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.
Having a sick-day plan
One of the best things you can do in preparation for being sick is to have a discussion about sick-day care with your diabetes care providers. This will not only help you know what to do, but it may also ease some stress since you won’t be facing an illness completely in the dark. It will also give you an idea of how long to manage your illness alone and when to call for help.
Topics to discuss include when to call for help, how often you should monitor your blood glucose and ketones, what medicines to take and how much of each to take, and how and what to eat. Typically, doctors want to hear from you in the following circumstances:
• When you have been sick or have had a fever for 2–3 days and aren’t getting any better.
• When you have been vomiting or having diarrhea for more than six hours.
• When you have moderate to large amounts of ketones.
• When your blood glucose is consistently higher than 250 mg/dl despite having taken extra insulin.
• When you have taken only oral medicines and your blood glucose has stayed above 250 mg/dl for more than 24 hours.
• When you have any symptoms of DKA.
• When you don’t know how to take care of yourself.
However, these are only general guidelines. Be sure to ask your doctor for guidelines that fit your diabetes and life on when he wants you to call, as well as what kinds of information he will want to know when you call. Some likely questions include how long you have been sick, whether you have lost weight during your illness, how much fluid you have been able to drink, your current blood glucose level, whether you’ve had any episodes of very high or very low blood glucose, whether you’re taking your usual medicines or any additional medicines called for in your sick-day plan, and whether you have a fever.
With this in mind, a critical aspect of helping yourself and your doctor manage your illness is to keep a log of what is going on with your body. Through record-keeping, you may be able to identify patterns. It will be especially important to monitor your blood glucose level every two to four hours while your levels are elevated or until symptoms of your illness subside. Ketones should be monitored every four hours until they are no longer present. Since your body is going through a small trauma, you might not have or notice your normal signs of high or low blood glucose. By checking your blood glucose level often, you may be able to catch any problems early and treat them quickly.
Some items to log and keep track of include the following:
• Blood glucose readings
• Results of ketone tests
• Fluid intake
• Any symptoms such as vomiting, diarrhea, stomach pain, or headache
• Your temperature
Sick-day tool kit
The last thing you want to do when you feel sick is go to the store for medicine, food, or tissues. Having shelf-stable foods in your kitchen cupboards and other supplies on hand can be a lifesaver when you realize you may be planting yourself on the couch or in your bed for a while. Some items to stock in your kitchen include fluids with calories such non-diet soda, fruit juice, and regular Jell-O, as well as some sugar-free items such as diet soda and sugar-free Jell-O or pudding. Include things that taste good to you when you are ill. Other items you will want include the following: