Sick-Day Management

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Any illness, and particularly one that causes vomiting, diarrhea, and dehydration, can trigger either diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). To avoid having a garden-variety flu turn into something much worse, here are some guidelines to follow when you're sick:

• Plan ahead. The best time to discuss sick-day management with your health-care team is before you become sick. You should agree on how to manage your blood sugar, when to test for ketones, and, most important, when to seek medical help. Keep adequate supplies of test strips, ketone strips, and insulin on hand (if insulin is part of your sick-day treatment), and make sure to store them properly.
• When you are sick, let a friend, neighbor, or relative know, so that he or she can check in on you and call for help if you are unable to help yourself.
• If you have symptoms of a cold or flu, check your blood glucose level and test your urine for ketones, and continue checking both every four hours. (In fact, you should set an alarm clock to wake you every four hours during the night.) If your blood glucose level is below 250 mg/dl and your urine shows no ketones, stick with your usual insulin or pill regimen and continue checking your blood and urine every four hours until the symptoms have passed.
• If your blood glucose level rises above 250 mg/dl, if your urine tests positive for ketones, or if you are vomiting repeatedly, call your health-care provider.
• Treat the underlying illness. Be sure to consult your health-care team and follow their directions for treating any sickness. This may mean taking a course of antibiotics if you have a bacterial infection or taking acetaminophen or other medicines for a fever. The sooner your illness resolves, the sooner your blood sugar levels go back to normal.
• If you have vomiting or diarrhea, drink plenty of fluids. Some good choices for fluid replacement are Gatorade or similar products or one standard bouillon cube dissolved in 8 ounces of water. To prevent more vomiting, it is best to sip these fluids a little at a time rather than drinking a large amount all at once.
• Ask your physician if he recommends any medicines or techniques to minimize nausea and vomiting. Stopping vomiting can be an important step for preventing dehydration.
• Never skip an insulin dose because of loss of appetite, nausea, or vomiting. Even though you're not eating or keeping food down, your blood glucose may still be high because of the action of the counterregulatory hormones. Frequently monitor your blood and urine, and adjust your insulin dose as needed, with the help of your health-care team.
• Maintain contact with your health-care team and be prepared to tell them about your blood sugar levels, urine ketones, and the type and quantity of fluids you have consumed.
• Signs that your condition may be getting worse include continued vomiting, becoming short of breath, or becoming excessively sleepy. Let your health-care provider know: He or she may recommend that you go to an emergency room.

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