Illness can easily upset a person’s blood glucose levels. When people are sick it is also harder to manage diabetes. This combination can easily tip people over into serious illness and result in a need for hospital treatment.
FOR Whãnau / family or friends – please help and support the person with diabetes when they are sick.
- Hyperglycaemia and fever increase fluid loss
- Increase drinks – mainly unsweetened, but if blood glucose levels are dropping to less than 8 - 10 mmol/L some sweetened fluids can be included
More frequent monitoring (if blood glucose testing has been advised by your healthcare provider)
- Frequent blood glucose testing helps to understand the impact of the illness on blood glucose levels and to make sensible decisions about how to manage them 4 times a day in type 2 diabetes, 2-4 hourly in type 1
Loss of appetite
- Meals can be replaced with easily digestible food and fluids
- Be guided by blood glucose levels – if they are less than 8 - 10mmol/l Food and fluids should contain some sugar - e.g. sips of lemonade or fruit juice, small but regular amounts of ice cream or yoghurt
Check with your healthcare professional -
- Generally people take their usual medication however Metformin may need to be stopped if you are vomiting or unable to eat
- Some people with type 2 diabetes may need to temporarily commence on insulin when unwell
- Sometimes people need their insulin doses increased while there is infection present. Check with your healthcare provider for advice
MANAGEMENT OF ILLNESS FOR PEOPLE WITH TYPE 1 DIABETES
Illness is hard to manage for people with type 1 diabetes. They are at risk of developing diabetic ketoacidosis (DKA) or alternatively significant hypoglycaemia. They need to test their blood glucose levels frequently, continue to take their insulin – although it may need adjusting - and replace complex carbohydrate food with simple carbohydrates (sugars) if they are unable to eat.
It is also important to test blood glucose, and urine for ketones, if blood glucose levels are greater than 18mmol/L. Diabetic ketoacidosis is a very serious illness. The presence of ketones in blood or urine indicates that the person does not have enough insulin on board.
Key points for people with type 1 diabetes when sick
- Illness tends to raise blood glucose levels even if you are not eating
- Illness associated with vomiting and diarrhoea may lower blood glucose levels leading to hypoglycaemia
- Never stop insulin (extra insulin may be required or some reduction if blood glucose levels are low)
- You may need specialist advice or decision support on alteration of insulin doses
- Capillary or urine ketone testing is a valuable tool and can guide management and insulin dosage
- Whether fluid replacement contains sugar or is without sugar is determined by the blood glucose levels – above 8 mmol/L drink water only, 8 mol/L or below drink some sweetened fluids especially if you are not able to eat normal carbohydrate foods
- Maintaining hydration is very important
Contact your doctor early if you have any concerns.
If vomiting or diarrhoea is persistent there may be a need for admission to hospital
Ketones signal the need for urgent treatment and action - extra insulin, extra oral fluids and hospitalisation if the ketones are high or not resolving.