Making the correct decisions today will keep Michelle’s sickness from becoming life-threatening.
If you have type 1 diabetes, you are no more likely to get sick than those without diabetes. However, if you are ill, diabetes management becomes challenging. During sickness, the body produces stress hormones. These hormones help the body fight off the infection or virus. However, they also act against insulin.
If insulin is not working, or if there is too little circulating, glucose builds up in the blood stream and is unavailable to cells as a source of energy. The body makes up for this by burning fat. When fat is burned, toxic ketones are produced. Producing too many ketones, too quickly, is bad news. It upsets the delicate balance of body chemistry and can lead to a state called diabetic ketoacidosis (DKA) – and that is dangerous.
Diabetic ketoacidosis (DKA) can quickly develop if the illness is not managed properly. As the ketone level rises, the blood becomes more acidic. Dehydration combined with the acidic blood causes DKA.
Symptoms of DKA include:
These symptoms are due to lack of insulin. More insulin is needed to allow the body’s cells to use available glucose and stop it from burning fat for energy. When ketones cause vomiting, deciding to stop injecting insulin (thinking you might not need it because you’re not eating) could result in severe sickness or even death.
Another concern with illness is dehydration. If you are nauseated, you may not be drinking enough. Diarrhea, vomiting, and increased passing of urine caused by high blood glucose and ketones can cause fluid loss. Fluid requirements are actually increased and failing to drink enough liquid during illness can dehydrate you. This throws off the balance of electrolytes such as sodium and potassium in your body.
Stomach flu with vomiting and or diarrhea may cause low blood glucose, although this is less common in teens and adults. You may not be able to eat or drink enough food or fluids containing carbohydrate to work with the insulin you injected or you may not be absorbing nutrients as usual.
In summary, when you are sick you must be aware of these possible complications:
Knowing how to manage illness and having the right supplies on hand can prevent these potentially life-threatening complications.
When you are sick, you must know your blood glucose level. Check it every two to four hours around the clock. If you want to sleep, set an alarm so that you will wake frequently to test. If your blood glucose is above 14 mmol/L, it is recommended that you check your blood or urine for ketones.
A few products are available. Your doctor or diabetes educator may recommend one over the other. (The Precision Xtra™ meter can be used to check your blood. Two urine testing products are also available – Chemstrip™ uGK or Ketostix™. Be sure to read the package insert regarding shelf life and storage. Mark the date of opening on the bottle and throw the strips away once they have expired. Outdated strips can give a false negative reading.)
The most important thing to remember when you are sick is always take insulin, even if you are unable to eat or you are vomiting. High blood glucose and ketones mean you need extra regular or rapid-acting insulin. Usually, you would need extra insulin totalling around 10 to 20 per cent of your total daily dose. Give extra rapid-acting insulin every two hours (or regular-acting every 4 hours) until your blood glucose is below 14 mmol/L or your ketones are negative. Ensure that you have a detailed sick day management plan worked out with your doctor or diabetes educator well in advance so that you are not guessing during a time when you are also feeling sick.
Rarely, you might need to reduce your insulin when you are sick. If your blood glucose is below 7 mmol/L and you are unable to eat, lower your insulin by 20 per cent. Remember: never stop taking insulin!
Make sure you are drinking enough to prevent dehydration. Try to have one cup of fluid per hour. If you are nauseated, sip fluids. If your blood glucose is above 14 mmol/L, choose sugar-free liquids. If below 14 mmol/L, select fluids containing sugar. If you are vomiting and/or have diarrhea, try chicken broth and sports drinks such as Gatorade™ to prevent electrolytes in your blood from dropping too low.
Finally, know when to get help. Call your doctor or diabetes educator if you have any concerns or are unsure of how to manage your diabetes. Do not guess. If you do not have a detailed sick day plan with information about insulin dosing in the presence of high blood glucose or when ketones are present, it is better to be safe than sorry. A good rule of thumb is to go to emergency if you are unable to keep fluids down, have vomited more than two times in four hours, have blood ketones above 3.0 mmol/L, or are showing moderate to large levels through a urine test. You may have life-threatening DKA, or at the very least a stomach flu that will cause dehydration. You need medical help!
Plan for unexpected illness. When you are home alone and sick, you must have illness management supplies on hand. You may be too ill to make a trip to the pharmacy or corner store. Keep the following items in an ‘illness management kit’ (shoe box or plastic container) so that they are ready when you need them.