Sick Days
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Tuesday, March 14, 2006 |
Q: "I had been given a pre-printed page with sick day guidelines on it shortly after I was diagnosed with type 2 diabetes. The guidelines seem to be more geared to type 1, so I have several questions:
- "I've read that even a type 2 needs to test for ketones if they are sick and their blood sugar is high (over 250). Is this correct?
- I've read that if a person with type 1 vomits more than once they need to call their doctor. What about type 2? Are there any guidelines for a type 2 that is sick and vomiting?
- Does a type 2 need to more closely monitor blood sugars during illness even though there is virtually nothing they can do to bring their sugars down unless they are on insulin?
- I guess I'm basically asking for more info on sick day protocol for type 2 diabetics. Thanks."
A: You bring up some important issues. Although many diabetes books and websites offer general sick day guidelines, there are always individual variations and exceptions, and it is important that you first discuss any guidelines with your healthcare team to make sure you understand specifically what they recommend for you. Sometimes there is a "blurring" in the distinction of type 1 and type 2 diabetes-meaning that some people think they have type 1 diabetes just because they take insulin (not necessarily true); some people might actually have type 1 diabetes but have been told they have type 2; as type 2 diabetes progresses over time, some people with type 2 could be prone to show ketones in severe conditions, due to the fact that they may be very insulin deficient.
General Sick Day Guidelines:
- A reminder that when you are ill, your body perceives this as a stress; to provide you with energy to fight this stress, your body releases hormones that raise your blood glucose.
- High blood glucose can interfere with your ability to heal, which is another reason why you would want to get your glucose back to normal as soon as possible.
- The American Diabetes Association (ADA) lists guidelines under both the type 2 and type 1 sections of the website regarding "when you're sick". To read more about the ADA "when you're sick" guidelines, please refer to the related links below.
Answering your specific questions:
- Whether or not you should test ketones when you are over 250 is up to your physician to decide. Many diabetes centers choose not to teach people with type 2 diabetes to test for ketones, but rather to individually provide this advice only to those with type 2 for which this might apply (such as if the person with type 2 is taking multiple shots of insulin daily, or is using an insulin pump).
- Regarding when to call the doctor if you are sick and vomiting: Some clinics recommend that if you've vomited more than once in a day, to call your doctor; whereas the ADA site recommends calling if you have been vomiting for more than 6 hours. However, if you were using an insulin pump and there were any concern that the insulin delivery were disrupted, then many pump users (type 1 or type 2) would be told to call immediately if 2 blood glucose readings were over 250, or if vomiting. The important point to understand is that vomiting can cause dehydration, which can make you feel worse as well as raise your glucose even higher causing your diabetes to get out of control.
- Specific guidelines for the person with type 2 who is vomiting: As you’ll read in the ADA guidelines, if possible, you should still continue to take your pills (and insulin, if applicable), since usually your blood glucose will be higher than usual. Naturally, if you cannot keep your pills down, you would need to call your doctor. You’ll also read that if you can’t follow your normal meal plan due to nausea and vomiting, that you need to keep hydrated by drinking adequate noncaloric liquids. Also, if you can’t tolerate your usual food, the guidelines suggest soup, crackers, applesauce, gelatin, regular soft drinks, sherbet, juices, frozen juice bars, tea and broth. Furthermore, the ADA recommends that you aim for 50 grams of carbohydrate every three to four hours. Again, some doctors and clinics will be more specific and recommend certain noncaloric liquids if your glucose is over 250, and then have you switch to different, sugar-containing liquid foods when your glucose drops below 180—so you need to check with your doctor.
- Do you need to more closely monitor blood glucose during illness even though there is nothing you can do to bring it down unless you are on insulin? As noted above, if you were taking diabetes pills, you would still take them, and perhaps your doctor would advise a temporary increase in the dose. If you are on no medication, it is still important to monitor your blood glucose closely because even though you may have been well controlled before the illness, sometimes an illness can dramatically raise your glucose to a level that might temporarily require you to need diabetes medication. I have seen people with previously well-controlled diabetes who became ill and developed very high glucose levels that required hospitalization—needless to say, this might have been prevented if they had followed the basic sick day rules.
- Finally, as I said before, check with your healthcare team first: Specific recommendations depend on your age, other medical conditions you might have, and whether or not you are diet controlled, take pills, or insulin.
Related Questions
Ketones
Q:
"What are ketones?"
Difference between Type 1 and Type 2
Q:
"What is the difference between Type 1 diabetes and Type 2?"
Related Links
American Diabetes Association (ADA)
http://www.diabetes.org
Joslin Diabetes Center
http://www.joslin.org
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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