uses insulin to help get glucose, a simple form of sugar and the body's first choice for energy, into its cells. Without insulin, the body begins to break down fat and muscle for energy and develops what are called ketones in the blood, which leads to a problem called ketoacidosis that can make people severely sick.

Type 2 diabetes is more common among adults, and is the result of the body's inability to respond to insulin, what is called insulin resistance. This disease doesn't necessarily require insulin for treatment. Usually we can treat it with diet and medications, although eventually some patients may need to take insulin. Patients with type 2 diabetes who are sick can often withhold their medicines for a period of time and not run the risk of developing ketones in their blood. So it's a little bit less serious than type 1 when there is an extra illness to contend with.

Sick diabetics

The response of blood sugar levels to the stress of an illness is somewhat unpredictable. In certain situations - perhaps with a serious infection - blood sugar levels might go very high, much higher than usual, because of the hormones that are released in the presence of that kind of infection. On the other hand, some people lose their appetites when they become ill, or they may have nausea or vomiting, and if that happens, blood sugar levels could be a lot lower than usual.

The first rule for anyone with type 1 or type 2 diabetes who is facing an acute illness is to increase the frequency of their blood sugar monitoring, because it's really unpredictable which way things are going to go.

Is this rule the same for those with type 1 and type 2 diabetes?

Yes, It is.

Should people with type 1 diabetes stop taking insulin while they're sick?

No. Most of the time a diabetes treatment plan, whether it's insulin or pill treatment, is based on the assumption that the person is eating three meals a day. When there's a big change in that schedule, the diabetes management has to change as well.

But people with type 1 diabetes should never completely stop taking their insulin because their body needs insulin even when they're not eating anything in order to maintain normal metabolism. As previous mentioned, in the complete absence of insulin the body starts to burn fat, which can lead to the breakdown of the fat tissues, ketones in the blood, then a ketoacidosis situation.

So, when they are ill, people with type 1 diabetes-even if they are vomiting and they're not able to eat-will still need to take insulin, but they should be guided in how much to take by the results of their blood sugar testing.

How often should diabetics check their blood sugar during illness?

It's sort of an individual matter, but every couple of hours during an acute illness would be the target.

What if a type 1 diabetics has a high blood sugar level?

The most important thing is to have a game plan ahead of time. Discuss this with your physician. Some people are able to adjust their own insulin doses and may need to take frequent small doses of a short-acting insulin throughout the day in order to maintain adequate control in the setting of an illness.

What to do if the blood sugar is low?

In that case, the person needs to eat some carbohydrates. If they're having trouble keeping food down, then they should probably call their physician.

What special care should a person with type 2 diabetes take during illness?

The number one thing is to monitor blood sugars more frequently. For most people with type 2 diabetes, it's generally safe to stop diabetes treatment, whether it's insulin or pills, for a brief period of time when they're not able to eat. But there are exceptions to that rule, and if they stop medication, they should discuss it with their physician.

But it's a lot easier for someone with type 2 diabetes to get through that kind of an illness than it is for someone with type 1.

Why would they need to stop medication at all?

The diabetes treatment plan is generally based on the assumption that you're going to be eating, so there's a tendency for blood sugar levels to drop lower than they should if you take your medicine and then you don't eat.

Do diabetics need to be more diligent about avoiding sickness than others?

People with diabetes, especially if their blood sugars are not under good control, may be more susceptible to getting infections of all kinds. So if a bug is going around, they may be the person in the office who's likely to get it.

Also, when people with type 1 diabetes get an infection, they're at high risk for getting ketoacidosis, which can be severe and dangerous, so that's why we pay special attention in those times of acute illness.

When should a person with diabetes consult his or her doctor during illness?

You should consult your doctor if you have a fever that's been going on for more than a couple of days, if your blood sugar is higher than, say, 250 or 300 mg/dl and you've tried yourself to get it down and you can't get it down, if you're a type 1 patient and you have ketones in the urine and they don't go away within a few hours, or any time that you just feel uncomfortable or confused about what to do.