Managing your diabetes when you are unwell

Why are people with diabetes at risk?

If you’ve been following the media – and let’s face it, it’s hard not to at the moment – you’d have heard that people with diabetes are in the ‘high risk’ group when it comes to being impacted by the coronavirus.  The same can be said for the seasonal flu. Understandably, this may make you anxious or scared. But what are the facts and should you really be concerned?

Overall, people with diabetes seem to get infections at higher rates than those without. What we don’t really know is whether everyone with diabetes is at greater risk or just some people—for example, those with diabetes-related complications. However, what we do know is that having diabetes increases the chances of becoming very unwell if you are infected with a virus. For this reason, it is especially important that you take steps to avoid becoming unwell and that you have a plan in place to manage your diabetes and health if you do.

The best way to reduce your risk of infection is to practise good hygiene, particularly washing your hands often with soap and water, including before and after eating or preparing food and after going to the toilet. When this isn’t possible, use alcohol-based hand sanitisers. Social distancing can also help – this means avoiding large gatherings, keeping a distance of 1.5 metres between you and other people whenever possible and avoiding close contact with others, particularly if they are unwell. You can find more information on reducing your risk on the Department of Health website www.health.gov.au

How does being unwell affect your diabetes?

As well as making you feel unwell, being sick can make it more difficult to manage your diabetes. Illness or infection is a stress on the body. To deal with this stress, your body releases hormones that help it fight the illness or infection. These hormones tend to raise blood glucose levels and make it harder for your insulin to work. Combined with changes in your eating and activity levels when you are under the weather, it can be harder to keep your blood glucose in your target range.

In many cases, illness will cause a mild or moderate increase in blood glucose levels for a few days and levels will return to normal once you start feeling better. But in some cases, particularly with severe infections, your blood glucose levels can become very high and you may need a change or increase in medication. For example, if you take insulin, you may need to increase your doses, while if you take tablets you might need to switch to insulin temporarily while you are unwell.

If high blood glucose levels aren’t managed, this can lead to conditions called diabetic ketoacidosis (also called DKA, which usually occurs in those with type 1 diabetes) or hyperosmolar hyperglycaemic syndrome (also called HHS, which usually occurs in older people with type 2 diabetes). These are medical emergencies which, if not treated urgently, can lead to loss of consciousness and coma.

What can you do to avoid complications when unwell?

The best way to avoid major problems with your diabetes management when you get sick is to work out a plan of action ahead of time. This way you will know what to do when you are ill, and will have the necessary supplies on hand.

There are two important things you can do: have a plan for managing your diabetes when you are unwell, and have sick-day kit containing everything you might need to manage your diabetes if you have an illness or infection.

Your diabetes sick-day plan

Your sick day plan should include:

• details of how often to check your blood glucose levels (and whether you need to check your levels when unwell if you have type 2 diabetes and don’t usually self-monitor)
• when and how to adjust your medication (particularly if you are taking insulin)
• when to contact your doctor or diabetes team
• emergency contact numbers (for example,  your GP, diabetes educator, local hospital or medical centre and support persons)

If you don’t already have a sick-day plan, your diabetes educator or doctor can help you to develop one. If you do have a plan, now is a good time to make sure it is up-to-date.

Your diabetes sick-day kit

Your sick day plan should include:

• a copy of your sick-day plan
• blood glucose monitoring equipment
• ketone test strips (blood or urine) if you have type 1 diabetes or are taking diabetes medications called sodium-glucose co-transporter-2 inhibitors (such as Forxiga, Jardiance, Xigduo, Jardiamet and Qtern)
• hypo treatments, if you are taking insulin or sulphonylureas (such a Diamicron, Danoil, Glyade, Minidiab, Glimel and Amaryl)
• food and drinks for sick days, including both sweetened and sugar-free fluids
• pain relief medication and a thermometer

If you already have a sick-day kit, check that it is well-stocked and everything is still in-date.

Also make sure you have plenty of medication, insulin and diabetes supplies including insulin pen needles, blood glucose and ketone test strips, lancets and pump cartridges and infusion sets in case you need to be in isolation. However, the Department of Health say that there is no need to stockpile, as there are no current shortages or supply issues with insulin, diabetes medicines or NDSS products and overbuying can prevent other people with diabetes from getting the medications and supplies they need.

What if you become unwell?

If you become unwell:

• Start following your sick-day plan
• Let someone know you are unwell, particularly if you live alone
• Drink plenty of fluids
• Keep eating, if possible
• If you self-monitor your blood glucose levels, particularly if you have type 1 diabetes, check your blood glucose levels more often
• Keep taking your diabetes medications, unless your sick-day plan advises otherwise – you may need to stop some medications if you are unable to eat, are vomiting and/or have diarrhoea, so check with your doctor or diabetes educator if you are unsure
• Keep taking your insulin and expect to increase your doses – even if you are unable to eat, it’s important not to stop taking your insulin, although doses may need adjusting
• See your doctor or contact your diabetes educator if you need help
• Seek urgent medical care if needed

For further information on managing sick days, download a free fact sheet from the NDSS website and speak to your diabetes educator or doctor about developing your own sick-day plan. Hopefully, you won’t need it, but it’s best to be prepared!

When to seek help

While, with the right plan, sick days can often be managed at home, it’s important to know when to seek help. Diabetes Australia recommends seeking help immediately if you:

• are drowsy or confused
• have deep rapid breathing or shortness of breath
• have a ‘fruity’ odour to your breath (a sign of DKA)
• can’t keep food or fluids down and are experiencing persistent vomiting, diarrhoea and/or stomach pain
• are showing signs of dehydration (such as extreme thirst, weakness, confusion and/or lack of urination)
• have blood glucose levels that continue to rise even though you have been following your sick-day management plan
• have difficulty keeping your blood glucose levels above 4mmol/L
• are not well enough to follow your sick-day action plan or you don’t have anyone to help you

Resources

https://www.ndss.com.au/living-with-diabetes/health-management/sick-days/

https://www.health.gov.au/health-alerts/covid-19

https://www.health.gov.au/diseases/influenza-flu

This article was originally published in Diabetic Living Magazine and has been republished with permission.