Having a bad cold or the flu can make anyone want to crawl into bed and stay there until it’s over. But when you have diabetes, hiding under the covers and sleeping until you feel better isn’t the best option (although getting plenty of rest is still a good idea). That’s because any illness or infection can make your blood glucose more difficult to control, which increases the risk of serious acute complications. So just when you’re feeling your worst is when it’s most important to stay vigilant about your diabetes care and to take good care of yourself to help your body heal.
What happens when you’re sick
Your body may know it’s sick even before you feel any symptoms, and a good clue can be an unexplained steady rise in blood glucose.
Everybody has a high release of stress hormones when they’re battling or about to battle an illness. Typically, stress hormones cause a rise in blood glucose level because they cause the liver to release more glucose than normal into the bloodstream. People who don’t have diabetes can compensate by releasing more insulin, but people who have diabetes may produce no insulin, or their bodies may not use insulin efficiently, so blood glucose levels stay high unless something is done (such as taking insulin) to lower them.
The release of stress hormones and consequent rise in blood glucose level is why people with diabetes are advised to continue taking their diabetes medicines (insulin or oral medicines) when they are sick, even if they’re vomiting. Monitoring blood glucose levels every 2–4 hours and sipping liquids every 15 minutes to stay hydrated are also important.
Not taking diabetes medicines during an illness raises the risk of developing diabetic ketoacidosis (DKA), a medical emergency characterized by high blood glucose levels, the presence of ketones in the blood and urine, and dehydration. When the body doesn’t have enough insulin available to use glucose as its primary fuel source, it breaks down stored fat for energy, which leads to the production of acidic metabolic by-products called ketones. An accumulation of ketones causes the blood — and eventually the body’s tissues — to become acidic, throwing off the delicate mechanisms that regulate bodily functioning.
While diabetic ketoacidosis is more likely to develop in a person with Type 1 diabetes, it can also occur in people who have Type 2 diabetes, so everyone with diabetes should discuss when and how to test for ketones in their blood or urine with their health-care provider. Symptoms of DKA include dry mouth, sleepiness, extreme nausea, stomach pain, vomiting or diarrhea, and shallow breathing. Contact your doctor immediately if you experience symptoms of DKA. If not caught early, it can develop into a very serious condition that needs to be treated at a hospital.
People with Type 2 diabetes, especially older people, can also develop a condition called hyperosmolar hyperglycemic syndrome, in which blood glucose levels are very high and a person is dehydrated, but ketones are not present in the blood or urine. This condition can also lead to coma and death. Symptoms include thirst, impairment of one or more of the five senses, hallucinations, rapid eye movements, paralysis on one side of the body, and seizures. Hyperosmolar hyperglycemic syndrome is a medical emergency that must be treated in a hospital.