Cold and Flu Sick-Day Guidelines for People With Diabetes

Aaaa choo-Cough-Blow-Sniff!  

A Cold or the flu?  

This is the season to be jolly, falalalala-lalalala!  The Thanksgiving, Christmas, and New Year holiday season is a festive time for most people.  Celebrations with family and friends are common during this time and we celebrate our moments via eating, shopping, family get-togethers, gift exchanges, weddings, music, etc.  Unfortunately, upon arrival with the holiday season are those uninvited and unwelcome viral nuisances known as colds and the flu.  Prompt attention to these viral illnesses is necessary for people with diabetes because these illnesses stress the body and can wreck havoc on blood sugar control.  Physical illnesses cause our body to produce stress hormones which are designed to help our body fight infections.  These stress hormones also raise the blood sugar which further contributes to you not feeling well.  Cough, sniffles, sneezes, fever, body aches, congestion, and sore throat - so how do you determine if you have a cold or the flu? 

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Important steps to take to manage diabetes control during times of illness include:                  

• Check your blood sugar levels often, about every four hours.  Call your health care team if you do not feel well and your blood sugars are less than 70 mg/dL or greater than 240 mg/dL.

• Check urine ketones if your blood sugar levels are above 240 mg/dL.  Ketones are a warning sign that the diabetes is not under good control.  High levels of ketones in the body can poison the body and lead to complications such as a diabetic coma or death.  It is usually recommended that urine ketones be checked every 4-6 hours when the blood sugars are 240 mg/dL or higher.   Urine ketones can be checked at home by using urine ketostixs which are available for purchase over-the-counter without a prescription from your local pharmacy.  

• Stay hydrated.  Drink 1 cup of a calorie free beverage (ex. water, crystal light, sugar-free/diet sodas, sugar-free koo-laid, tea with artificial sweeter, etc.) every hour while you are awake.  If you are unable to keep fluids down due to vomiting or if you have persistent diarrhea then call your health care team or you may need to go to an urgent care clinic or the emergency room.

• Take your medications, including insulin, daily as prescribed even if you are unable to eat solid foods unless you are told to do otherwise by your health care team.  Some oral pills (ex. Metformin) may need to be discontinued during times of dehydration, diarrhea, and/or vomiting.  Also, your insulin doses may need to be adjusted during this time.  Always check with your health care team before discontinuing a medication or changing the dose of your medication if you are unsure what to do.

• If you need to take over-the-counter medications for a cold, cough or flu then make sure that the medication is sugar-free.  Also, be careful if you have high blood pressure because some over the counter cold/flu medications can raise your blood pressure.  Check with your health care team if you are not sure which medications to take.  You can also ask the pharmacist.  Some prescription medications like antibiotics and steroids can lower or raise your blood sugars so discuss all new prescription medications with your health care team. 

Call your health care team if: 

• Your temperature greater than 100 degrees Fahrenheit for 24 hours or more
• You have diarrhea or vomiting for 6 hours or more
• Your blood sugars are less than 70 mg/dL or greater than 240 mg/dL
• You have moderate to large amounts of urine ketones
• You have signs of ketoacidosis (vomiting, headaches, stomach pains, trouble breathing, chest pains, fruity smell on breath) and signs of dehydration (fever, dry tongue and dry, cracked lips)
• You don't know what to do

What to eat/drink when you are not feeling well:

It is important to avoid dehydration and get healthy nutrients from fluids and meals when you are sick.  It is generally advisable to consume 15 grams of carbohydrates (1 carb serving) every hour or 45-65 grams of carbohydrates (3-4 carb servings) every 4 hours. (1 carbohydrate servings = 15 grams of carbohydrates.  For example, 1/2 cup of fruit juice equals to 1 carb serving or 15 grams of carbohydrates).

• Eat your normal daily meals if tolerable
• Consume liquids or soft foods such as those foods listed below if nausea, vomiting, diarrhea are present or you don't have a healthy appetite.  (Each item equals to between 10-15 grams of carbohydrates).

•  Fluids:
• 1 cup broth or soup
• 1/2 cup fruit juice
• 1/2 cup gatorade or powerade
• 1/2 cup gelatin
• 1/2 cup regular (not diet) soda
• 1 cup milk

• Solids:
• 6 saltine crackers
• 5 vanilla wafers
• 3 gram crackers
• 1 double stick popsicle
• 1/2 cup of ice cream or sherbert
• 1 slice toast (regular bread, not "lite/low carb" bread)
• 1/3 cup rice
• 1/2 cup cooked cereal (grits or oatmeal)
• 1/2 cup sugar-free pudding
• 1/2 cup regular (not sugar-free) jello

These sick-day guidelines are for informational purposes only and should never replace the medical advice and care of a licensed health care provider.  Always consult your professional health care providers before changing your treatment plan and/or medications.
 

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