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Learning About Sick Days
January 16, 2013
How appropriate! I was going to blog about sick days, and then I got the flu myself. I’m writing this from bed, thanks to my laptop. It’s not actually much fun, but I guess I’ll call it research.
It started with a sore throat and runny nose. I just thought I had a cold. Wednesday morning, I was up at my desk participating in a Webinar for diabetes educators. By the time it ended, I was feeling cold all over and started shaking. Went to bed, and haven’t been able to get up since.
Besides the sore throat, there’s coughing, headache, and body aches. But they’re not that bad. What’s bad is the fever in combination with my multiple sclerosis (MS). People with MS just can’t handle fevers. My legs won’t bend, and they won’t support my weight, so I can’t even transfer in and out of my scooter or the toilet or wherever. So the safest thing is just to stay in bed.
I’m thinking about what I could have done to prepare for this. It would really help me now to have some stuff like they have in hospitals — an overbed table maybe, or a commode, or at least a urinal. But I didn’t plan ahead. I didn’t see it coming, even though we all get sick at times.
Still, if I had diabetes — and a lot of people with MS do — I would be in a lot more trouble. Even a relatively minor illness can send blood glucose levels way up. They can dehydrate you and even send you into a coma.
I’ll bet you’ve heard this before, and I also bet you don’t have all the supplies and information you should have handy.
We have to clearly understand that being sick raises blood glucose, all by itself. That’s because the body sees illness as a threat and activates the stress response. Stress hormones cause the liver and muscle cells to release glucose into the bloodstream for fuel. As long as you are sick, stress will keep raising your glucose levels.
That’s OK for a person without diabetes. They can use the extra fuel to help fight the germs and repair damage. But you need insulin to use the glucose, and people with diabetes don’t have enough insulin for this kind of crisis.
You may understand this, but do your family and caregivers understand it? It’s a common mistake to say, “Well, you’re not eating, so you don’t need as much insulin or as much of your oral meds.” But actually the reverse is true. Even if you’re not eating a thing, even if you’re vomiting, your blood glucose levels will continue to rise. You may need more insulin, and people who don’t take insulin normally might need to do it when they’re sick.
If you’re not able to eat and drink normally, you’re at great risk for dehydration and diabetic ketoacidosis, which can be a life-threatening condition. Ketoacidosis results when the body breaks down fats for energy (due to a lack of insulin or carbohydrates to use as fuel), producing toxic byproducts known as ketones.
Here’s some very good advice Michelle Kowalski presented to us in 2009. I’m not going to rewrite all of it, but I strongly suggest you read it yourself. I did, and I learned a lot.
• Make a plan. Talk about sick days with your health-care team and agree on how to manage blood glucose, when to check for ketones, and when to get medical help. No matter how well you manage your diabetes normally, you might need to get some professional help, like some intravenous fluids, when you’re sick.
Experts suggest you have supplies of glucose strips and ketone strips, and insulin if that is part of your plan. You should have some fluids with calories and without them, a thermometer, decongestant medicine, throat lozenges, and some bottled water. Have that stuff near you, along with a telephone, important phone numbers, and a pen and paper.
• Kowalski says, “If possible, share your sick-day plan with family members or those you live with… One easy way to make your information readily available to others is to write it down and keep it with your sick-day food and supplies.”
• I can’t stress enough how important it is to have help available. My wife is away now, but our roommates have been bringing me water and other things when I need them. A couple of strong young guys pulled me off the floor when I fell and couldn’t get back to bed Thursday. I’m glad I had their phone number and a cell phone with me.
It’s now two days after I wrote the first part of the blog, and my fever is gone. Yay! I can stand up again. I still have the cough and sore throat, though.
It’s really interesting how, even without diabetes, the fever has left me dehydrated. I know what that feels like after what happened last month. It’s really important to push fluids when you are sick.
I hope sick days don’t happen to you, but sooner or later they will, so be ready. I’m going back to bed now.
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