Everyone gets colds and the flu. Most people fall victim to food poisoning once or twice. Few people fail to stay away from the surgeon’s knife or the dentist’s pliers for their entire lives, and there’s hardly anyone who has never spent a night as a hospital patient or a few hours in an emergency room.
For nondiabetics, colds and the flu are generally taken in stride (and there’s even some pleasure in snuggling under the covers with a good book and a supply of orange juice and hot tea while co-workers are slaving away in the office), and as soon as the unpleasantness of the illness is over, they forget it.
For diabetics, these minor illnesses require a bit more attention. Diabetics can certainly get through them all right, but they have to pay attention to things other than making sure they have enough tissues and cough syrup on hand. Once again, blood glucose must be monitored especially carefully during physical illness.
Any illness, no matter how minor or how quickly it is resolved, puts stress on the body, and stress causes certain hormonal changes, which in turn causes the liver to increase its production of glucose. The liver also releases stored glucose into the bloodstream to deal with the stress of illness.
At the same time, some of the hormonal changes make cells more resistant to insulin, which means that circulating glucose will not be as easily absorbed into the cells. So you have a double whammy: increased circulating glucose and increased release of glucose from the liver. This creates a potential for danger, which is why you need to be especially vigilant about your blood glucose, as well as ketones in the urine if you take insulin.
Although you must follow your physician’s instructions for treating the underlying illness and take the medications prescribed, you should also follow a number of general guidelines for managing your diabetes while you are ill:
- Drink sufficient liquids in order to prevent dehydration. If your blood glucose is higher than usual and spills over into your urine, the excess tends to draw additional water from your cells causing unusually large volumes of urine. Therefore, you need to compensate for this loss by drinking at least eight ounces of fluid (water, diet soda, bouillon) every hour.
- You may lose your appetite, but by now you know how important it is to follow your meal plan, so even though you don’t feel like eating, do it anyway. (If you absolutely can’t eat, or if you are vomiting a lot, you must call your physician.) Eat foods that are bland (chicken, gelatin, rice, whole grain cereal with skim milk, plain broiled or grilled meat, light vegetables) and alternate them with soups and other nourishing liquids. It is particularly important to eat your usual amount of carbohydrate-containing foods.
- Always take your full dose of diabetes medication unless you are instructed otherwise by your physician. Don’t skip doses, even if you don’t feel like eating.
- Monitor your blood glucose every three or four hours—night and day. It’s a nuisance to set your alarm to wake up in the middle of the night, but do it anyway. It’s not forever. If your blood glucose is too high or too low, follow the guidelines above for hyper- and hypoglycemia.
- Keep your medicine cabinet well stocked with things like cough and cold medicines antidiarrheal pills, laxatives, aspirin or acetaminophen, and the like so you don’t have to go to the drugstore when you fall ill.
- Keep a bottle of regular insulin on hand even if you don’t usually use it, because if you need extra insulin when you are sick, this is the type you will be told to take.
- Do not exercise until you are better, because it can have a paradoxic effect and elevate your blood glucose.
- If you fall ill while traveling, look in the yellow pages of the local phone book under either “diabetes” or “endocrinology” in the physicians section. Many hotels have doctors on call who can steer you to the right specialist, or in a real emergency, simply dial 911. If you are in a foreign country and have an American Express card, call the local office for a physician referral. Many Visa and MasterCard gold card memberships provide the same service.
- Take at least one travel companion into your confidence about your diabetes in case of an emergency.
- Wear a bracelet or necklace, or carry a notice in your wallet, that identifies you as a diabetic. It can be discreet, but it should be there. Also, in your wallet or some other conspicuous place, carry a notice of your allergies to medications, as well as the person(s) to notify in case of emergency.
- Try your best to prevent diarrhea and severe motion sickness that makes you vomit. If you know you are prone to seasickness, stay off cruise ships. If you go to Mexico or other countries where the food can be “iffy,” carry a supply of antidiarrheal pills and do not drink the water, eat unpeeled fruits and vegetables, or eat any uncooked foods.
- If you are not a seasoned traveler and find yourself in a job where you will be taking frequent business trips, or if you decide to take a major vacation, give yourself some practice before the big event. Start out with a day trip away from home, perhaps to a state park you’ve always wanted to see, or give yourself a day at the beach. Then go away for a whole weekend, stay at a hotel or inn, and eat all your meals in restaurants. Make notes of problem areas and devise creative ways to solve them.
- When you travel in a foreign country (and even in some remote areas of the United States), when you see a bathroom, use it. You never know when you’ll find another one.
- Test your blood glucose about twice as often as you do at home. The stress of travel, changing time zones, and mixed-up eating times all have an effect on blood glucose, and you want to catch hyper- or hypoglycemia before is becomes a problem.
