Test Your Knowledge

Illness puts stress on the body and can alter a person’s glucose (blood sugar) levels. When a person is sick with a cold, the flu, or an infection, the body releases hormones that help fight the illness. These hormones, however, interfere with the glucose-controlling effects of insulin and can raise and sometimes lower the level of glucose. As a result, it is harder for patients with diabetes to control their glucose when they are ill.

Illness can also lead to diabetic ketoacidosis (DKA), particularly in people with type 1 diabetes. DKA includes severe hyperglycemia and ketosis and typically involves a lack of insulin. Instead of breaking down glucose, the body begins to break down fats to use for energy, producing a waste product called ketones. The body is incapable of releasing all of the ketones through urine, so they begin to build up in the blood (ketosis). Although it usually develops slowly, the condition can develop in only a few hours once vomiting occurs. DKA is considered a life-threatening emergency and requires immediate medical attention.  Untreated, DKA can lead to a diabetic coma or death.

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a dangerous condition in which a person experiences severe hyperglycemia and dehydration. This condition is seen more frequently in older people and occurs more often with type 2 diabetes. HHNS is usually brought on by illness. If not treated, it can lead to seizures, coma or death.

Women should know how diabetes can affect their pregnancy and be alert for indications of possible complications. A particular concern is preeclampsia, a condition marked by elevated blood pressure and proteinuria (protein in the urine).

To prevent an illness from causing major problems, patients should work out a sick-day management plan in advance with their physician, dietitian and certified diabetes educator.  Then when patients become ill, they will know how to react and have the supplies on hand to treat themselves. A sick-day management plan should include:

• How often to perform glucose monitoring
  
  
• How often to perform a urine test or blood test for ketones
  
  
• How often to take the temperature
  
  
• Whether other tests such as blood pressure readings or microalbuminuria testing need to be performed
  
  
• What changes in diabetes medication or other medication may be needed
  
  
• What over-the-counter medications are good choices and when to take them
  
  
• What foods and fluids to consume
  
  
• Whether exercise needs to be limited or suspended
  
  
• When to call the physician
  
  
• What should be done in case of emergencies such as severe hypoglycemia, fainting or coma